Should you cut your antidepressant in half to save money? A look at pill splitting, cutting larger-dose pills in half.
Experts disagree on whether this cost-saving tactic is a safe and effective practice
The cost of some medications -- many of them widely used -- can be reduced by as much as 50 percent when patients split one high-dose tablet in half to achieve the potency of the prescribed lower dose.
It's a way of getting the medication you need at a significant savings. But pill-splitting is also at the heart of the prescription drug debate. Some experts say while it makes sense mathematically -- cutting one high-dose tablet in half to yield the dosage of two lower-strength pills -- they question whether it actually bodes well biochemically: Are patients really getting one-half of the higher dose?
Even as questions abound on do-it-yourself pharmacy, a growing number of studies have begun to show that pill-splitting is a feasible way to treat a wide range of ills and, at the same time, dramatically lower costs.
Picture right: A scored pill inside an EZY Dose Deluxe Tablet Cutter; some drug manufacturers score pills to make them easier to split into roughly equal doses.
"Sometimes, it is medically necessary, and it can be done," said Curtis Kellner, director of pharmacy at the University Hospital and Medical Center at Stony Brook.
Kellner, however, is not a fan of pill-splitting.
Some people have vision problems and can't split tablets, he said. Others have arthritis. "I can't imagine my own folks splitting tablets," Kellner said of his parents.
Cost was the only reason Kellner could find to justify splitting medications. He could see no sound medical reasons to endorse the practice.
But pill-splitting is catching on as more and more patients and insurers turn to it to beat back the rising cost of prescription drugs.
The idea behind pill-splitting stems from the way in which prescription drugs are made and priced. Many tablets are "scored," meaning they have a line running through the middle. When patients purchase the higher dose of their prescribed medication, cutting tablets along the score essentially yields two lower doses.
Tom Johnson, a pharmacist at Jones Drug Store in Northport, said pills are purposely scored by manufacturers. "This makes it easier for patients to take a lower dose," he said. "Midway through therapy, the doctor may decide the patient needs only a half dose. In that case, a patient can use a pill cutter to lower the dose." The score line through the tablets was added to help patients save money. However, pharmacists and physicians emphasize that patients should be trained in pill-splitting before they attempt it.
Some tablets should not be scored because they have extended-release properties built into their design. In fact, tablet function often dictates design, said pharmacist Vincent Terranova, also of Jones Drug Store. Having a drug remain active for 12 to 15 hours is vital in the treatment of several medical conditions.
While scoring does not interfere with the activity of dozens of types of medications, breaking pills that are not designed that way can destroy properties in the coating, resulting in too much or too little medication.
"Years ago, you might have gotten a prescription to take one tablet four times a day; now, you don't have to do that. You may take one capsule daily or two times a day," the result of extended-release properties in nonscored tablets.
"Every few hours, medication is released in a certain amount. If you break that tablet, you will interfere with the extended-release mechanisms," Terranova said.
Many -- but not all -- drugs that are scored can be cut in half. Patients can split pills, using a special blade that can be purchased at pharmacies for $5 to $10.
The practice becomes an economic strategy, some experts say, because the lower and higher strengths of any given medication usually cost about the same. For example, at drugstore.com, 30 10-milligram tablets of the antidepressant Paxil cost $72.02. The same amount of tablets in the 20-milligram dose sells for $76.80. With pill-splitting, patients can get twice as much medication for only a few dollars more.
Additionally, doctors have identified all manner of tablets that can be split: those that impede pain, those for high cholesterol, depression, hypertension, and male erectile dysfunction, to name a few.
Medications, like the antidepressant Celexa, generically known as citalopram hydrobromide, are so deeply scored on both sides, that a 40-milligram tablet can be easily snapped in half by hand to yield the lower, 20-milligram dose, doctors say.
Medical experts who favor pill-splitting say people have been doing it for years. "This is a practice that has been present at a low level for a very long time," said Dr. Randall Stafford, a professor of medicine at Stanford University Medical Center in Palo Alto, Calif.
Stafford, who led a major study on the feasibility of pill-splitting, said the practice renders high-cost medications imminently affordable. And he believes it is an idea worth considering by anyone lacking prescription-drug insurance coverage. He and his team identified a range of medications that could be safely split to yield a cost savings.
"The potential cost savings with pill- splitting are not trivial," Stafford said, "and are in the range of $25 a month for most of the drugs we identified." In his investigation, Stafford identified 11 commonly used medications that could be safely split.