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Altostrata

Splitting or crushing tablets or pills

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Altostrata

Doctors are often unaware that gradual tapering may be accomplished by splitting tablets and almost always unaware of the use of liquid formulations, either compounded or do-it-yourself.
 
(For tips on tapering specific drugs, find your drug in this list: Important topics in the Tapering forum and FAQ )
 
Despite the general instruction "do not split" regarding most psychiatric drugs, cost-conscious health coverage plans often recommend splitting tablets to save money, particularly on brand-name drugs.
 
This article from Current Psychiatry December 2006, full text http://www.currentpsychiatry.com/the-publication/past-issue-single-view/pros-and-cons-of-pill-splitting/fe4ca41728ceb6bbd8531fd8b92e5d8e.html , authored by a psychopharmacology researcher and a medical school professor, lists common psychiatric drugs where tablets may be split:

  • Adderall tablets
  • Abilify tablets
  • Celexa or citalopram tablets
  • Effexor tablets†
  • Lamictal tablets†
  • Lexapro tablets
  • Luvox tablets
  • Paxil or paroxetine tablets
  • Prozac 10 mg tablet or fluoxetine tablets
  • Remeron or mirtazapine tablets
  • Risperdal tablet
  • Seroquel tablets
  • Tegretol
  • Wellbutrin and bupropion tablets
  • Zyprexa tablets

† Tablets may have uneven shapes, making even cuts difficult
 
See How to cut up tablets or pills
 
The article states, as we do here on SurvivingAntidepressants.org, that splitting extended-release formulations is "contraindicated" because the extended-release mechanism is compromised.
 
(Breaking down the extended-release mechanism of a tablet can bring on "dose dumping", where more of the drug is released into the person's system than the person is accustomed to. This may cause adverse effects. However, we do have people successfully tapering Pristiq by splitting the tablet because there is no other way to taper).
 
The article states that capsules, such as Cymbalta, cannot be split. We agree, that would be silly: the contents would spill out and make a mess.
 
To taper a drug in a capsule, carefully open the two halves, empty the contents on a clean piece of paper, and measure your dosage. If the capsule is filled with beads, count beads or weigh with a digital scale. See Counting beads in a capsule versus weighing
 
If the capsule is filled with powder, using a digital scale is the most precise way to measure dosage.
 
See Using a digital scale to measure doses
 
For drugs that are splittable tablets or powders in capsules (NOT drugs that are extended-release), making a liquid is often the easiest way to accurately measure dosage, see

How to make a liquid from tablets or capsules
 
Or, with a prescription, you can get your drug compounded into a liquid by a pharmacy, see Compounding pharmacies (US, UK, and elsewhere)
 
Also see

Why taper by 10% of my dosage?

PDF of article Pros and cons of pill splitting by Rakesh Jain, MD, MPH, and Shailesh Jain, MD, MPH, Current Psychiatry, December 2006

http://www.currentpsychiatry.com/fileadmin/cp_archive/pdf/0512/0512CP_Pearls2.pdf

Edited by Altostrata
updated

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Altostrata

From Current Psychiatry May 2014 http://www.currentpsychiatry.com/specialty-focus/practice-trends/article/pills-to-powder-a-clinicians-reference-for-crushable-psychotropic-medications/4da7b11719692768cf7cb6048b6a1f93.html

 

These are tablets that may be crushed without loss of "extended-release" properties. Tablets that may be crushed may also be split.

 

14_bostwick_pills_to_powder_chart.jpg

 
PDF of article Pills to powder: A clinician’s reference for crushable psychotropic medications by Jolene R. Bostwick, PharmD, BCPS, BCPP, and Angela Demehri, MD, Current Psychiatry 2014 May;13(5):e1-e4.

http://www.currentpsychiatry.com/uploads/media/e0_0514CP_PRLS_Demehri_Web_FINAL.pdf

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Altostrata

Drugs are manufactured in different ways. Some tablets, such as buproprion immediate release, will be released quickly into the bloodstream from the digestive system.
 
Other tablets have protective coatings that will gradually dissolve (reservoir matrix or reservoir or osmotic pump matrix). If the coatings are broken, the entire contents of the drug will be immediately released. These tablets cannot be cut, split, or crushed without making the drug immediate-release.
 
Other tablets, such as Pristiq, are manufactured in a monolithic matrix formulation. Rather than a timed-release coating, the coating on the Pristiq tablet is only protective. The extended-release mechanism is part of the tablet matrix, or the glue that holds the tablet together.

 

I verified the above in a phone conversation with Pfizer medical information (1-800-438-1985).

 

(If the tablet is split, the matrix is damaged and may not reliably be extended-release, depending on the size of the fragments. Larger fragments are more likely to retain some extended-release capability. When the tablet is CRUSHED, the matrix is completely destroyed. The particles should be assumed to have NO extended-release capability.)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648939/
The Role of Oral Controlled Release Matrix Tablets in Drug Delivery Systems

You might excrete the shell of the tablet, or fragments of it. The coating material is not easily digested. See
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110830/
Curse of the ghost pills: the role of oral controlled-release formulations in the passage of empty intact shells in faeces. Two case reports and a literature review relevant to psychiatry

 
http://file.scirp.org/pdf/PP20120100009_94401954.pdf
 
Pharmacology & Pharmacy, 2012, 3, 15-19
Development and in Vitro-in Vivo Evaluation of Controlled Release Matrix Tablets of Desvenlafaxine
DOI: 10.4236/pp.2012.31003 
Author(s)  Shashidhar Reddy Dodda, Prakash Rao B

ABSTRACT
The objective of this investigation was to prepare extended release tablet containing matrix granules of Desvenlafaxine succinate monohydrate and to study its in vitro release and in vivo absorption. The design of dosage form was performed by choosing hydrophilic hydroxypropyl methyl cellulose (HPMC K100M), sodium carboxyl methyl cellulose (Blanose), microcrystalline cellulose (MCC) and lactose monohydrate polymers as matrix builders and polyvinyl pyrolidine (Kollidon K30) as granulating polymers. Granules were prepared by composing drug with HPMC K100M, sodium CMC, MCC and lactose monohydrate by spray drying method. Optimized formulation of Desvenlafaxine succinate monohydrate was formed by using 20% HPMC K100M, 26.6% MCC, 6.6% of sodium CMC (Blanose), 13.3% of lactose monohydrate and 5% ratio of Kollidon K30 as binder. Tablets were compressed with free flowing optimized granules of uniform drug content. This extended the release period up to 24 h in vitro study. Similarity factor and mean dissolution time were also reported to compare various dissolution profiles. The network formed by HPMC, MCC and Blanose had been coupled satisfactorily with the controlled resistance. Biopharmaceutical study of this optimized dosage form in rabbit model showed 24 h prolonged drug release in vivo. A close correlation (R2 = 0.9833) was established between the in vitro release and the in vivo absorption of drug. The results suggested that wet granulation with spray dried technique, is a suitable method to formulate sustained release Desvenlafaxine succinate monohydrate and it can Perform therapeutically better than conventional immediate release dosage form.

 

If you have additional information about matrix formulations of specific psychiatric drugs, please post is here (with reference links to authoritative sources).

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