The Practice of Splitting Tablets

Bachynsky, John; Wiens, Cheryl A.; Melnychuk, Krystal

doi:10.2165/00019053-200220050-00005

Cited by 35 publications

(10 citation statements)

References 7 publications

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“…Several studies studied the advantages of tablet splitting with regard to the health outcomes of patients, particularly within the geriatric and psychiatric communities. These advantages include dose adjustment [1], ease of swallowing and cost savings [2,3]. However, some studies revealed that splitting may result in the administration of an inaccurate dose, which can be of significant risk, especially if the split tablet formulation has a narrow therapeutic index [4,5].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Certain Pharmaceutical Quality Attributes of Lisinopril Split Tablets

et al. 2016

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Tablet splitting is an accepted practice for the administration of drugs for a variety of reasons, including dose adjustment, ease of swallowing and cost savings. The purpose of this study was to evaluate the physical properties of lisinopril tablets as a result of splitting the tablets either by hand or with a splitting device. The impact of the splitting technique of lisinopril (Zestril® tablets, 20 mg) on certain physical parameters such as weight variation, friability, disintegration, dissolution and drug content were studied. Splitting the tablets either by hand or with a splitter resulted in a minute but statistically significant average weight loss of <0.25% of the tablet to the surrounding environment. The variability in the weight of the hand-split tablet halves was more pronounced (37 out of 40 tablet halves varied by more than 10% from the mean weight) than when using the tablet splitter (3 out of 40 tablet halves). The dissolution and drug content of the hand-split tablets were therefore affected because of weight differences. However, the pharmacopoeia requirements for friability and disintegration time were met. Hand splitting of tablets can result in an inaccurate dose and may present clinical safety issues, especially for drugs with a narrow therapeutic window in which large fluctuations in drug concentrations are undesirable. It is recommended to use tablets with the exact desired dose, but if this is not an option, then a tablet splitter could be used.

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Section: Introductionmentioning

confidence: 99%

Evaluation of Certain Pharmaceutical Quality Attributes of Lisinopril Split Tablets

et al. 2016

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“…Further, effective instruction of the patients by the pharmacy is a prerequisite to minimise confusion and intake errors, especially when patients received information at the time of discharge that diverges from the finally dispensed medication. All processes may influence drug safety, take time and generate costs that may exceed the potential cost savings that physicians had advocated for splitting tablets [30]. For countries like Switzerland, where medication is dispensed in the original treatment pack, maximum savings from tablet splitting could theoreti-cally be obtained for products that have similar prices for each of the dosages.…”

Section: Discussionmentioning

confidence: 99%

Wrongly Prescribed Half Tablets in a Swiss University Hospital

Arnet¹,

Moos²,

Hersberger³

2012

IJCM

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Background: Prescription of 1/2 tablets is a widespread practice, mainly to achieve dose flexibility and to facilitate swallowing. However, tablet splitting includes several disadvantages, like destruction of galenic formulation, stability problems, and unequal amount of active ingredient that may reduce effectiveness or result in a greater risk of toxicity. Objective: To assess the rate of wrongly prescribed 1/2 tablets in discharge prescriptions at the University Hospital in Basel (UHBS, 600 beds) and to evaluate its consequences for community pharmacists. Setting: Discharge prescriptions written between January 1st and December 31st 2011 and containing the term “1/2” were extracted from the electronic patients’ data management system of the UHBS. Presence of a score line and suitability for splitting were retrieved from two official sources of drug information. Main Outcome Measure: Wrong prescription was assigned for tablets with no score line or not suitable for dose splitting. Results: Of the 36,751 discharge prescriptions that were recorded in 2011 at the UHBS, 3724 (10.1%) contained at least one prescription item with the term “1/2”. The recipient patients were on average 72.9 ± 14.8 years old (median 76 years), 50.9% were women. Of the 4517 analysed items, 49% had a corresponding lower dosage strength available on the market, making splitting unnecessary. Rate of wrongly prescribed 1/2 tablets reached 16.4% (2.8% of all prescriptions) and concerned predominantly unscored tablets. When the lack of information on splitting suitability (5.6%) and on score lines (0.5%) was taken into account, the rate reached 22.4%. Half of all wrong prescriptions could be assigned to 14 different products that were prescribed with an overall rate between 3.1 and 0.2%. Quetiapine (Seroquel?) at all strengths was the most often wrongly prescribed tablet to split (3.1%; no score line), followed by atorvastatin (Sortis?) at all strengths (1.3%; no score line) and oxazepam (Seresta?) 15 mg (1.2%; with decorative score line). ...

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“…Pills are frequently split to achieve dose flexibility, facilitate swallowing or reduce medication costs [2], [3]. However, the splitting of certain specific drugs is deemed unsafe, such as extended-release (ER) formulations and enteric-coated (EC) formulations because these specific kinds of formulations could be damaged by pill splitting, resulting in rapid absorption of the drug and a subsequent abrupt rise in blood concentration.…”

Section: Introductionmentioning

confidence: 99%

Association between Physician Specialty and Risk of Prescribing Inappropriate Pill Splitting

et al. 2013

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BackgroundPrescription errors that occur due to the process of pill splitting are a common medication problem; however, available prescription information involving inappropriate pill splitting and its associated factors is lacking.MethodsWe retrospectively evaluated a cohort of ambulatory prescriptions involving extended-release or enteric-coated formulations in a Taiwan medical center during a 5-month period in 2010. For this study, those pill splitting prescriptions involving special oral formulations were defined as inappropriate prescriptions. Information obtained included patient demographics, prescriber specialty and prescription details, which were assessed to identify factors associated with inappropriate pill splitting.ResultsThere were 1,252 inappropriate prescriptions identified in this cohort study, representing a prescription frequency for inappropriate pill splitting of 1.0% among 124,300 prescriptions with special oral formulations. Among 35 drugs with special oral formulations in our study, 20 different drugs (57.1%, 20/35) had ever been prescribed to split. Anti-diabetic agents, cardiovascular agents and central nervous system agents were the most common drug classes involved in inappropriate splitting. The rate of inappropriate pill splitting was higher in older (over 65 years of age) patients (1.1%, 832/75,387). Eighty-seven percent (1089/1252) of inappropriate prescriptions were prescribed by internists. The rate of inappropriate pill splitting was highest from endocrinologists (3.4%, 429/12,477), nephrologists (1.3%, 81/6,028) and cardiologists (1.3%, 297/23,531). Multivariate logistic regression analysis revealed that the strongest factor associated with individual specific drug of inappropriate splitting was particular physician specialties.ConclusionThis study provides important insights into the inappropriate prescription of special oral formulation related to pill splitting, and helps to aggregate information that can assist medical professionals in creating processes for reducing inappropriate pill splitting in the future.

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The Practice of Splitting Tablets

Cited by 35 publications

References 7 publications

Evaluation of Certain Pharmaceutical Quality Attributes of Lisinopril Split Tablets

Evaluation of Certain Pharmaceutical Quality Attributes of Lisinopril Split Tablets

Wrongly Prescribed Half Tablets in a Swiss University Hospital

Association between Physician Specialty and Risk of Prescribing Inappropriate Pill Splitting

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