Splitting pills in half

Question

Sometimes a physician will instruct the patient to reduce the dosage of a prescription medication by 50%.

Obviously, if the tablet has an enteric coating, or is in a special encapsulation (such as with medications like Pristiq), it should not be split in half.

But what about other medications? Can they be split in half?

I have heard that, unless the pill is scored, the patient should not split the pill in half. The reasoning I have always been provided is that the active ingredient in the pill may not be evenly distributed.

Is this true? Or is it a way to sell more medications and increase profits?

Is there any scientific (or even anecdotal) evidence regarding this?

Answer 1

Yes, it's true, or at least it might be true for any given pill. In the US, the FDA specifically approves splitting of pills only when the manufacturer plans for it by including it in their drug approval application. By including it in their application the FDA will require the manufacturer to submit evidence that splitting the pills results in equal dosages and equal effectiveness. Without that evidence, you as a consumer have no way of being sure how it will behave. Maybe it will be okay and maybe it won't.

Per the FDA:

FDA has approved drugs where tablet splitting is part of the manufacturer’s drug application. "If the tablet is approved for splitting, the information will be provided in the drug’s professional prescribing information," says Mansoor Khan, Ph.D., director of the Division of Product Quality Research in FDA's Office of Pharmaceutical Science.

It's pretty far fetched to think that manufacturers are going to increase profits by telling consumers their pills shouldn't be split. The percentage of patients that would even apply to would be small since doctors don't make a practice of prescribing stronger strengths than patients actually need. Also, pill dosages are sized to meet the majority of patients' needs so any increased profits they actually realized would be trivial and probably not worth the risk of the bad PR that would result from being discovered.