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Is it possible to split the tablet? Use in children

Tablet splitting is traditionally used in pharmaceutical practice to select the required dose of a drug if a dosage form with the required dose is not available. It also reduces the cost of therapy. The presence on tablet forms of a number of drugs approved by the US Food and Drug Agency ( Food and Drug Administration, FDA), a transverse groove is regarded as approval of such a practice and often indicates that the drug has been subjected to additional research in virtual.

However, the procedure for separating tablets is not standardized and its accuracy varies widely depending on a number of factors, including the characteristics of the drug, the size and shape of the tablet, and the abilities and skills of the person separating it.

Characteristics of the drug

It is not recommended to split tablets of drugs whose dosage deviations may lead to severe consequences. These drugs include drugs with a narrow therapeutic range and dose-dependent effect.

Characteristics of the tablet

The presence of a transverse groove on the tablet makes it easier to separate, but size, shape and strength also have a significant impact on the accuracy of the result obtained. Large oblong tablets with deep notches on both sides separate most easily.

A number of special dosage forms, such as film-coated tablets for enteral dissolution, delayed-release forms, and combination drugs, the concentration of one of the ingredients varies depending on the tablet size (for example, amoxicillin/clavulanate ( Augmentin, Amoxiclav), irbesartan/hydrochlorothiazide ( Avalid), oxycodone/acetaminophen ( Percocet), ezetimibe/simvastatin ( Vytorin) etc.) should not be separated.

Uniform distribution of the drug in the tablet

As research results have shown, the uniform distribution of the drug in the tablet, as well as the likelihood of its even separation and crumbling, are associated with the quality of the drug’s production. Thus, the presence of large fragments of the active ingredient was detected in generic simvastatin tablets produced in 4 different countries, but not in the original drug produced in the United States.

Separation Accuracy

The accuracy of tablet separation has been assessed in a number of studies. During three of them, pharmacists separated tablets of 22 drugs; the resulting fragments were considered to contain a half dose if they weighed 85–115% of the weight of an ideal half. Weight uniformity requirements were achieved for 7 of 22 (32%), 3 of 11 (27%) and 8 of 12 (67%) products tested. In another study, when unstriated 10 mg cyclobenzapine tablets were cut with a special cutting tool, the weight of the halves varied between 69% and 130% of expected, resulting in dose variations of 3.5-6.5 mg, provided the active substance was evenly distributed throughout the body. tablet. When using a kitchen knife to separate, variations in the weight of the halves reached 50-150%, and dose variations reached 2.5-7.5 mg.

In a study assessing the ability of elderly patients to split pills, deviations in the weight of the resulting halves from the expected weight reached 9-37%.

The influence of tablet separation on the clinical outcome of therapy

In two studies involving 2,128 patients taking statins, there were no significant differences in cholesterol concentrations in patients receiving half-tablets for 6 weeks or more. Another crossover study of 29 patients receiving lisinopril halves for 2 weeks also found no clinically significant differences in systolic and diastolic blood pressure.

Economic efficiency

Splitting tablets can reduce therapy costs by up to 50%, since, according to existing pricing policies, many drugs have the same or similar prices per dosage unit, regardless of the dose contained in it active substance. Using a program to separate tablets of atorvastatin, simvastatin and ovastatin within a year, a 39% cost-effectiveness was shown.

The use of whole tablets, of course, allows for the most precise control of the dose of the drug received by the patient. However, if there is a desire and opportunity on the part of the patient, as well as a wide therapeutic range, the relative safety of the drug and the absence of a dose-dependent effect, the separation of its dosage forms seems possible, since small dose deviations are leveled out, especially for drugs with long period half-life.

Patients are advised not to split more than 1 tablet at a time and, if possible, use the other half when next appointment drug to compensate for deviations previous dose. Some help The use of special cutting devices may help, but this does not guarantee the accuracy of the separation.


Tablet splitting.

The Medical Letter 2004; 46 (Issue 1195): 89-91.


See also:

  • Tablet Separation - Advantages and Disadvantages

tablets, division

    In my opinion, almost everything.

    For example, my child was prescribed the drug, but not in the dosage of a whole tablet, but only half, since he is small and one tablet is too much for him.

    What about half and half, sometimes I had to divide the tablet into four parts and nothing.

    Of course, this is not very convenient, but usually I cut the tablet with a regular knife and it turns out quite evenly.

    You can safely divide tablets that are not coated. But covered ones, even with a characteristic stripe, should not be divided. The shell can not only hide bad taste or the smell of a medicine, but also not to allow the substance to break down in the stomach, if its place of work is, say, in the intestines.

    Only those tablets that have a dividing line can be divided into 2 parts, this is precisely what it is intended for, and those tablets that do not have this line are undesirable to divide, because when breaking, the structure is disrupted and it will crumble unevenly and the weight parts will be still different.

    There is such a science - pharmaceutical economics. It has been calculated that if you buy drugs in larger dosages and divide them into 2-3 doses, it will be more profitable for the buyer - the patient.

    Notch, dividing line, dividing line, depression on the surface of the tablet, and exists for this purpose.

    There is one transverse - longitudinal risk on the tablet, yes cruciform. Some tablets are engraved with the name of the drug or dose. I respect manufacturers who care about the patient. But, we must remember that some drugs consist of microgranules If you divide them, some of the granules will be destroyed and the dose will be inaccurate.

    There's more in the tablet chamfer- this is its processed edge.

    It should be remembered that the drug Capsule form cannot be divided, pour out the contents of the granule and drink without the shell. Such gelatin shells are specially created to ensure that the drug is absorbed in a specific part of the intestine.

    It is generally not advisable to divide tablets, even those that are divided in half. It happens that a doctor prescribes 25 mg of a drug that is released in a minimum of 50 mg. We have to divide, because there is a dividing strip. So the oblique parts come out. One part has to be thrown away, it is small, and the other has to be cut.

    According to the rules, it is of course not advisable to divide the tablets into two parts, but if there is such a need, then nothing bad will happen from this. You also need to know that the tablets are formulated in such a way that one part may contain more active ingredient than another part.

    If the tablets have a dividing strip, then you can safely divide them.

    Capsules cannot be divided at all, since they cannot be divided exactly. It is also necessary to remember that almost all capsules must dissolve in the stomach, they are designed for this.

    Tablets that have a dividing strip in the middle can generally be divided in half. Another thing is that if the tablet is coated, then when broken, the bitter part of the tablet may open - and it will be unpleasant to swallow.

    Tablets in capsule form cannot be divided in half.. The capsule is specially designed to protect the active substance from absorption in the stomach until the capsule reaches the right place - for example, the intestines.

    Tablets (not coated capsules) can be divided if this division is part of the treatment regimen and is recommended by a specialist. This is possible even if there is no special strip on the tablet itself. Yes, sometimes the halves turn out to be very different, but since it’s necessary... We even divided rectal suppositories in half.

    You can’t just divide the pills yourself so that, for example, you can take half as much medicine as the doctor prescribed! For example, someone decided that he was no longer seriously ill and began to take an antibiotic in a dosage half as much as prescribed; as a result, the medicine does not work as it should, the disease does not completely go away, plus the surviving bacteria develop an addiction to the drug.

Modern medicines usually do not require any division. I define this very simply, if the tablet has a dividing line in the middle, then it can be divided, if there is no such line, then the tablet is indivisible and you need to look for other dosages of this medicine, since it will not be possible to accurately divide in half. Also, indications for smaller dosages (for example, for children) are indicated in the instructions for the drug, provided that there are no smaller dosage forms, and they are indicated in the instructions.

Compound medications, which may contain two or more components in their composition, are also not recommended to be divided or taken in double doses, since additional components may contain different dosages. For example, it contains two components: Amoxicillin and Clavulanic acid, but in different dosages tablets contain varying amounts of these components.

The following dosages are available: 250+125 mg (250 mg Amoxicillin and 125 mg Clavulanic acid), 500+125 mg, 875+125 mg. Naturally, people have a question: if the pharmacy does not have a dosage of 500+125 mg, can a double dosage of 250+125 mg be used? Answer: no, it’s not possible, because we are going to the right dosage(500 mg), but for Clavulanic acid there is an excess, instead of 125 mg you get 250 mg, the final tablet comes out: 500+250 mg.

The difference is obvious, the effects are also impossible to predict. Therefore, always follow the dosage regimen prescribed to you by your doctor. There is no medicine in one pharmacy - go to another.

And do not try to replace medications with cheaper generics; also, unobvious benefits in terms of price can negatively affect recovery. After all, the substance for this kind of medicine is not always completely identical to the original, plus additional components from manufacturers of cheap medicines may also be of worse quality than the original.

About opening the capsule and using the powder to prepare the suspension. Mothers often like to do this for their children. This is also the wrong approach. The capsule mostly protects the contents from the acidic environment of the stomach, where the drug can be destroyed or change its properties and is destroyed in the alkaline environment of the intestine, where active substance The drug is freely absorbed and begins to act. Thus, preparing a suspension from capsule components is incorrect.

There are drugs in the form of dispersible tablets (antibiotics or), so they can be dissolved in water and the resulting suspension can be used for use in pediatrics or in people who cannot swallow large tablets. But this is a special case, moreover, mentioned in the instructions for these drugs.

I would like to believe that there will now be fewer questions about dividing or multiplying the dosages of tablet forms of drugs, as well as using the contents of capsules to prepare a suspension.

Answers to a question about the symposium “Algorithms” rational therapy atherosclerosis".

Andrey Vladimirovich Susekov, :

Dear colleagues, we do not have much time for discussion.

Question: Is it possible to divide statins in half if the tablet does not contain a break mark? Do I need to take a break of 3 months in the summer?

It is better not to divide, because the companies' instructions indicate that the division process may interfere with the dose of the drug. There is a world experience “every other day”. Like diuretics. "Rosuvastatin" 10 mg - Monday, Wednesday, Friday or 80 mg once a week. But there is a remark. It is not a fact that such a regime reduces risks.

Is it necessary to take a break of 3 months in the summer? I think, my personal opinion, it is possible. This is not in the recommendations. Drac Holiday is a medicinal holiday for people who have been taking statins for decades. Your opinion, Oksana Mikhailovna.

Oksana Mikhailovna Drapkina, Executive Director of the Internet session, Secretary of the Interdepartmental Council on Therapy of the Russian Academy of Medical Sciences:

Andrey Susekov: Viktor Savelyevich, do you think it is possible to divide a statin tablet in half? Our listeners ask.

Viktor Savelievich Gurevich, Doctor of Medical Sciences, Professor:

I will join the opinion that you have already voiced, Andrey Vladimirovich.

Regarding the holidays of taking statins during the summer holidays. But if you just give the statins a break from the patient. No need to interrupt, it seems to me.

Andrey Susekov: Good remark. Thank you.

Rostov-on-Don, Ushakova Irina.

Question: What place do bile acid secretrates currently occupy in the treatment of dyslipidemia?

Very necessary for children and pregnant women in Russia, unfortunately, are not registered. There was Questran. As far as I know, "Colesevelam" up to 3.5 mg per day now has a good reputation in the world. But it is not registered in Russia.

Oksana Mikhailovna? Victor Savelyevich?

Victor Gurevich: Several dosages, even more. But Colesevelam, I think, is a drug with promise.

Question: If, when prescribing statins, total LDL cholesterol is at the lower limit of normal, can statins be given at half the dose?

My answer and position is that I am not a supporter of half and half low doses. Now in the cardio center (I’m expanding the answer to the next question) in the laboratory clinical epidemiology We are starting a statin dose escalation program in clinical practice And clinical trials Atorvastatin 80 mg and Rosuvastatin 40 mg. The dose was 10 mg. I wouldn't do this. At half dose.

There is also the Finnish phenomenon of statin and scape, when long-term use Cholesterol begins to rise. Here, on the contrary, you need to add doses, but not reduce them. What do you think, Oksana Mikhailovna?

Andrey Susekov: There is a certain niche for Rosuvastatin because it is the most powerful statin.

Question: A young woman with autoimmune thyroiditis, xanthelasmas, total LDL cholesterol and triglycerides are normal. But a high level of good cholesterol. What to do?

3 times more. The case is non-standard. Here it is necessary to exclude a deficiency of the protein that transports cholesterol esters. This is an extremely rare situation. You need to watch either activity or STP mass special methods. But our laboratory capabilities are limited.

In such patients, you probably need to look at the global risk Score. If it is high, then we prescribe statins, regardless of the lipid profile. I would also order AP-1 protein here, which according to the literature has better indicator return transport CS than high-density CS.

Victor Savelyevich, your opinion. High level good CS, what needs to be excluded and further examined here?

Victor Gurevich: You remember well, Andrey Vladimirovich, the failures that occurred when increasing alpha cholesterol with the help of Torsetrapib. It turned out that this was of purely academic interest. We need to look at what sulfation of alpha-CS is the first.

Second. Sometimes this situation can occur with low triglyceride levels, low release of 3-beta from the liver. Should probably use the suggestions you made.

Maybe this is the most important thing - to focus on cardiovascular risk. There is no need to be alarmed by the numbers alpha-HS 2 and above.

Andrey Susekov: Thanks a lot. A very good point. With beta this is a subject for future research. Now in Russia, active research is beginning on new drugs that increase the level of alpha-cholesterol. RVX-08 injection forms. The future will tell.

Question: Statins for oncological negligence and oncological diseases. Clinicians often do not prescribe statins to this group of patients. Is this justified?

A difficult question, multidisciplinary. But we have a very experienced person in the audience. Your opinion please.

Vladimir Trofimovich Ivashkin,Academician of the Russian Academy of Medical Sciences, Doctor of Medical Sciences:

I think patients with cancer should not be prescribed statins. Any tumor is a glucose trap. In such patients, taking into account prognostic factors, there is no point in prescribing statins.

Side effects that these patients typically experience when undergoing chemotherapy or radiation therapy(in particular, the development of myocardial infarctions, which we see during radiation therapy with lung or breast tumors) are not caused by an increase in cholesterol. There we're talking about about the direct damaging effect on blood vessels and the development of endothelial pathology.

It is endothelial pathology that determines possible development thrombosis in such patients. I think there is no point in prescribing statins here.

Oksana Drapkina: I wouldn't risk it. A patient with cancer has many problems. He probably has a chance to die from his cancer. This is the case when people no longer die from cardiovascular pathology.

Andrey Susekov: Viktor Savelyevich, I know that you have extensive experience in clinical lipidology. Have there been such compromising patients in your practice?

Victor Gurevich: I completely agree with the statements that have been made now. Absolutely correct. At the same time, we must keep in mind the first thing: the presence of cancer in different stages and in different localization is not absolute contraindication for prescribing statins. Here we must refer to cardiovascular risk.

For example, liver cancer or liver metastases - direct contraindication. But if the first stage is zero of another cancer localization, if this is a patient with cardiovascular disease, then the cardiologist and oncologist should consider these problems and so on. I don’t develop the idea further. I think my colleagues also share the same point of view, taking into account the above.

Andrey Susekov: I literally have half a minute of remarks. We had a very seriously ill patient from Vologda. She, unfortunately, died. With severe familial hypercholesterolemia. On high doses statins, in one of the studies she was diagnosed with breast cancer. Mastectomy, chemotherapy.

We were afraid, doubted, consulted with foreigners. The opinion was that there was a cardiovascular risk, operations were performed and chemotherapy courses were completed. We returned to statin therapy, but in lower doses. This was such an interesting case.

Last question. Rostov-on-Don.

Question: How effective are generics of Rosuvastatin? In particular, "Mertenil".

Our guest has the floor. Do you have experience at Mertenil, Viktor Savelyevich? Your opinion on how ready we are for broader recommendations for generic Rosuvastatin. On the market for two years already.

Victor Gurevich: How do generics or generics appear, as they say now? Firstly, because original drug good. Secondly, because the license and protection period has passed. We must be good about the emergence of generics - number one.

As for Mertinil specifically. This is the second year we have been using it together. Absolutely positive result so far. The only thing we are missing is an additional Russian post-registration study so that we can establish ourselves in own ideas about this drug.

Andrey Susekov: Agree. Our laboratory also has good experience with Mertinil. But for objectification, Russian research is needed. They are scheduled at the heart center. This is probably the subject of our next conversation, colleagues. The drug is really good.

Oksana Drapkina: I will join. Probably everything.

Andrey Susekov: Thank you very much, dear colleagues, for being with us and taking an active part in our session. Not all issues were included in the regulations. But we promise you that email, according to technical capabilities, we will definitely answer all these questions.

Thanks a lot.

Tablet splitting is traditionally used in pharmaceutical practice to select the required dose of a drug if a dosage form with the required dose is not available. It is also used to reduce the cost of therapy. Although this practice does provide some economic benefits, there are concerns about dosing accuracy, compliance, and clinical outcome of therapy.

Sometimes splitting tablets is necessary. This is a recognized method of obtaining the required dose if it is not available in a finished dosage form, which may occur in a number of circumstances:

  • prescribing the drug to children or elderly people in the absence of specially developed dosage forms with a low concentration of the drug,
  • dose selection or reduction,
  • the need for frequent dose adjustments.

Sometimes this practice is caused by economic reasons. Existing pricing policy is that many drugs have similar or similar prices per dosage unit. Thus, the cost of a course of treatment can be reduced by almost 50% by separating tablets with a concentration twice as high as required.

Opponents of this procedure cite a number of arguments, the main one of which is the inability to ensure accurate dosing of the drug. Many factors influence the correct division of the tablet, including its size, shape, characteristics, the division technique and equipment used for this, and the ability and experience of the person performing the operation. Even in tablets divided by a pharmacist, the dose may differ from the ideal dose. One study showed that 5.7% of tablet halves divided by pharmacists were different from ideal weight more than 15% and only 7 (31.8%) of the 22 fragments met USP standards. Not surprisingly, even greater differences are observed when patients split the pills themselves. However, how important is this fact? A number of studies have been undertaken to compare clinical effectiveness therapy in patients receiving the same dose of drugs in the form of whole and split tablets, during which no differences were noted in the effectiveness of both treatment regimens.

Also not detected negative influence practices of dividing tablets for compliance. A survey of 1617 patients was conducted, all of them did not report any problems in connection with the division of tablets. Moreover, only 4% of respondents said that having to split pills reduced their willingness to follow the course of therapy. A survey of patients in another study showed they were willing to follow the procedure if it would reduce the cost of treatment, despite some inconvenience. On the other hand, 97% of the volunteers who took part in the pill splitting study preferred to use lower dose official drugs medicinal substance, and 77% were willing to pay for it.

Separating tablets by pharmacists may improve compliance, but this procedure has certain material costs. It has been shown that it takes an average of 5 seconds to separate 1 tablet. Taking into account the hourly cost of a pharmacist (according to a Canadian study), the cost of dividing 1 tablet is about 10 Canadian cents. In the case of patients dividing tablets independently, receiving advance instructions can reduce the frequency of errors during the procedure, but the pharmacist spends about 1 minute of working time, which is the equivalent of 1 Canadian dollar, explaining to each patient. Tablet splitters cost $6-$10 CAD.

Moreover, although tablet splitting potentially promises significant economic benefits, only small quantity The separation of currently frequently used drugs is not only possible, but also brings economic benefits. Such preparations must have the following characteristics:

  • availability in successively doubling doses (for example, tablets containing 10 and 20 mg of active substance),
  • suitable shape and size (tablets are considered the most suitable large size, covered with a shell, elongated in shape with wide edges),
  • sufficiently high cost to provide economic benefits,
  • lack of specific features associated with the release of the drug dose,
  • long course of therapy.

Of the 200 most commonly used drugs in Canada (1998 data), only 14 met the above criteria. A similar study conducted in the USA found 11 similar drugs. These include ACE inhibitors(enalapril, lisinopril), statins (atorvastine, lovastine, pravastin), antidepressants (cialopram, paroxetine, nefazadone), antipsychotics (olanzapine, risperidone) and a number of others medicines(warfarin, clonazepam, doxazosin).

As practice shows, separation of tablets is undertaken more often for clinical reasons than for reasons economic reasons. The economic benefit of separating the 11 most commonly treated drugs in the United States is less than 2%.

Summarizing the above, we can conclude that the introduction of tablet separation into widespread practice as a means of reducing the cost of therapy is not economically justified and can create a number of problems, such as incorrect use of drugs, incorrect dosing of drugs associated with errors in tablet separation, and reduced compliance. This practice should be used only in certain clinical situations in order to select the required dose of the drug.


The usefulness of splitting tablets as a cost-saving strategy is limited.


tablet separation, pharmacoeconomics, economic benefit, drug dose, compliance