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PL Detail-Document #280737 − This PL Detail-Document gives subscribers additional insight related to the
PL Detail-Document #280737 − This PL Detail-Document gives subscribers additional insight related to the

PL Detail-Document #280737

This PL Detail-Document gives subscribers additional insight related to the Recommendations published in

PHARMACIST’S LETTER / PRESCRIBER’S LETTER

July 2012

Tablet Splitting: “To Split or Not To Split”

Tablet splitting can save patients money, especially when considering sole-source brand name products. Yet, the practice of tablet splitting can be problematic as a result of failed therapeutic outcomes due to over or under dosing. Also, the stability of a medication might be altered or there may be other unknown reasons not to split a tablet. The following checklist and guide may help you determine which patients are able to split their own tablets and which tablets might safely be split. 1-3

A. Patient Considerations:

a. Physical ability:

Does the patient or patient’s caregiver have the skill, dexterity, strength, and visual ability to split a tablet?

No, splitting should not be considereddexterity, strength, and visual ability to split a tablet? Yes, go to the next question b.

Yes, go to the next questionto split a tablet? No, splitting should not be considered b. Cognitive ability: • Does the

b. Cognitive ability:

Does the patient or patient’s caregiver have the mental ability to select the correct medication and split a tablet?

No, splitting should not be consideredto select the correct medication and split a tablet? Yes, go to the next question B.

Yes, go to the next questionand split a tablet? No, splitting should not be considered B. Product Considerations (Drug, Potency, and

B. Product Considerations (Drug, Potency, and Dosage Form):

a. Is the active ingredient a narrow therapeutic index product (digoxin, levothyroxine, others)?

Yes, splitting should not be consideredindex pr oduct (digoxin, levothyroxine, others)? No, go to the next question b. Is the tablet

No, go to the next questionothers)? Yes, splitting should not be considered b. Is the tablet a controlled- or modified-release product?

b. Is the tablet a controlled- or modified-release product?

Yes, go to the next questionb. Is the tablet a controlled- or modified-release product? • Is the tablet scored? No, splitting

Is the tablet scored?

No, splitting should not be consideredYes, go to the next question • Is the tablet scored? Yes, go to the next

Yes, go to the next questionIs the tablet scored? No, splitting should not be considered No, go to the next question

No, go to the next questionshould not be considered Yes, go to the next question c. Does the tablet contain more

c. Does the tablet contain more than one active ingredient?

Yes, splitting should not be consideredc. Does the tablet contain more than one active ingredient? No, go to the next question

No, go to the next questionactive ingredient? Yes, splitting should not be considered d. Does the tablet easily break into pi

d. Does the tablet easily break into pieces with minimal handling (friability)?

Yes, splitting should not be consideredbreak into pi eces with minimal handling (friability)? No, go to the next question e. Is

No, go to the next question(friability)? Yes, splitting should not be considered e. Is the tablet enteric-coat ed, sublingual, or buccal

e. Is the tablet enteric-coated, sublingual, or buccal OR Does it have a poor taste, is it teratogenic if handled, or can it cause mouth irritation? (See our PL Detail-Document, Meds That Should Not Be Crushed, for a helpful list of these medications.)

Yes, splitting should not be consideredNot Be Crushed , for a helpful list of these medications.) No, splitting is possible .

No, splitting is possible. .

Copyright © 2012 by Therapeutic Research Center 3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com

(PL Detail-Document #280737: Page 2 of 2)

Users of this PL Detail-Document are cautioned to use their own professional judgment and consult any other necessary or appropriate sources prior to making clinical judgments based on the content of this document. Our editors have researched the information with input from experts, government agencies, and national organizations. Information and internet links in this article were current as of the date of publication.

Project Leaders in preparation of this PL Detail- Document: Jennifer Obenrader, Pharm.D. and Joseph A. Woelfel, Ph.D., FASCP, R.Ph., Assistant Editor (Original February 2006), Stacy A. Hester, R.Ph., BCPS, Assistant Editor (July 2012 update)

References

1. APhA Strategic Directions Committee. Tablet splitting: evaluating appropriateness for patients. J Am Pharm Assoc 2004;44:324-5.

2. Griffin RM. Pill splitting: When is it safe? When is

it unsafe?

http://www.webmd.com/a-to-z-guides/features/pill-

splitting-when-is-it-safe-when-is-it-unsafe (Accessed June 11, 2012).

October 4, 2010.

3. Clark, TR. Tablet splitting for cost containment. August 2002. American Society of Consultant Pharmacists. https://www.ascp.com/articles/tablet- splitting-cost-containment. (Accessed June 11,

2012).

Cite this document as follows: PL Detail-Document, Tablet Splitting: “To Split or Not To Split.” Pharmacist’s Letter/Prescriber’s Letter. July 2012.

Evidence and Recommendations You Can Trust… 3120 West March Lane, Stockton, CA 95219 ~ TEL

Evidence and Recommendations You Can Trust…

Evidence and Recommendations You Can Trust… 3120 West March Lane, Stockton, CA 95219 ~ TEL (209)

3120 West March Lane, Stockton, CA 95219 ~ TEL (209) 472-2240 ~ FAX (209) 472-2249

Copyright © 2012 by Therapeutic Research Center

Subscribers to the Letter can get PL Detail-Documents, like this one, on any topic covered in any issue by going to www.PharmacistsLetter.com, www.PrescribersLetter.com, or www.PharmacyTechniciansLetter.com