Ever gagged on a pill? Downed a whole glass of water, only to find the tablet still stuck at the back of your tongue? (and worse - that moment when it starts to dissolve and taste all funny, gasp!)
The temptation to split pills can be due to many reasons:
- Children or elderly may find it hard to swallow a big pill at one go
- You may only want half the dose of a single tablet
- Patients using a feeding tube may have to grind tablets up so that the tube does not clog and cause problems
As if it's not confusing enough when your pharmacist tells you all the similar-looking white tablets are different, I'm here to share that NOT all pills are made for splitting!
Before getting frustrated, there's a lot of science that goes into manufacturing an innocuous tablet. We call this "dosage-form design", and this technology is sometimes the reason why you can’t break pills.
Here are 2 types of tablets that CANNOT be split:
1. Enteric-coated tablets (shortened to "EC" on most medication labels)
These are tablets that are specially formulated to only release the active drug in your intestines ("Enteric" means intestines), because some medicines are irritating to the stomach lining, or are absorbed best in the alkaline environment of the intestines.
If you split these, the medicine may be digested and made inactive by the enzymes in your tummy, rendering it ineffective. Plus, you may even suffer from an upset stomach!
2. Slow-release / Modified-release / Sustained-release / Extended-release / Long-acting tablets
These preparations go by a variety of names, or their acronyms (SR, MR, ER, LA – you may see some of your medications having these suffixes, they actually mean something!)
Research in formulation science has given us these wonderful products which allow for reduced dosing frequency - eg. once-a-day tablets, instead of having to take one every 4 hours!
This magic happens typically through creating a tablet with many coatings – imagine the Teochew mooncake pastry (or Russian nesting dolls, if that works for you) where the many layers of pastry slowly dissolve over a long period of time. With each layer, a small amount of medicine is released for your body to absorb.
Cutting these kinds of "high-tech" tablets disrupts the layers, and causes more of the active substance to be released in your body at once. This can be harmful as you may be exposed to more of the medicine than you should, and hence side effects become more prominent. There might also not be enough medicine to last you for the original duration, as it’s all been dissolved and absorbed.
Due to rapid advancement in dosage-form design, there are many more interesting ways scientists can engineer a tablet to release medicine. Now, if you cut a mooncake, it’s not going to be a nice gift anymore, right?
3. What other pills should not be cut or crushed?
The Institute of Safe Medication Practices regularly updates a list of medications which should not be crushed (or chopped, or split, or cut) which I personally find helpful.
You can find it here: http://www.ismp.org/Tools/DoNotCrush.pdf
4. Pill-swallowing phobia, yet I can't cut them! What's a man to do?
If you’re terrified that you have to deal with whole tablets because they can’t be cut, don’t worry. Here are some suggestions that you can discuss with your pharmacist or doctor!
- If you have swallowing difficulties, you may be able to swap the pill to a liquid form of the medication
- If you only want to take half a dose of a single tablet, there may be tablets of smaller doses available
- For medications that have to be administered through a feeding tube, always check for compatibility with the tube material and lumen size, as unwanted interactions can happen. Also, crushing tablets into powder that's fine enough to fit in the tube can sometimes cause clogging. It's best to seek expert opinion on compatibility from a medical professional
5. A final pill-chopping tip!
As an aside, even if you have a tablet that's safe to be split, try to do it with a tablet splitter (a box contraption with a single blade within) or with a clean sharp knife.
This will give you two relatively equal halves, rather than ¾ of a tablet and small crumbs if you did it with your fingers.
So remember - if you're not exactly sure if you are doing the right thing with your tablets, always check with your pharmacist or doctor!
Sarah is a guest writer at DxD, and a fully registered pharmacist with the Singapore Pharmacy Council. She’s currently working towards completing a further degree in public health. Things that excite her include a good book, a good cup of coffee and being able to help people use medicines safely.