Split Pills to Cut Bills

The safe way to get more meds for your money

split pills Cutting higher-dose pills in half has become a popular way to lower healthcare costs. Experts say it's safe to do this in some cases, but you have to do it right -- and know when you shouldn't do it at all.

With many medications, you pay the same or nearly the same price regardless of dosage. A 100-milligram prescription and a 50-milligram version may cost the same. Among the most commonly split drugs: uncoated aspirin and certain prescription pills for high cholesterol, high blood pressure and psychiatric conditions such as depression. Some health insurers have lists of pills suitable for splitting.

But before you start slashing your pills and bills, get educated: Though some studies have found that pill splitting can be performed effectively and safely, other research has found pitfalls, notably concerns about accurate dosage. According to one study, doses of tablets split by elderly patients deviated between 9 and 37 percent from the intended dosage, and the greater variations may be dangerous. That's why you should talk to your doctor first.

Tips for safer pill splitting:

Ask questions first. Talk to your doctor or pharmacist to see if you and your medication are candidates for pill splitting. Ask for a demonstration, then try it yourself and ask if you did it correctly.
Use a pill splitter. These devices cost only a few dollars and are safer and more accurate than knives or razor blades.
Get help as needed. Some patients cannot split pills accurately because of poor eyesight, confusion, tremors or other issues. Some pharmacies will split pills for you, or ask a reliable relative, friend or caregiver for assistance.

What can't be split

Many medications should not be split, including capsules, soft gels, powders, sprays, liquids, injections, suppositories and the like. Generally the only candidates are certain solid pills and tablets, particularly those that come with a scoring mark (groove). Even some of these can't be divided. Other pills that shouldn't be split include:

Controlled release, extended release or timed release. Look for the letters CR, ER or TR after the drug's brand name. Damage to the coating would affect the dosage.
Other special coatings. Pills with protective coatings, such as the enteric-coated aspirin that is easier on the stomach, should not be split. Some pills, such as certain diabetes medications, have thick shells and fragment when cut.
Prepackaged pills. Birth control pills are a prime example of a set that can't be broken.
Pills requiring precise dosage. Don't split medications when even a slightly inaccurate dose could cause undesired or significant health problems, such as anticoagulants. Children and medically fragile individuals often have less margin of safety in the dosage of their medications, and the risks may outweigh any financial benefit gained from pill splitting.
Odd shapes. Some pills come in triangles or other shapes that can make it hard to get an even split. There may be exceptions to this rule. For instance, some authorities say you shouldn't split diamond-shaped sildenafil (Viagra), but a study in the American Journal of Managed Care listed it among the best candidates for splitting. When in doubt, ask your doctor or pharmacist.

An end to splitting?

Not surprisingly, drug companies aren't thrilled with the pill-splitting trend, which has become increasingly popular with cash-strapped consumers. The comparable pricing of high-dose and low-dose drugs has long benefited people who need more medication. But this pricing structure may change.

"My primary concern is that popularizing the use of pill splitting for cost-saving reasons may ultimately boomerang and not only increase pharmaceutical costs but also adversely affect medication adherence," wrote Peter Weiden, M.D., of SUNY Downstate Medical Center in the February 2007 issue of the journal Psychiatric Services. He predicted that "no one should be surprised when new medications are priced per milligram rather than what is effective for the individual patient, or when the medications are not easy to split or are inconvenient in other ways."

For now, go ahead and find out if your medications are good candidates for the splitting cure to high drug costs. Ask your physician or pharmacist for a brand or version of your medication that is amenable for pill splitting. While you still can.

More: Do you have tips or questions about pill splitting or other ways to cut healthcare costs? Check out the Hot Topics in Health message board.