Breaking, cutting or crushing tablets are common practical need of medication dosing, but there are hidden risks. Pharmacists must always dispense not just drugs, but also advice the patients.

Splitting tablets is a common practice where tablets of a higher strength are broken in halves, or even quarters, to provide the correct dose. This is often done to reduce costs, since the higher strength tablet tends to cost less per unit strength. In some cases the pharmacy may not stock the lower strengths in their inventory.

In simple physical term, this is size reduction and ratio of surface area over volume increases disproportionately when an object is divided. Dosing error and drug safety issue can arise as a result.

Splitting tablets at home can be a confusing affair. Whilst properly split tablet can be identified with some accuracy; the same may not be true for the highly friable tablets that have split unevenly, or even disintegrated. It will become dangerous guess-work trying to figure out whether it is half, quarter or what?

Older folks living alone may not have the hand-eye coordination acumen to do the task properly. Some fragments can be lost and caused under-dosage.

Many new tablets could be controlled-release formulation whose pharmacokinetic profile may change drastically after splitting.

Patients may not be the only possible source of error. When the prescription is written as "1/2 tablet," the pharmacist can confuse this with "1-2 tablets," which could lead to a fourfold overdose.

These are some of the tips Institute for Safe Medication Practices suggests for pharmacists:

1. Ascertain that the tablet in question is suitable for splitting. If in doubt, check with the supplier or manufacturer.
2. Ensure and educate patients the skill and motivation to split the tablets; enlist a family member or caretaker if necessary.
3. If the tablets are to be split at home, provide the patient or family with a tablet cutter to improve accuracy.
4. For inpatients, the pharmacy staff should dispense the tablets already split, rather than relying on nurses to do this in the ward.
5. Prescribers should order by strength (eg. mg) instead of "1/2 tablet" which can be interpreted as for "1-2 tablets."

For additional Information, please log on: http://www.ismp.org/Newsletters/acutecare/articles/20060518.asp

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