Is It Safe to Split My Pills?

What pills can be split safely?

​​Pills and tablets that the U.S. Food and Drug Administration (FDA) has approved to be split will say so in the “How Supplied” label insert and on the package insert included with some medications. If your medicine doesn’t have this on the label, the FDA hasn’t evaluated whether two equal halves will work the same way as the whole tablet.

“Another telltale sign of a medication that might be OK to split is if it’s scored,” Berenbrok says. “That’s the little split down a tablet, where you can see an indentation that [signifies] you can break the tablet in two.”

But Berenbrok reiterates that you should always check with your pharmacist or health care provider first. A score doesn’t always indicate that the table is safe to split, he says. ​​

Which pills should you never split?

​​Because not all medications are formulated or manufactured the same way, not every pill can be crushed or split.

Pills that are extended-release, enteric-coated, capsules, chemotherapy drugs, blood thinners, seizure medications or combination medications should not be split unless a health professional specifically tells you it’s OK to split them.

Asymmetrical pills, like the blood thinner Xarelto, should not be split.

Courtesy drugs.com

If you have pills that aren’t scored down the center, that’s a good sign they’re not safe to split. Here are some medications that should not be split. ​

• Tiny or unevenly shaped tablets. Very small, oddly or asymmetrically shaped medication (triangular or otherwise not the same shape on both sides), crumbly or unscored tablets should not be split unless a pharmacist approves. These range from rounded, triangular medications like some sumatriptan (Imitrex) formulations, often used to relieve migraines, to the highest common dose (a 20 mg tablet) of the blood thinner Xarelto, which looks like a dancing red flame (or, some might say, a poop emoji) as well as other medications with more than four sides. ​​
• Extended-release medications. “If you split an extended release pill, you might end up getting too much medication in a short period of time,” Lynch says. Because those pills are designed to release the medication over an extended period, by cutting it, you may end up dumping all the medication in the pill at once, “So we advise people not to cut extended-release pills.” (This is different from immediate-release medications, which Lynch says should be OK to cut, if necessary, because the halved tablets would still be absorbed at the same speed as a whole tablet.) In some cases, splitting is recommended for extended-release meds, and in those cases, the information will be printed in the “How Supplied” label and patient package insert. Those pills should also be scored, according to the FDA.
• Pills with a polymer (enteric) coating. The coating allows the medicine to bypass your stomach so that it’s digested in your small intestine. If you split the pill, you break that protective coating. A range of medications have these coatings, Lynch notes, including some aspirin tablet formulations; nonsteroidal anti-inflammatory drugs (NSAIDs), like diclofenac; heartburn medications, or proton pump inhibitors, such as omeprazole (Prilosec) and pantoprazole (Protonix); and other medications that are designed to release in a specific place in the intestine, such as sulfasalazine (Azulfidine EN) and mesalamine (Asacol HD, Lialda).
• Capsules. If you split or open a capsule, the medication is going to spill out, and you won’t have an exact amount in each dose. While some capsules can be safely opened, the contents are meant to be taken immediately, not stored to ingest later.
• Oral chemotherapy medication. These work by affecting the immune system and damaging certain types of cells. “So when you cut it, the powder … may disperse and get into the air,” Lynch says, and you don’t want to endanger others in your household.
• Blood thinners. Even “small changes in the size of the pill can affect how much of any effect you get,” she says.
• Antiseizure medications. The dose needs to be exact to ensure effectiveness. “We don’t want to put someone at risk of having seizures because cutting the medication has resulted in them getting less from a portion of the tablet,” Lynch emphasizes.
• Combination medications with more than one active ingredient.

How to safely cut pills in half

​​If you’ve discussed all the options with your pharmacist or health care provider and still must cut pills in half, here are the safest ways to do it.

• Use a quality pill cutter. You can find them in most pharmacies. They’re easy to use and split pills down the score lines. Your pill splitter should also securely hold pills in place and have a clear or transparent safety case (whatever their color), so you can see the tablet while splitting it, Berenbrok says.
• Split your pills right before you take them. Splitting the entire prescription at once exposes the pills to potential degradation, meaning you get less of the medication and effect.
• Clean your pill cutter after each use.
• Replace your pill splitter if you think the blade has become dull. If you’re not getting a nice, even split, it’s time to get a new tablet splitter.​​

Common pill splitting mistakes

​​In addition to taking the steps above to properly cut medications in half, you will want to avoid the following common mistakes.

• Don’t use a knife, because you can end up with uneven doses. You could also slip and cut yourself.
• Don’t split a pill into more than two pieces. You’ll likely get uneven pieces and crumbling, which will affect the dosage.
• Don’t split multiple pills — and certainly not a whole prescription — upfront. Split only what you’re immediately about to take.

And there are numerous reasons to avoid splitting pills en masse. Lynch shares a few reasons it’s a bad idea to split a whole prescription:

• The pill’s cut surface is exposed to air, humidity and moisture, which can affect its stability, particularly when not taken for a while.
• Presplit tablets could crumble, reducing the dose taken.
• Most splits aren’t exactly 50-50. So taking the two (slightly uneven) doses over the recommended time period ensures a person gets the full amount as prescribed.
• Half tablets are harder to identify than whole tablets when stored alongside other medications.
• A doctor’s instructions could change to taking a full dose, and it’s better to take a whole tablet rather than two halves.​

What are the risks of pill splitting?

​​One of the biggest risks is making a mistake in the dosage. Lynch says some patients may get confused about their dose and take the whole tablet instead of half.

There’s also a chance the electronic prescription (or e-Rx) for the pills you’re splitting won’t be clear to other health care professionals when they look at your medical records. If your doctor doesn’t write the electronic prescription to specifically say you must split the dosage in half, “that means it’s documented in an electronic health record in a different way,” Berenbrok says. In an emergency or in case of hospitalization, for instance, you could be given double the dosage you need. “I think it just offers too much uncertainty and error,” Berenbrok says.

And speaking of dosage, a study published in the  Journal of Managed Care & Specialty Pharmacy of 16 commonly used medications found that the amount of active ingredients in split tablet halves wasn’t always equal. Sixteen percent of the tablet halves in the study weighed less — and 15 percent had lower drug content — than recommended by United States Pharmacopeia guidelines. Carvedilol (brand name Coreg), a medication for high blood pressure, and digoxin (Digitek), which treats atrial fibrillation, had the most powder loss in the study.

Other risks of splitting tablets include:

• Assuming the tablets are already split when they’re not.  
• Not being able to split pills because of vision or dexterity problems.  
• Splitting the wrong medication.  
• Splitting tablets that crumble easily.  

The bottom line: Talk to your doctor or pharmacist first if you’re considering splitting your pills, whether it’s an effort to save money or to make them easier to swallow. There might be a better solution.