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How to cut up tablets or pills (using a pill cutter)

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Brandy   
Brandy

Using a pill cutter

This video How to Use a Pill Cutter might be helpful, though very basic and doesn't show closeups of using it. (I find the UMM site very helpful on many things.)

One thing I would have added is that it's best to get a pill cutter that has a little line (indentation) coming down from the point (along the line the blade will fall), to use as a guideline in placing a scored pill - especially when cutting a pill smaller than 1/2.

I cut my pill into fourths, so I find it works best for me to put the pill in with the scored line horizontal (as close as I can eyeball it - can take some maneuvering), the each half is "scored" and that score line aligned with the line on the cutter. I'll try to find more resources that might illustrate this.

 

 

 

Admin note: Here is an example of an inexpensive pill splitter:

post-1-0-22037300-1437783530_thumb.jpg

Edited by Altostrata
added introduction

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Brandy   
Brandy

Another resource: Pill splitting

One thing I've found is that I had to try different manufacturers of generics to find a brand that splits cleanly without crumbling. Had to try a few, found one that works best for my med, and stick with that one.

(Many pharmacies will only supply brand they have on hand, and that generally varies from time to time as prices fluctuate, they've told me. But I go to a small independent pharmacy, and they really cooperate. When I call in my refills, I always do so at least a few days before I need it (in case they have to special order it) and remind them it needs to be that specific brand. I've been doing that so long they always keep a supply of "my" brand on hand now.)

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Altostrata   
Altostrata

They'll do studies on just about anything (as long as doesn't reduce pharma profits):

 

Pill-Splitting: How To Correctly Split A Pill

Last Updated ( Mar 09, 2009 ) HealthyPlace.com

 

....

Researchers at the Veterans Administration Medical Center in Asheville, N.C., studied patients to determine how effectively they were able to cut various types of splittable pills....

 

The researchers also wanted to know if detailed instructions from pharmacists made people better pill splitters.

 

"We had them use two fairly common splitting devices," [brian Peek, the clinical pharmacist who led the VA study] said of a hinged cutter and a special razor blade, both of which can be purchased at pharmacies.

 

All too often, Peek said, patients buy splitters from pharmacies and never ask for individual instruction. He and his colleagues set up the study to take that reality into account.

 

In the analysis, 30 men between the ages of 50 and 79 were assigned to rotating groups: splitter A with instruction and splitter A without instructions. The two groups used the hinged cutting device. There were also two splitter B groups, with and without instructions, using the razor.

 

Participants who were in the "instructed" groups were read how to split pills, followed by a demonstration of the practice. Pill splitters in the instructed groups were allowed time to ask questions. The groups receiving no instruction were simply read general information about the study itself.

 

Patients then were asked to split 14 tablets of each of these types: flat round tablets, irregularly shaped tablets, small oblong tablets and large oblong ones. Tablet weight before and after splitting was determined by an analytical weight.

 

In the end, regardless of group, researchers found patients' tablet-splitting resulted in dosage deviations between 9 percent and 37 percent from those intended. Peek said about 47 percent of patients in the study reported experience with having split pills on their own. And those with experience, regardless of instruction, were most accurate at splitting flat, round tablets. More deviations in dosage were found with the more irregularly shaped pills.

 

However, Peek added that an approximate deviation of as much as 10 percent may not be clinically significant with many medications that are split. Larger deviations in the study could prove hazardous for medications with a "narrow therapeutic index." Such an index, Peek said, refers to medications that can have under- or overdoses when inaccurately cut.

 

Warfarin, a powerful blood thinner, is a prime example of a narrowly indexed drug. Cutting away even slightly more than half of the drug eliminates the medication's therapeutic ability, leaving the patient vulnerable to dangerous clots. When too much of the medication is left on the split "half," patients are in danger of hemorrhaging.

 

"We hope that this study, along with others in the medical literature, will help health care providers make decisions about tablet splitting, especially when tablet-splitting is looked at as an option," Peek said.

 

http://www.healthyplace.com/depression/antidepressants/pill-splitting-how-to-correctly-split-a-pill/menu-id-68/

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Altostrata   
Altostrata

How to cut a tablet into eighths?

Probably the best way to cut a tablet into eighths is to cut it into quarters and then split it again with a sharp knife from the side.

 

This is like taking a wedge of layer cake and then cutting between the layers.

 

If you are tapering, you will want to take the larger piece of the eighth and save the smaller pieces in a clean, dry container with a top for later.

also see How to make a liquid from tablets or capsules http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

Edited by Altostrata
added method for eighths

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MNgal1960   
MNgal1960

Question about tapering by cutting tablets. If you cut tablets and end up with a lot of little pieces, is it OK to save the pieces and use them later or do you have to throw your cut pieces away? If it's OK to save then, for how long? I'm not asking about extended release, just normal tablets. Thanks.

Edited by KarenB
merged similar topics

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SquirrellyGirl   
SquirrellyGirl

Yes, you can save the bits and use them towards future doses.  I would store them under the same conditions as the full tablets, darkened, sealed container with silica drying agent if you have it (those little pouches or cylinders that are included in the bottle, sometimes).  Store in a cool, dark place.  Try to use the bits towards the next doses rather than hanging onto them for months.

 

SG

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MNgal1960   
MNgal1960

Thanks. None of my meds come with any drying agent, so I guess they don't need them. Yes, always darkened place and sealed container. Room temp is about 72 degrees. I hope that's OK.

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SquirrellyGirl   
SquirrellyGirl

Should be.  When in doubt, check with your pharmacist about storage conditions of your meds.  If yours didn't come with a package insert/disclosures which would include such info, your pharmacist (or some searching on the web) can get those details for you.

 

SG

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MNgal1960   
MNgal1960

Thanks. 72 degrees seems to be OK for the uncut tablet, so I guess that means it's OK for the cut tablet, too. I just won't keep the pieces more than a week. :)

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SquirrellyGirl   
SquirrellyGirl

Sounds good.  And if you find yourself having symptoms that aren't part of your normal pattern, then you can always revise and stop using the pieces to see if that makes a difference.  I saves pieces for my Remeron dry-cutting and had no trouble with it.  I did use them pretty quickly though, within a week, I'd say.

 

Good luck and happy tapering!

SG

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Junglechicken   
Junglechicken

I have a whole load of 10mg Escitalopram tabs left and once I've run out of my 5mg tabs will start cutting up the 10's.  Also, the pharma company helpfully made the tabs a long oblong shape, so very difficult to cut consistently each time.

 

My pill cutter is exactly like the one pictured at the top of the thread (Brandy's post).

 

Any suggestions as to how I can better accuracy cutting up the 10's?

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Altostrata   
Altostrata

There may be other types of pill cutters that better fit an oblong tablet. If you find such, please post it in this topic.

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Junglechicken   
Junglechicken

Will do Alto.

 

The blue/plastic pill cutter works fine for symmetrically shaped pills i.e. round.

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MNgal1960   
MNgal1960

Hi. I have a question about accuracy.

 

I have been dry cutting pills and using a scale to weigh the pieces. How exact does the weight need to be?

 

For example, I have pills that weigh .101. I was at .080 for a long time. Now I am trying to reduce by .001 every week. Hitting the desired weight exactly is so extremely difficult. I end up with lots of pieces. I try to assemble them to hit the right weight. I can't. I cut a little more. Oops, that was too much. Try a different little piece. Cut it a bit. It turns to crumbs. Try another piece. And on and on until I hit the desired weight exactly. It takes forever. Is this over-fussy?

 

BTW, the pills are amazingly consistent in their weight before I cut them. There is rarely one that is not .101. So I always ask for the same brand and get it special ordered. So I'm starting with a very consistent pill.

 

Is it possible to accurately make such small cuts and weigh them to such a small amount consistently?  Am I just kidding myself that I'm getting exactly the same dose every day all week because I'm being so careful and taking so long to cut each pill to exactly the right weight?

 

Thanks.

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AmyK   
AmyK

I am also very accurate. It takes 30 min- 1 hour for me each day to cut to the exact amount. It's exhausting, but I am quite used to it now. I dont know how to do it in another way.

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MNgal1960   
MNgal1960

Yes, that's about right. Takes half an hour or more to cut my pills and it's nerve wracking.

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pete27   
pete27

The question is ....is the drug evenly distributed?

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scallywag   
scallywag

Pete, the answer is "it depends." To which drug are you referring?

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MNgal1960   
MNgal1960

Scallywag, I have the same question. I take a 25mg tablet of Seroquel. It has no score mark. I gave up trying to cut it and reduced it via suspension (suspend, pull, and pitch). I stopped reducing but the symptoms continue and are horrible. I am wondering if suspending is less accurate than cutting and I am messing up my doses. But if the drug is not evenly distributed, then suspending would be more accurate than cutting, right?

 

MN

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scallywag   
scallywag

Seroquel is "moderately soluble" in water. If you have concerns about the dosage or about whether the liquid's faster absorption is causing problems, the most accurate and precise approach is dry-cutting the tablet and then weighing the result.

Using a digital scale to measure doses

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MNgal1960   
MNgal1960

Thanks. I have heard both ways. A chemist told me that she thought the scales were not accurate and suspending was more accurate, even with water. Wish I could afford OraPlus.

 

I was having bad symptoms dry cutting and was so frustrated by how bad I was at it (just don't have the fine motor skills to make those cuts), that I decided to switch to a suspension. But the symptoms have not improved. Probably have worsened. I only take Seroquel at bedtime. It does hit a bit faster as a liquid but not much. If you drop it in water, the tablet starts to degrade very quickly, so I imagine it's the same in the stomach, very quickly disintegrates.

 

Sadly, 25mg unscored is the smallest tablet Seroquel comes in. And I seem to have gotten as far as I can and am waiting for the neuropathy to settle down. It is awful and is not letting up.

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scallywag   
scallywag

MNG:  I wasn't clear enough about the "if" in my post.

If you have concerns about the liquid absorbing too fast, then the next most accurate dosing tactic is to weigh the powder from a crushed tablet.

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MNgal1960   
MNgal1960

Ah, I see. No, given how fast this tablet disintegrates in plain old water, I don't think liquefying it makes much difference. As for weighing powder, I shudder to think of what would happen if I tried to measure little bits of powder. I miss the days when my son lived with me and could do hard stuff like that. Mr. Patience with the steady hand and clear eyesight of a young man! Ah, I was spoiled.

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MNgal1960   
MNgal1960

Here's a thought that came to me. I weighed my Q tablet and found out that 25% of the weight of the tablet is actual medication. On the other hand, my V tablet has only a tiny amount of V compared to binders and fillers. I am thinking that the higher the percentage the med is, the more each little deviation from a perfect cut is going to matter, right? Maybe that's why I had such a hard time with dry cutting the Q. Maybe the symptoms I'm having now are still from the partial Q taper, especially when I as trying to dry cut.

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Road2drugfree   
Road2drugfree

How would i split a 20mg prozac capsule into a 5mg dose? I tried cutting it with scissors and the powder fell out. 

 

Edited by ChessieCat
removed underlining

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ChessieCat   
ChessieCat

You could open the capsule onto a piece of dark stiff paper and using a razor blade make a "line" of powder and then separate it in four.

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