Pill Splitting: When Is It OK?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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If you take prescription drugs to treat a chronic illness, it’s possible to save more than 50% off cost of your medication by simply splitting your pills.

Sadly, it’s not all that easy to know when pill splitting is all right.

Not all pills can be split. However, many doctors and insurance companies are advising this strategy with an increasing number of medicines. (It’s also worth noting that the American Medical Association, the American Pharmacists Association, and most pharmaceutical companies oppose pill-splitting.)

Drugs that can be usually be split include Lipitor (atorvastatin), Zocor (simvastatin), Crestor (rosuvastatin), Norvasc (amlodipine), Zestril (lisinopril), Accupril (quinapril), Glucophage (metformin), Synthroid (levothyroxine), Zyprexa (olanzapine), Celexa (citalopram), Paxil (paroxetine), Zoloft (sertraline), Klonopin (clonazepam), Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil), and a number of others.

Drugs that should usually not be split include capsules, chemotherapy drugs, birth control pills, seizure-related medications, and any pill that has a coating or other controlled- or extended-release feature.

Be sure to check with your doctor prior to splitting any medication.

Some other things to watch for:

• Is it scored? Tablets that are scored can be easily split and have been evaluated by the FDA for safety.

• Invest in a pill splitter. Pill splitters are very inexpensive and carried by most pharmacies. If you’re going to split a pill, spend the $5.

• Only split once. It is only recommended that you split pills in half, not any smaller. The dose per piece is too likely to be uneven and pills may shatter or crumble.

• Unequal halves. Even scored tablets can be difficult to split into two perfect halves, and medicine is sometimes distributed unevenly within a single tablet. Buy a pill splitter to help and don’t split with a knife.

• Crumbs. Tablets that are round or too small may crumble easily or unevenly when split and that will affect the dose you are actually getting.

• Don’t forget! Patients who are given a higher dose pill and told to take half may forget to do so, resulting in a double dose of medication. Splitting is not recommended for patients with poor eyesight, arthritis, memory problems or impaired thinking.

• Don’t split in advance. Some pills may deteriorate after being split, and taking two halves of the same pill consecutively will get you the most even dosing.

• To split or not to split? When in doubt about whether your pill can be split, check the package insert or ask your doctor or pharmacist.

Keep calm and save on . . .

Dr O.

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