Tablet splitting may cause wrong dosage

Researchers have recommended pharmaceutical companies introduce a wider range of tablet doses after a study suggested splitting tablets may result in an incorrect level of medication for patients.

Published in the Journal of Advanced Nursing, 'Tablet-splitting: a common yet not so innocent practice' concluded that the practice of splitting tablets 'could have serious clinical consequences for medications with a narrow therapeutic-toxic range', with splitting only to occur when unavoidable. This includes when the prescribed dose is not commercially available, or if there is no alternative formulation which can be used.

Healthcare professionals use tablet splitting for several reasons, including flexibility in dosing; making the medicine easier to take orally; and helping to reduce costs.

However, researchers from Ghent University in Belgium, who conducted the study, said splitting tablets leads to unequal sizes with a potentially significant amount of the drug lost after it has been cut.

The results were based on five participants working at a nursing home who split tablets using three commonly used methods: Pilomat – a specific splitting device; scissors for unscored tablets or by hand for scored tablets; and a kitchen knife. Tablets were weighed before and after splitting using an analytical balance.

It was found that almost a third of tablets that were split deviated from the recommended dose by at least 15 per cent, with some differences of more than 25 per cent recorded.

As well as the recommendations to drug manufacturers for increased variation in products, the researchers recommended use of a splitting device over other methods when splitting is unavoidable due to its superior performance in the study. It was also advised that nursing home staff be educated in how best to split tablets, and to increase their understand the consequences of incorrect doses.