When It's Safe to Split Pills

Consumer Reports
December 30, 2015

This practice can save money, but make sure you choose the right ones

It sounds simple enough: Cut your pills in half to cut your prescription costs in half. The do-it-yourself practice of pill splitting is one that many doctors and health plans support. It’s a way to counter rising drug prices and encourage people to take their medications if they’re likely to skip doses and refills because of high costs. And those who have trouble swallowing medicine might find a smaller pill easier to manage.

How It Works

Your doctor will prescribe a higher dose of medication, often double. (Sometimes the higher dose is the same price as the lower dose.) At home, you cut the pills in half and take one half each day, ending up with two doses for the price of one.

But deep discounts aren’t guaranteed, so first ask your pharmacist what you’ll save, advises Barbara Young, Pharm.D., editor of consumer-medication information for the American Society of Health System Pharmacists in Bethesda, Md.

Note that the Food and Drug Administration has called pill splitting a “risky practice” and doesn’t encourage it unless a drug’s package insert specifically says it has been approved for splitting. But our medical advisers say it’s safe if you follow the guidelines below.

Four Smart Steps

1. Get your doctor (or pharmacist) to OK it first.  According to an April 2015 poll by Consumer Reports Best Buy Drugs, 8 percent of consumers trying to save money on medications admitted to cutting their pills in half without a doctor’s or pharmacist’s approval. Many drugs—notably most cholesterol-lowering statins, and those to treat high blood pressure and depression—can be split without losing effectiveness or causing a negative health impact, but it can be dangerous for you to divide others.

Your doctor may have other reasons to warn you about splitting pills. It’s not advised if you have dementia or memory problems, for example, or if you have a condition that makes it physically difficult, such as arthritis, hand tremors, or poor eyesight.

2. Only split pills that can be divided accurately.  Most time-released, long-acting, and combination drugs shouldn’t be split because it’s difficult to make sure that you’ll get the proper amount of the active ingredient in each half. Pills that are coated to protect your stomach, such as enteric-coated aspirin and ibuprofen, shouldn’t be split, either.

Those with a hard coating and capsules of any kind are best swallowed whole because they can easily crumble, leak, or crack into pieces. Chemotherapy drugs and those that require stable daily blood levels, such as antiseizure medication, birth-control pills, and blood thinners, should never be split.

3. Use the right tool.  Get a pill splitter, a small device that cuts with a sharp blade or by pressing pills between two opposing edges. Studies have found that pill splitters come closest to dividing medication into precise halves. They’re usually inexpensive and widely available at most pharmacies and large discount stores. Your health insurer may even send you one free or here's how to find the right splitter.

Never use a knife, scissors, a razor blade, a box cutter, an X-Acto knife, or any other sharp tool for the job. They can create unequal parts, and using them may increase the likelihood of an injury. Replace a splitter when it no longer divides pills easily and accurately. Find out which one performed best in our recent test of pill splitters.

4. Split pills one at a time.  Some pills deteriorate when exposed to air, heat, or moisture after being split. So cut a pill just before you take it, then take the other half as your next dose. That helps ensure that you compensate for any deviation in size. And split pills in half—not into smaller portions, such as quarters. When in doubt, ask your doctor or pharmacist to show you how to do it properly.

Good to Know: Not All Pills Can Be Split

Always ask your doctor or pharmacist if it is safe to split your pills.

There is no official, complete list of medicines that can be split. But it is usually okay to split drugs that treat:

• High cholesterol (“statins”)
• High blood pressure
• Depression

But some drugs should never be split. For example, the pain medicine oxycodone (OxyContin) is released over time in the body. If you split it, you could get an overdose.

Can I Split That Pill?

Pills That CAN Usually Be Split	Pills That CANNOT Be Split
Amlodipine (Norvasc)	Oxycodone (OxyContin) for pain
Atenolol (Tenormin)	Omeprazole (Prilosec) for heartburn
Atorvastatin (Lipitor)	Cetirizine (Zyrtec) for allergies
Citalopram (Celexa)	Chemotherapy drugs and anti-seizure medicines
Clonazepam (Klonopin)	Birth control pills
Doxazosin (Cardura)	Blood thinners (Coumadin, warfarin)
Finasteride (Proscar)	Capsules containing powders or gels
Levothyroxine (Synthroid)	Pills with hard outside coatings or coatings to protect your stomach
Lisinopril (Zestril)	Pills that release the drug throughout the day (extended-release)
Lovastatin (Mevacor)	Pills that crumble easily
Metformin (Glucophage)	Pills that irritate the mouth or taste bitter
Metoprolol (Toprol)	Pills with strong dyes that could stain your teeth and mouth
Nefazodone (Serzone)
Olanzapine (Zyprexa)
Paroxetine (Paxil)
Pravastatin (Pravachol)
Quinapril (Accupril)
Rosuvastatin (Crestor)
Sertraline (Zoloft)
Sildenafil (Viagra)
Simvastatin (Zocor)

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