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Should You Split Your Pills?

By David Mendosa

Last Update: July 6, 2004

Prescription drug prices are so high that many of us already use strategies to help bring them under control. Undoubtedly the most common is switching to generic formulations wherever that’s possible. Others skirt the law by purchasing their medicine from foreign countries.

A less common strategy, but one that can also yield large dollar benefits, is pill splitting. This strategy works because you can buy higher dosages of many prescription drugs for the same or similar costs as smaller dosages. Although your diabetes medicine alone probably won’t break the bank, prescriptions for related conditions like high cholesterol and hypertension can be quite expensive. A month’s supply of some common drugs can cost more than $500.

You need to work with your doctor to implement this strategy. Only a physician can prescribe larger-dose pills.

It might seem strange that larger-dose pills sell for the same price or little more than smaller doses. But it makes sense.

The drug firms “score” pills to give doctors flexibility in adjusting the dosages they prescribe for their patients. Scored drugs have a line running through the middle, making it easier to split them in half.

Pill-splitting is an idea especially worth the consideration of anyone lacking prescription-drug insurance coverage. But even if your health insurance includes drugs, you usually have a copay, and pill-splitting can reduce your cost.

“Pill-splitting has been present at a low level for a long time,” says Dr. Randall Stafford, a professor of medicine at Stanford University Medical Center in Palo Alto, California. He is the lead author of an article, “The potential of pill splitting to achieve cost savings,” that the American Journal of Managed Care published in its August 2002 issue.

It has become a common practice now, especially among seniors “who have to pay an arm and a leg for their medication,” says Nick Bains. He is a pharmacist and owner of and the manager of a retail pharmacy, Sienna Meds, in Vancouver, British Columbia, Canada.

“In fact we recommend it where we know that the patient is able to save some money,” Bains continues. “We ask every patient, ‘Do you mind cutting the pills?’ For a lot of patients it is not whether they can, it is a question of whether they are willing to spend the extra 20 seconds.”

Pill-splitting is easier and more accurate with the proper tool. Bains recommends that you spend $3 to $5 at most pharmacies for a “tablet cutter.”

Even if you could save money by splitting extended release tablets, Bains says, “In some cases it is not advised for those pills, because that could destroy the extended properties.”

Likewise, you should usually not split pills with enteric coatings because the special coating decreases stomach irritation for some patients. Other patients who have tremors or psychosis should not split pills themselves, Bains advises. “But I do think that it would be OK for a caregiver to split the pills for them.”

Generally, the best clue whether you can split a pill is whether it is scored. “Scoring is usually a pretty good giveaway that it is something you can cut,” Bains concludes. 

Potential Cost Savings From Pill-Splitting
Clonazepam (Klonopin) Panic disorder; epilepsy 41 percent
Doxazosin (Cardura) Hypertension; prostate enlargement 46 percent
Citalopram (Celexra) Depression 46 percent
Atorvastatin (Lipitor) High cholesterol 33 percent
Paroxetine (Paxil) Depression; anxiety 46 percent
Prevastatin (Pravachol) High cholesterol 23 percent
Nefazodone (Serzone) Depression 48 percent
Sildenafil (Viagra) Erectile dysfunction 50 percent
Lisinopril (Zestril) Congestive heart failure; hypertension 38 percent
Sertraline (Zoloft) Depression 46 percent
Olanzapine (Zyprexa) Schizophrenic; bipolar disorder 31 percent
Source: Stanford Report, September 11, 2002, online at Many other medications also offer cost savings from pill-splitting.

This article originally appeared in Diabetes Wellness News, July 2004, p. 7.

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