Is It Safe To Split Pills?

It’s not ideal to split a pill. But can it be done? Absolutely, in some cases — but it’s a process that can come with definite risks, primarily related to getting a correct dosage.

But the reality is that the slicing and dicing of medications happens … and it happens a lot. One study estimated that almost 25% of pills are split. The reasons why vary from the economic (saving cash) to the physical (difficulty swallowing a whole tablet).

So, if you’re going to do it, follow this advice: Ask before you make a cut and take safety steps to do it properly, advises pharmacist Alison Miller, PharmD.

“Splitting a pill can be dangerous,” says Dr. Miller. “That’s where the discussion needs to start.”

What pills can be cut in half?

Tablets with a score line typically mean they can be split. This mark, or notch, offers assistance to make a clean cut — usually to make two even halves. “A score is the No. 1 thing to look for,” notes Dr. Miller.

Guidance can also be found within the gobs of text on medication labels or patient package inserts. The “How Supplied” section notes whether a pill has been approved for splitting by the U.S. Food and Drug Administration (FDA).

But don’t just assume it’s safe to split any pill with a score mark.

“It’s always best to talk with your pharmacist or doctor first,” cautions Dr. Miller. “A score line might indicate a pill can be split, but it doesn’t mean that you should.”

Pills to never split

If there’s no score line on a pill, consider it a STRONG message that it’s not meant to be split. Medications that fall in this category include:

• Extended-release pills. Cutting a pill engineered to slowly release medication undermines that intended delay. “Splitting this sort of pill can lead to the entire dosage being dumped at once — and that can be very unsafe,” cautions Dr. Miller.
• Liquid- or bead-filled capsules. Aside from being messy, there’s just no good way to ensure a proper dosage after cutting into a liquid- or bead-filled capsule.
• Asymmetrical pills. Imagine trying to make a precise and measured cut on a uniquely shaped tablet. (Spoiler alert: Your odds aren’t good.)
• Tiny tablets. Avoid any pill cut that demands high surgical precision.

How to cut pills in half

The right equipment is essential for splitting a pill. For more accurate splitting, look for a specialized pill cutter at a pharmacy or online market.

The most common design features a V-shaped pill holder and a retractable blade that presses down on the tablet. Make sure to do the downward cutting motion quickly. A slow press can make the pill crumble.

These nifty pill cutting devices — which often can be purchased for just a few bucks — are a much better option than, ahem, other more creative methods.

“I’ve had people tell me they’ve bitten pills in half or used their fingernails,” says Dr. Miller. “I’ve heard from people about using butter knives, too, which usually sends pill pieces flying all over the kitchen.”

Other splitting tips include:

• Cut only one pill at a time.Splitting multiple pills at once can make it difficult to identify the medication later. Also, the FDA reports that split pills that sit around are more likely to be affected ­— and made less effective — by heat, humidity and moisture.
• Focus on cleanliness.Wear gloves or make sure to wash your hands before and after splitting a pill to help avoid any reaction. Make sure to clean the pill cutter, too.
• Don’t assume it’s OK to split a pill.Always check to make sure a pill can be split, even if it’s a medication or prescription you have previously used and cut. Manufacturing changes happen. Don’t be caught off guard by them.

Risks of splitting pills

How difficult can it be to evenly split a pill in half? Well, it’s tougher than you might think. One study found that almost 1 in 8 split pills were off by more than 20%. That’s not exactly top precision.

Dosage errors can be dangerous in either direction, notes Dr. Miller. Taking too much of a medication can lead to a potential overdose. Getting too little, meanwhile, can limit the intended benefits.

“Whenever you split a pill, you probably aren’t getting the exact dosage your prescription calls for,” says Dr. Miller. “That can have consequences.”

So, why split pills at all?

While splitting pills may not be encouraged, there are definite and understandable reasons why it’s done. The most common explanations include:

• Maximizing prescriptions.Say you need a 10 milligram (mg) dosage and 20 mg pills are available. Splitting tablets can stretch 30 pills into a 60-day supply, saving you cost on the refill.
• A nonstandard dosage. Splitting pills may be necessary if pills aren’t made in your prescribed amount.
• Difficulty swallowing whole pills.A national survey once revealed that more than 40% of adults experience problems swallowing pills. To borrow a phrase from “Mary Poppins,” splitting pills can serve as the “spoonful of sugar that helps the medicine go down.”

“There are times when you might need to split a pill,” says Dr. Miller. “But it’s always best to talk to your doctor or pharmacist first. There may be ways to get the proper dosage into one pill that works, which is preferred.”