Pill Splitting Can Cut Rx Costs, but Make Sure You Do It Right

The high cost of prescription drugs can be a bitter pill to swallow, so a two-for-one deal can be just what the doctor ordered.

Many popular drugs are often priced the same, or about the same, regardless of strength. A bottle of 100-milligram pills might cost no more than the same number of 50-milligram pills.

To help patients save money, doctors sometimes prescribe pills at twice the required dosage and instruct the patients to cut them in half, effectively cutting costs in half as well.

Cost aside, pills are often split because certain drugs come only in higher strengths, or whole and half tablets must be combined for the exact dosage.

But splitting the wrong kinds of pills—or splitting the right kinds incorrectly—can cause rather than cure medical problems.
“Some pills aren’t meant to be cut or broken in half,” says Paul F. Dende, DO, a primary-care physician and a Pennsylvania Medical Society member.

“Never split time-released tablets or those with coatings that are formulated to be swallowed whole. Breaking the coating and exposing the inside of the split pill will alter the absorption rate in the body, which could result in a toxic overdose,” explains Dr. Dende.

Pills that aren’t scored, or notched, also should be left intact. Trying to halve them will likely produce a fragmented or crumbled mess.

Special care is required when splitting pills with a narrow therapeutic range or margin for error. Failure to divide a pill precisely results in uneven doses.

“With some medications, such as those to lower cholesterol, a slightly lower dose one time and slightly higher dose the next won’t create a problem,” says Dr. Dende. “But other drugs, like blood thinners and heart medicines, can be dangerous with only minor deviations in strength.”

Never split pills without your doctor’s OK, stresses Dr. Dende.

Even pill splitting that has a doctor’s blessing may provoke curses from the patient. It takes keen eyes and a steady hand to bisect a tiny pill or position it just right in a pill-splitting device. Oblong and odd-shaped tablets are the most troublesome.

Aging patients with failing vision, arthritis, or tremors may find the task daunting. Out of frustration, they may avoid taking their medication, or double up one time and skip the next dose with potentially harmful results.

“This is one of many situations where a close relationship between patient and doctor can really prove beneficial,” says Dr. Dende. “Say I have a patient living alone with retinal degeneration, arthritic fingers, or diminished mental capacity. If I know that person’s background, I can help arrange for someone else to split the pills — perhaps the pharmacist, a family member, or visiting nurse.”

The Institute for Good Medicine offers these tips for splitting pills safely:

  • Never split pills with a knife. You could botch the job and bloody your fingertips in the attempt.
  • Invest in a good-quality pill splitter. Choose one with a stainless-steel blade that slices all the way through the pill. Cheaper versions cut only three-quarters of the way. A deluxe splitter that handles large and oblong pills can be bought at most drug stores, or ordered online, for under $10. Some models even magnify tablets, store them, or crush them into powdered form.
  • Consider “reverse pill splitting” if you have trouble swallowing big pills. “With calcium and potassium supplements, which can be quite large, I sometimes prescribe half-strength pills and tell the patient to take two instead of one,” says Dr. Dende.
  • Ask your pharmacist for instructions on pill splitting. If your pills are split for you at the pharmacy, make sure this is indicated on their computer records. Otherwise, a new pharmacy technician unaware of the arrangement may unwittingly fill the Rx with whole tablets. If you don’t notice the difference in pill size, you’ll ingest double the prescribed dose. The pharmacy should also note on the label of your medicine bottle that the pills have been split. If you forget they’ve been split and halve them again yourself, you’ll be undermedicated. As a precaution, read the label each time you take your medications.

“Pill splitting can be a safe, practical way to bring down the cost of prescription drugs,” says Dr. Dende. “As with other components of effective medication management, the keys are good communication, trust, and an ongoing relationship between the patient and doctor.”