How to take the medicine: can I split the tablet in half? Discussion: expert comments, live broadcasts with participating cities.

Tablets: to divide or not to divide? Dividing tablets into parts - daily practice, a familiar and common way of obtaining the required dose in cases where the drug in the required dose is not available, or in order to reduce the cost of therapy. Division is often used to select, reduce the dose, and also if frequent adjustments are necessary. Lack of special dosage forms for children and the elderly, it is also replenished (not always justified) by mechanical division of tablets. In addition, people with average and low level prosperity, in particular for pensioners, dividing tablets allows you to save significant money. Existing price policy is such that many drugs have the same (or approximately the same) prices for different dosages. For example, 30 Lipitor tablets of 20, 40 or 80 mg cost $116 in Wallgreens pharmacies (USA). Thus, treatment costs can be reduced by almost 50% only by dividing tablets with a dose twice as high as required. The economic benefits of dividing tablets can be judged from the following examples. Experts at the University of Michigan calculated that if 45% of the employees of this institution taking cholesterol-lowering drugs joined the voluntary pill splitting program as part of federal program to reduce costs for prescription drugs, the university will save $1.3 million per year, and the employees themselves will save up to $190 thousand. The savings on a national scale would be even more significant (if the ongoing outreach campaign is successful). The U.S. Department of Veterans Affairs alone saved $46.5 million in 2003 by splitting Zocor pills between older patients. Proponents of splitting tablets are confident that it does not have any effect negative influence on clinical effectiveness therapy and its compliance (the degree of adherence of patients to the prescribed treatment). Moreover, the majority of study volunteers preferred to continue using pill splitting, and 77% were willing to pay for it. Dividing tablets is advisable if there is following conditions: - suitable shape and size (coated tablets are considered the most acceptable, big size, elongated shape and wide edges); - the drug is available in dosages that increase by 2 times (for example, 10 and 20 mg); - a sufficiently high price at which division provides economic benefits; - absence specific features associated with the release active substance. Obviously, only a small proportion of the most widely used tablet medications meet all of these criteria. The arguments of opponents of dividing tablets mainly boil down to the impossibility of ensuring dosing accuracy. Mainly pharmaceutical companies fearing a decline in their income. They rightly note that the halves of the tablet in most cases contain unequal amounts of the active substance, even if the active substance is evenly distributed throughout the entire volume. One study found that 5.7% of pharmacist-split tablet halves were different from ideal weight more than 15% and only 31.8% met USP standards. Many factors influence how a tablet can be divided correctly, including size, shape, dividing technique and equipment used, and the ability and experience of the person doing the dividing. Even in tablets divided by a pharmacist, the dose may differ from the ideal dose. Even greater differences are observed when patients divide the pills themselves. Manufacturers apply a score (notch) to pressed tablets with a diameter of more than 9 mm in order to simplify their division. Tablets with two perpendicular notches can be easily divided into four fairly even parts. However, almost 10% of prescribed tablets do not have notches. Many tablets are coated to prevent release active substance in the stomach. If such tablets are split, the active substance is released in the stomach and destroyed. Accordingly, the medicine loses its effectiveness. Some tablets have shells that protect the active substance from the influence of oxygen, light, and moisture. In addition, the active substance may taste unpleasant. Particular attention should be paid to the fact that even tablets with a notch cannot always be divided. It's about about the so-called disorienting “decorating” notch. There is a lack of information in instructions for doctors and patients regarding the possibility of dividing tablets. Therefore, it is not always clear whether tablets can be divided. This creates serious problem in cases where an individual dose of the drug is required. Dividing drugs by pharmacists could theoretically increase the accuracy of drug dosing, but it is not economically feasible as it would take up a lot of their time. Canadian economists have calculated that, taking into account the cost of an hour of pharmacist work, dividing one tablet, which takes an average of 5 seconds, costs 10 Canadian cents. When the patient independently divides the tablets, having previously received necessary instructions, the frequency of errors during the procedure is reduced, however, the pharmacist spends about a minute of working time explaining to each patient, which in monetary terms is 1 Canadian dollar. In this regard, it is cost-effective for patients to use tablet splitting devices. To facilitate and improve the accuracy of tablet division, many designs have been proposed. Thus, the company TehniTab Technologies (USA) has developed a device in the form of a bubble (DemiDose), which splits tablets exactly into two parts. To divide the medicine, you need to open the lid of the device, insert the template, place the tablet in the middle, close the lid and press it. The accuracy of tablet separation is 92-100%, without unnecessary breaks and crumbs. DemiDose costs about $13. The manufacturer of the device claims that it will quickly pay for itself, allowing its owner to save 35% to 55% of monthly drug costs. There is a multi-functional pill container that has a splitting razor in the lid. It also has a tablet crushing device. In addition, there is a cup at the bottom of the double container. The price of the product is 5.9 euros. No less original is a device in the form of a guillotine for dividing hard Viagra tablets (Revolutionary Viagra splitter) at a price of $30. It was developed by 70-year-old US pensioner Carmen Reitan. The device is in great demand, since doctors usually recommend that patients reduce the daily dose of Viagra, and large tablets of this drug with a dense shell do not break in two. Many modifications of this device have appeared. Sometimes, in the absence of special devices for precise division, they resort to crushing tablets. In this case, the tablets can be crushed with any in an accessible way(most often between two spoons). Then a strip is formed from the resulting powder using the same spoons and divided into the required number of parts. This is not as simple a task as it might seem at first glance, especially for older people who do not have acute vision and a steady hand. In addition, such manipulation disrupts the structure of the drug, which can affect its effectiveness. It must be borne in mind that the practice of dividing tablets is not suitable for all patients and not for every drug. It may cause the drug to lose its therapeutic effectiveness and should only be used with the approval of your doctor or pharmacist. Additionally, patients may mistakenly split a tablet that should not be split or forget to split a tablet and take a double dose. For children, it is better not to divide, but to use children’s medications. And not only because it is difficult to ensure dosage accuracy medicinal substance when dividing. For children's drugs, the requirements for active and excipients, affecting the quality of the drug, is much higher than for adults. Mark SINOVATS

Is it great wisdom to take medicine?! He put a pill in his mouth, washed it down with something that came to hand... But if you want this pill to really help you, then you should take it, observing certain rules. It is about them that Elena Aleksandrovna Fomicheva, a clinical pharmacologist at Petrozavodsk Polyclinic No. 2, talks about them. Similar specialists have now been available in all clinics for several years. This position was introduced for a reason. Medicines in Lately There are so many that it is sometimes difficult even for a doctor to sort them out. What can we say about the patient?!

6 tablets at once is dangerous

We all know that in mathematics or grammar there are rules that need to be memorized - without any explanation. They are an axiom. The same applies to the rules for using medications. They must be remembered and followed unquestioningly. Because if you are not a doctor, then any explanations will only confuse you. If you don’t follow the rules for taking medications, you won’t be cured.

First a few numbers. Up to 25% of all patients in the world are hospitalized due to improper administration medicines, and not because of illness. More than 20% of drug complications are due to drug interactions. The more medications you take at the same time, the more sensitive your body is to them. Taking three medications at once risks developing adverse reactions in 20% of cases, and if you take 6 medications at once (without a doctor’s prescription), then the likelihood of developing side effects increases up to 80%!

A short general instruction

For treatment to be effective, adhere to following rules taking medications.

It is best to take your medications neat boiled water, since many drugs are incompatible with a number of products, for example:

– milk and dairy products reduce the effectiveness of antibiotics taken to treat respiratory and sexually transmitted infections, as well as tetracycline;

– alcohol enhances (not in better side) action sedatives and drugs containing paracetamol and lowering blood pressure (hypotensives). Alcohol can affect the absorption of almost all medications, although this depends on individual characteristics body;

– grapefruit juice can cause unpredictable side effects of medications;

– tea and coffee often reduce the effect of medications;

– mineral water interferes with the absorption of certain drugs.

Do not chew the coated tablets; swallow the capsules whole, as such "external protection" medicinal product promotes proper absorption of the active substance and protects the mucous membrane gastrointestinal tract from irritation.

Do not self-medicate. Remember that it is very undesirable to take more than three medications at the same time, even if these are vitamins and herbs.

Medicine and alcohol are incompatible

All alcoholic drinks interact with most drugs. This not only reduces efficiency drug therapy, but also increases the likelihood of developing adverse side effects. Ethanol not only excites you and affects you emotionally, but also changes the behavior of the drug in the body.

The combination of antibiotics and alcohol significantly reduces the effectiveness of the former, so it is strictly not recommended. If a patient takes phenobarbital and abuses alcohol, he risks dying from respiratory arrest. The combined use of alcohol and antidepressants, sleeping pills, and antiallergic drugs significantly increases their sedative effect, which can have a detrimental effect on well-being. The interaction of alcohol and nitroglycerin can lead to sharp decline blood pressure to the point of fainting. Under the influence of alcohol, the hypoglycemic effect of insulin and other drugs for the treatment of diabetes increases, and this threatens the development diabetic coma. Drinking alcohol with diuretics and digoxin can cause changes in potassium balance and, as a result, heart rhythm disturbances.

Here we are talking about nicotine. It and other substances that make up cigarettes reduce the therapeutic effect of many drugs - psychotropic (amitriptyline, haloperidol, diazepam, phenobarbital), cardiovascular (metoprolol, nitrates), "pulmonary inhalers", oral contraceptives.

Don't drink tea with pills

Now we will try to say at least a little about the mechanism of interaction of drugs with our body, and in connection with this, about the peculiarities of taking certain drugs.

A leaflet indicating the time of administration is included in the medicine package, and the doctor must write in the prescription when and how to take this or that medicine. What do doctors base their prescriptions on?

One of the fundamental laws of pharmacology states that a drug begins to act only when it accumulates in sufficient concentration in the tissues of the diseased organ. This is called the "threshold phenomenon". If the concentration is below the threshold, the medicine will not have the desired effect. Required to receive therapeutic effect the concentration of the drug in the blood, and therefore in the organ, is created when the optimal dose is introduced into the body.

The path of the medicine to its destination is complex, especially if it is taken orally. This method of drug administration has its advantages: the content of the drug in the blood is maintained longer. maximum level. What then is the difficulty? Yes, the fact is that drugs are not absorbed directly in the stomach. First, they must pass into the intestine, dissolve in its contents and not be destroyed by hydrochloric acid, enzymes, or food components.

If the tablet has a special coating, for example, thrombo-ASS, it is not recommended to chew or crush it: the coating protects the medicine from the action of hydrochloric acid of the stomach or the gastric mucosa from the medicine.

It is better to take medications with a glass boiled water. Tea is not suitable. The tannin contained in it forms insoluble and, therefore, non-absorbable compounds with many substances. Tannin is especially active in binding papaverine, amidopyrine, cardiac glycosides, enzymes, and active ingredients in herbal infusions and decoctions.

When the drug is taken on an empty stomach, after 10-15 minutes it enters the intestines and is absorbed into the blood completely or almost completely.

Don't eat soup with pills

What happens to the pill if it is swallowed with food? The tablet will not dissolve in food, and since gastric juice gradually dilutes the contents of the stomach, then the hydrochloric acid can completely destroy the medicine, stomach enzymes will begin to digest the drug. In particular, this applies to herbal remedies: only pitiful remnants remain of them.

But the main thing is different. Food stays in the stomach for about 4 hours. And fatty, sweet, or taken with alcohol and some medications (no-spa, digoxin) - even longer, up to 7 hours! Accordingly, the transition of the drug to the intestines is extended for the same period. Absorption will slow down so much that it will not be possible to create the required concentration in the blood. In addition, there is a risk of a toxic effect of the drug.

And medications prescribed for coronary disease hearts, it is preferable to take it not on an empty stomach, as some believe, but after a meal.

Aspirin: no joke!

Acetylsalicylic acid is known to be so irritating to the mucous membrane that it can cause ulcers in the stomach. Scientists have noticed that if this drug is taken after a meal, its irritating effect on the gastric mucosa is indeed reduced, but at the same time the therapeutic effect is weakened. Experts have determined that the concentration of the drug in the blood is highest if it is washed down with warm water. alkaline solution or half a glass of warm milk.

By the way, acetylsalicylic acid It is not recommended for use by pregnant women, as it helps reduce fetal growth. It is contraindicated in children under 12 years of age due to the possibility of severe complication– liver necrosis. Let's also say a few unkind words about analgin. It is still sold in pharmacies, although it has not been used abroad since 1977, as it causes dangerous hematopoietic disorders. It is enough to take two tablets of analgin to cause a critical situation.

Not all herbs are beneficial

Seemingly harmless weeds are also unsafe. By pharmacological classification They are classified as medications, which means they have side effects. For example, aloe juice is contraindicated for kidney inflammation and Bladder, hemorrhoids, pregnancy, uterine bleeding.

Chokeberry should not be taken if you have low blood pressure, stomach ulcers or duodenum.

But ordinary grapes and wine are contraindicated for diabetes and edema.

Oregano, which is now called oregano seasoning, is strictly prohibited for use by pregnant women. In old times, it was popularly used to terminate pregnancy.

Elecampane, like St. John's wort and lovage, can only be consumed in small quantities. These plants are basically poisonous. But poison in small quantities is medicine.

Rhodiola rosea, that is, golden root, in vodka tincture increases potency, relieves stress, and calms the nerves. Cool drink. But again, it is contraindicated for hypertension.

Correctly taken medicine is more effective

Proper administration of the drug also affects the duration of its action. For example, antacids, used in treatment peptic ulcer stomach and duodenum, when taken on an empty stomach they act for about half an hour, and when taken 1 hour after a meal, they “work” for 3-4 hours.

It should be remembered that in order to maintain a constant concentration of the drug in the blood, the medicine must be taken regularly at regular intervals. That is, the drug taken 3 times a day must be drunk every 8 hours, and not only during the day.

Some drugs are not swallowed, but dissolve in the mouth, under the tongue. A classic example is nitroglycerin for relieving heart pain. In this way, the substance taken is absorbed into the body faster, since the oral cavity is abundantly supplied with blood. The same method of taking captopril and nifedipine is recommended for hypertensive crisis.

In addition, the active substance, when absorbed in the oral cavity, does not immediately enter the liver, which means it does not undergo significant changes. This explains the speed and effectiveness of the drugs used under the tongue.

Cold medicines can increase blood pressure and make a broken tablet useless

Cold medicines like naphthyzin, which constrict blood vessels in the swollen mucous membrane and help breathe, are dangerous for people with high blood pressure: after all, they narrow all blood vessels, and not just in the nose, and this can provoke a hypertensive crisis.

Finally, remember that not every tablet can be broken. If there is a line on it dividing the tablet in half, or even a cross dividing it into four parts, you can safely break it in half or into quarters. In such a tablet, the drug is distributed evenly. If the tablet is smooth, without marks, it cannot be broken - the medicine is unevenly distributed in it. Having broken it into pieces, you can take the part where there is no medicine - it may be on the other side. You will eat filler without any benefit.

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This is the content of the active substance per unit of dosage form (capsule, tablet, etc.)

What are the dangers of increasing the dosage?

A drug can have a healing effect on the body, or it can cause harm.

In moderate doses the drug is a MEDICINE, and in large doses it is POISON!

Doctors assess the effectiveness and tolerability of drugs individually!

Under no circumstances increase the dosage on your own!

Only doctors can decide what is best for you. In their medical practice, they study diseases and analyze individual treatment regimens.

Dosages are adjusted depending on the situation, age, characteristics of the body and group affiliation of the patient.

This takes into account allergic reactions to other drugs, as well as concomitant pathologies, especially the liver and kidneys.
For example, there is a very pronounced difference in the dosages of antibiotics and heart medications. Even the dosages of vitamins at different ages differ greatly.
Do not violate the treatment regimen prescribed by your doctor!

Even if someone was prescribed a different therapy or you found a different way to use the drug on the Internet. Self-medication is fraught with consequences!

After agreement with the doctor, changes in the treatment regimen are possible. For example, if the patient gets worse, the doctor will adjust the prescribed dosage of the drug, possibly replace the drug with another one, or even stop it altogether. In any case, this decision should only be made by a doctor!

Do not violate the treatment regimen prescribed by your doctor!
What are the dangers of reducing the dosage?
There are people who buy packages with a dosage twice as large, and then divide the tablets in half.

It seems like savings. However, this is allowed provided that there is a risk on the tablet! Not all dosage forms can be crushed.
If there is no division on the tablet, then you CANNOT cut it in half!
The absence of a risk indicates that the active substance in the dosage form is evenly distributed.

If you divide such a tablet in half, the dosage will not become exactly half as much. In addition, you will destroy the protective shell, which means the contents of the tablet will dissolve before it reaches the stomach.

You risk getting a bunch of side effects. And the therapeutic effect of the drug will also decrease, because the protective shell is a barrier against oxidation by air and neutralization of the main component of the drug by stomach acid.

The presence of a mark (divided in half) indicates that the content of the active component in both halves of the tablet is the same.

This makes it possible to reduce the dosage by dividing the tablet in half without harm to health. The production of this form takes this into account.

In other words, if there are no marks on the tablet, it means that it is whole!

The substance in it is distributed evenly throughout the dosage form. If you cut such a tablet in half, the components will not be distributed evenly in both parts of the drug.

And if there is a risk, then the substance is distributed evenly in each half of the tablet.

If there is no division on the tablet, then you cannot cut it in half!
When purchasing a medicine, find out whether this form can be divided into halves, quarters or eighths.

If the drug does not have a dividing strip, and you need a concentration 2 or 4 times less, check if such dosages are available in pharmacies.

If not, be sure to discuss the possibility of crushing such tablets with your doctor. Most likely, the doctor will replace the drug without risk with another one that is more convenient to use.
Be careful when choosing the dosage!

About children's dosages

The method of dosing medications for children is based on the relationship between the dose and the child’s weight.

A small dose may not be enough for a therapeutic effect, while a large dose may cause harm.

If you buy an over-the-counter drug without consulting your doctor, read the instructions carefully before use!
Remember! Self-medication is dangerous! A consultation with a pharmacist is not a complete substitute for a visit to a doctor.

Be healthy! Treat consciously!

Tablet splitting is traditionally used in pharmaceutical practice to select the required dose of a drug if a dosage form with the required dose is not available. It also reduces the cost of therapy. The presence on tablet forms of a number of drugs approved by the US Food and Drug Agency ( Food and Drug Administration, FDA), a transverse groove is regarded as approval of such a practice and often indicates that the drug has been subjected to additional research in virtual.

However, the procedure for separating tablets is not standardized and its accuracy varies widely depending on a number of factors, including the characteristics of the drug, the size and shape of the tablet, and the abilities and skills of the person separating it.

Characteristics of the drug

It is not recommended to split tablets of drugs whose dosage deviations may lead to severe consequences. These drugs include drugs with a narrow therapeutic range and dose-dependent effect.

Characteristics of the tablet

The presence of a transverse groove on the tablet makes it easier to separate, but size, shape and strength also have a significant impact on the accuracy of the result. Large oblong tablets with deep notches on both sides separate most easily.

A number of special dosage forms, such as film-coated tablets for enteral dissolution, forms with delayed release of the active substance, as well as combination drugs, the concentration of one of the ingredients varies depending on the tablet size (for example, amoxicillin/clavulanate ( Augmentin, Amoxiclav), irbesartan/hydrochlorothiazide ( Avalid), oxycodone/acetaminophen ( Percocet), ezetimibe/simvastatin ( Vytorin) etc.) should not be separated.

Uniform distribution of the drug in the tablet

As research results have shown, the uniformity of distribution of the drug in the tablet, as well as the likelihood of its even separation and crumbling, are associated with the quality of the drug’s production. Thus, the presence of large fragments of the active ingredient was detected in generic simvastatin tablets produced in 4 different countries, but not in original drug, produced in the USA.

Separation Accuracy

The accuracy of tablet separation has been assessed in a number of studies. IN during three Of these, tablets of 22 drugs were separated by pharmacists; the resulting fragments were considered to contain a half dose if they weighed 85–115% of the weight of an ideal half. Weight uniformity requirements were achieved for 7 of 22 (32%), 3 of 11 (27%) and 8 of 12 (67%) products tested. In another study, when unstriated 10 mg cyclobenzapine tablets were cut with a special cutting tool, the weight of the halves varied between 69% and 130% of expected, resulting in dose variations of 3.5 to 6.5 mg provided uniform distribution active ingredient in the tablet. When used for separation kitchen knife variations in the weight of the halves reached 50-150%, dose variations - 2.5-7.5 mg.

In a study assessing the ability of elderly patients to split pills, deviations in the weight of the resulting halves from the expected weight reached 9-37%.

The influence of tablet separation on the clinical outcome of therapy

In two studies involving 2,128 patients taking statins, there were no significant differences in cholesterol concentrations in patients receiving half-tablets for 6 weeks or more. In another crossover study of 29 patients receiving lisinopril halves for 2 weeks, there were also no clinically significant differences in systolic and diastolic blood pressure.

Economic efficiency

Splitting tablets can reduce therapy costs by up to 50%, since, according to existing pricing policies, many drugs have similar or similar prices per dosage unit, regardless of the dose of active substance contained in it. Using a program to separate tablets of atorvastatin, simvastatin and ovastatin within a year, a 39% cost-effectiveness was shown.

The use of whole tablets, of course, allows for the most precise control of the dose of the drug received by the patient. However, if there is a desire and opportunity on the part of the patient, as well as a wide therapeutic range, the relative safety of the drug and the absence of a dose-dependent effect, the separation of its dosage forms seems possible, since small dose deviations are leveled out, especially for drugs with long period half-life.

Patients are advised not to split more than 1 tablet at a time and, if possible, use the other half when next appointment drug to compensate for deviations from the previous dose. Some help The use of special cutting devices may help, but this does not guarantee the accuracy of the separation.

Tablet splitting.

The Medical Letter 2004; 46 (Issue 1195): 89-91.