One cost saving strategy employed by some health maintenance organizations (HMOs) is to have the patient split pills or tablets into smaller dosage portions. While attractive in some circumstances, this can result in a number of problems that may outweigh the benefits.
Problems:
(1) variation in dosage (either too high or too low)
(2) wastage (lost or crushed product)
(3) difficulty for a disabled patient
Parameter |
Splitting is a Good Idea |
Splitting is a Bad Idea |
drug toxicity |
low |
high |
dose-response efficacy curve |
flat |
steep |
patient eyesight |
excellent |
poor |
patient dexterity |
good |
poor |
patient's ability to comply with instructions |
good |
poor |
implement requirement |
no or simple tool |
requires special tool (complexity) |
product consistency |
relatively soft |
relatively hard, requiring force to split |
product size |
relatively large |
tiny |
product surface stability |
flat and stable |
round and unstable |
ease to determine center (based on product shape) |
simple (regular) |
difficult (irregular) |
response to splitting |
intact, equally sized pieces |
crumbles or very irregular pieces |
where:
• A scored tablet may not split evenly, so that scoring is not a predictor of proper splitting.
• Some pills split better by hand while others split better using a razor.
Specialty: Pharmacology, clinical
ICD-10: ,