Splitting tablets ‘may be risky’

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Splitting pills could lead to patients taking the wrong doses, a study suggests.Researchers from Ghent University in Belgium said there could be “serious clinical consequences” for patients.

Tablets which have a narrow margin between a dose that is therapeutic and one that is toxic are riskiest. The research was published in the Journal of Advanced Nursing.

Researchers from Ghent University asked five volunteers to split eight different sized tablets using three different techniques.The participants used three different methods to split the pills – a specialist splitting device, scissors and a kitchen knife. The pills were different shapes and sizes.

They found that 31% of the tablets that were split were different from the expected remaining dose.The study found the splitting device was the most accurate. However, it still produced errors in 13% of cases.

The drugs were prescribed for a range of health conditions, including Parkinson’s, heart failure, thrombosis and arthritis.Dr Charlotte Verrue, who led the study, said there were many reasons for tablets to be divided.

“It is done for a number of reasons: to increase dose flexibility, to make tablets easier to swallow and to save money for both patients and healthcare providers. However, the split tablets are often unequal sizes and a substantial amount of the tablet can be lost during splitting.”

She said that most tablets were not suitable for splitting and it would be better for more doses to be available.”We would also like to see manufacturers introduce a wider range of tablet doses or liquid formulations so that tablet splitting becomes increasingly unnecessary.”

Nina Barnett, a consultant pharmacist for older people at the Royal Pharmaceutical Society, said that pharmacists sometimes do recommend that tablets are split, but only when no other options are available.

She said: “There are situations where patients require a dose of medication which can only be provided through splitting a tablet. This might be because there is no liquid form available or it is not acceptable to the patient.

She said decisions were made on a case by case basis, in order to minimise risk and maximise benefit to the patients.She added that all decisions should involving the patient where possible and take into account patient and formulation related factors.

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