What tablets can be divided? Cold medicines can increase blood pressure and make a broken tablet useless

Answers to a question about the symposium “Algorithms” rational therapy atherosclerosis".

Andrey Vladimirovich Susekov, :

Dear colleagues, we do not have much time for discussion.

Question: Is it possible to divide statins in half if the tablet does not contain a break mark? Do I need to take a break of 3 months in the summer?

It is better not to divide, because the companies' instructions indicate that the division process may interfere with the dose of the drug. There is a world experience “every other day”. Like diuretics. "Rosuvastatin" 10 mg - Monday, Wednesday, Friday or 80 mg once a week. But there is a remark. It is not a fact that such a regime reduces risks.

Is it necessary to take a break of 3 months in the summer? I think, my personal opinion, it is possible. This is not in the recommendations. Drac Holiday is a medicinal holiday for people who have been taking statins for decades. Your opinion, Oksana Mikhailovna.

Oksana Mikhailovna Drapkina, Executive Director of the Internet session, Secretary of the Interdepartmental Council on Therapy of the Russian Academy of Medical Sciences:

Andrey Susekov: Viktor Savelyevich, do you think it is possible to divide a statin tablet in half? Our listeners ask.

Viktor Savelievich Gurevich, doctor medical sciences, Professor:

I will join the opinion that you have already voiced, Andrei Vladimirovich.

Regarding the holidays of taking statins during the summer holidays. But if you just give the statins a break from the patient. No need to interrupt, it seems to me.

Andrey Susekov: Good remark. Thank you.

Rostov-on-Don, Ushakova Irina.

Question: What place do bile acid secretrates currently occupy in the treatment of dyslipidemia?

Very necessary for children and pregnant women in Russia, unfortunately, are not registered. There was Questran. As far as I know, "Colesevelam" up to 3.5 mg per day now has a good reputation in the world. But it is not registered in Russia.

Oksana Mikhailovna? Viktor Savelyevich?

Victor Gurevich: Several dosages, even more. But Colesevelam, I think, is a drug with promise.

Question: If, when prescribing statins, total LDL cholesterol is at the lower limit of normal, can statins be given at half the dose?

My answer and position is that I am not in favor of half and low doses. Now in the cardio center (I’m expanding the answer to the next question) in the laboratory clinical epidemiology We are starting a statin dose escalation program in clinical practice and clinical researches Atorvastatin 80 mg and Rosuvastatin 40 mg. The dose was 10 mg. I wouldn't do this. At half dose.

There is also the Finnish phenomenon of statin and scape, when, with long-term use, cholesterol begins to increase. Here, on the contrary, you need to add doses, but not reduce them. What do you think, Oksana Mikhailovna?

Andrey Susekov: There is a certain niche for Rosuvastatin because it is the most powerful statin.

Question: A young woman with autoimmune thyroiditis, xanthelasmas, total LDL cholesterol and triglycerides are normal. But high level good HS. What to do?

3 times more. The case is non-standard. Here it is necessary to exclude a deficiency of the protein that transports cholesterol esters. This is an extremely rare situation. You need to watch either activity or STP mass special methods. But our laboratory capabilities are limited.

In such patients, you probably need to look at the global risk Score. If it is high, then we prescribe statins, regardless of lipid profile. I would also order AP-1 protein here, which, according to the literature, has a better indicator of reverse cholesterol transport than high-density cholesterol.

Victor Savelyevich, your opinion. High level of good cholesterol, what should be excluded and further examined here?

Victor Gurevich: You remember well, Andrey Vladimirovich, the failures that occurred when increasing alpha cholesterol with the help of Torsetrapib. It turned out that this was of purely academic interest. We need to look at what sulfation of alpha-CS is the first.

Second. Sometimes this situation can occur with low triglyceride levels, low release of 3-beta from the liver. Should probably use the suggestions you made.

Maybe this is the most important thing - to focus on cardiovascular risk. There is no need to be alarmed by the numbers alpha-HS 2 and above.

Andrey Susekov: Thanks a lot. A very good point. With beta this is a subject for future research. Now in Russia, active research is beginning on new drugs that increase the level of alpha-cholesterol. RVX-08 injection forms. Future will tell.

Question: Statins for oncological negligence and oncological diseases. Clinicians often do not prescribe statins to this group of patients. Is this justified?

A difficult question, multidisciplinary. But we have a very experienced person in the audience. Your opinion please.

Vladimir Trofimovich Ivashkin,Academician of the Russian Academy of Medical Sciences, Doctor of Medical Sciences:

I think patients with cancer should not be prescribed statins. Any tumor is a glucose trap. In such patients, taking into account prognostic factors, there is no point in prescribing statins.

The side effects that these patients typically experience during chemotherapy or radiation therapy (in particular, the development of myocardial infarctions, which we see with radiation therapy for lung or breast tumors) are not due to an increase in cholesterol. There we are talking about a direct damaging effect on blood vessels and the development of endothelial pathology.

It is endothelial pathology that determines possible development thrombosis in such patients. I think there is no point in prescribing statins here.

Oksana Drapkina: I wouldn't risk it. A patient with cancer has many problems. He probably has a chance to die from his cancer. This is the case when people no longer die from cardiovascular pathology.

Andrey Susekov: Viktor Savelyevich, I know that you have extensive experience in clinical lipidology. Have there been such compromising patients in your practice?

Victor Gurevich: I completely agree with the statements that have been made now. Absolutely correct. At the same time, we must keep in mind the first thing: the presence of cancer in different stages and in different localizations is not an absolute contraindication for the prescription of statins. Here we must refer to cardiovascular risk.

For example, liver cancer or liver metastases - direct contraindication. But if the first stage is zero of another cancer localization, if this is a patient with cardiovascular disease, then the cardiologist and oncologist should consider these problems and so on. I don’t develop the idea further. I think my colleagues also share the same point of view, taking into account the above.

Andrey Susekov: I literally have half a minute of remarks. We had a very seriously ill patient from Vologda. She, unfortunately, died. With severe familial hypercholesterolemia. While on high doses of statins, she developed breast cancer in one study. Mastectomy, chemotherapy.

We were afraid, doubted, consulted with foreigners. The opinion was that there was a cardiovascular risk, operations were performed and chemotherapy courses were completed. We returned to statin therapy, but in lower doses. This was such an interesting case.

Last question. Rostov-on-Don.

Question: How effective are generics of Rosuvastatin? In particular, "Mertenil".

Our guest has the floor. Do you have experience at Mertenil, Viktor Savelyevich? Your opinion on how ready we are for broader recommendations for generic Rosuvastatin. On the market for two years already.

Victor Gurevich: How do generics or generics appear, as they say now? Firstly, because the original drug is good. Secondly, because the license and protection period has passed. We must be good about the emergence of generics - number one.

As for Mertinil specifically. This is the second year we have been using it together. Absolutely positive result so far. The only thing we lack is an additional Russian post-registration study so that we can confirm our own ideas about this drug.

Andrey Susekov: Agree. Our laboratory also has good experience with Mertinil. But for objectification, Russian research is needed. They are scheduled at the heart center. This is probably the subject of our next conversation, colleagues. The drug is really good.

Oksana Drapkina: I will join. Probably everything.

Andrey Susekov: Thank you very much, dear colleagues, for being with us and taking an active part in our session. Not all issues were included in the regulations. But we promise you that e-mail, according to technical capabilities, we will definitely answer all these questions.

Thanks a lot.

If the tablet is coated, then it is not allowed.

We need to share! If the prescribed dosage suggests half, then you need to take exactly half. I once divided an almost round tablet into 3 parts, because this was prescribed by the doctor. What can you do?

Can all tablets be divided into 2 parts?

Some tablets have marks on them, and some are smooth. It means something?

You can split the tablets in half if your doctor recommends it. The tablet must be divided strictly along a certain stripe, the dividing line. I once had to deal with such a case when it was necessary to split the tablet, but there was no split line. In this case, I very carefully tried to divide equally. Otherwise, almost all tablets have a line along which they need to be divided.

There is such a science - pharmaceutical economics. It has been calculated that if you buy drugs in larger dosages and divide the doses, it will be more profitable for the buyer - the patient.

A mark, a dividing strip, a dividing line, a recess on the surface of the tablet, exists for this purpose.

There is one transverse - longitudinal mark on the tablet, and there is a cruciform one. Some tablets are engraved with the name of the drug or dose. I respect manufacturers who care about the patient. But, we must remember that some drugs consist of microgranules; if they are divided, a certain amount of granules will be destroyed and the dose will be inaccurate.

The tablet also has a chamfer - this is its processed edge.

It should be remembered that the drug in capsule form cannot be divided by pouring out the contents of the granule and drinking without the shell. Such gelatin shells are specially created to ensure that the drug is absorbed in a specific part of the intestine.

According to the rules, it is of course not advisable to divide the tablets into two parts, but if there is such a need, then nothing bad will happen from this. You also need to know that the tablets are formulated in such a way that one part may contain more active ingredient than another part.

If the tablets have a dividing strip, then you can safely divide them.

Capsules cannot be divided at all, since they cannot be divided exactly. It is also necessary to remember that almost all capsules must dissolve in the stomach, they are intended for this.

In my opinion, almost everything.

For example, my child was prescribed the drug, but in the dosage of not a whole tablet, but only half, since he is small and one tablet is too much for him.

What about half and half, sometimes I had to divide the tablet into four parts and nothing.

Of course, this is not very convenient, but usually I cut the tablet with a regular knife and it turns out quite evenly.

Tablets that have a dividing strip in the middle can generally be divided in half. Another thing is that if the tablet is coated, then when broken, the bitter part of the tablet may open - and it will be unpleasant to swallow.

Tablets in capsule form cannot be divided in half. The capsule is specially designed to protect the active substance from absorption in the stomach until the capsule reaches the right place - for example, the intestines.

Only those tablets that have a dividing line can be divided into 2 parts, this is precisely what it is intended for, and those tablets that do not have this line are undesirable to divide, because when breaking, the structure is disrupted and it will crumble unevenly and the weight parts will be still different.

Tablets (not coated capsules) can be divided if this division is part of the treatment regimen and is recommended by a specialist. This is possible even if there is no special strip on the tablet itself. Yes, sometimes the halves turn out very different, but that’s the way it’s needed. We once even divided rectal suppositories in half.

You can’t just divide the pills yourself so that, for example, you can take half as much medicine as the doctor prescribed! For example, someone decided that he was no longer seriously ill and began to take an antibiotic in a dosage half as much as prescribed; as a result, the medicine does not work as it should, the disease does not completely go away, plus the surviving bacteria develop an addiction to the drug.

If the tablet has indentations for division, then such tablets can be taken in 1/2 or 1/4 portions.

The annotation for any tablets contains doses and methods of use - it all depends on the drug. There are tablets that cannot be split, as they are coated with a special coating. But this, again, will be written in the annotation.

It is generally not advisable to divide tablets, even those that are divided in half. It happens that a doctor prescribes 25 mg of a drug that is released in a minimum of 50 mg. We have to divide, because there is a dividing strip. So the oblique parts come out. One part has to be thrown away, it is small, and the other has to be cut.

You can safely divide tablets that are not coated. But covered ones, even with a characteristic stripe, should not be divided. The shell can not only hide bad taste or the smell of a medicine, but also not to allow the substance to break down in the stomach, if its place of “work” is, say, in the intestines.

Atoris against cholesterol

The drug Atoris is a drug related to cholesterol-lowering drugs. As an active ingredient, the drug Atoris contains active ingredient Atorvastatin. Atoris is tradename drug, which is assigned to it by the manufacturer. Common name, or international generic name(INN) of drugs containing this component - Atorvastatin. Atoris tablets are produced in Slovenia by the company KRKA Novo Mesto. The tablets have several dosages - Atoris 10 mg, Atoris 20 mg, Atoris 30 mg, Atoris 40 mg, Atoris 60 mg, Atoris 80 mg. A wide range of dosages of the drug is created for ease of use of the drug.

The active ingredient of Atoris is Atorvastatin.

When can the tablet be split?

For example, if a person is prescribed Atoris 10 mg, tablets with an amount of active ingredient of 20 mg or 30 mg will be inconvenient to use. Those dosage forms whose design is provided for this purpose can be divided. So, is it possible to split an Atoris tablet? Divisible tablet must have a special line that will allow the dosage form to be divided into equal parts. Atoris tablets, the instructions for which contain information about the structure of the dosage form, indicate that there is no risk this drug. Therefore, the use of Atoris is possible only in the form of a whole tablet.

Why can't you split the tablet without risk? This is explained by the fact that the presence of risks on the dosage form is a “guarantee” of the manufacturer about uniform distribution active ingredient in each part of the divided tablet.

If there is no risk, this means that the manufacturing technology of the drug guarantees the presence of a certain amount of the active substance only in the entire tablet.

Diet before starting statin treatment

Atoris belongs to the drugs – statins. The prescription of Atoris is indicated for lipid metabolism disorders and the ensuing consequences. Currently used for cholesterol various medications and dietary supplements. However, before prescribing statins or other drugs, you should try to normalize fat metabolism by following a special diet.

At elevated level cholesterol in the blood, a special diet is prescribed

Diet for high cholesterol should contain a minimum of fat, an average amount of carbohydrates and proteins, and a lot of fiber. The calorie content of food per day should not exceed calories.

The consumption of animal fats should be strictly limited. Allowed for use in food butter for seasoning porridge or vegetable puree. This product when high cholesterol cannot be eaten in pure form. In addition, lard, bacon, jellied meat, smoked and dry-cured sausages, sausages, bacon, fatty sausages, canned meat, pork in any form, fatty fish, mayonnaise and sauces made from it.
As a source of protein, cottage cheese dishes prepared without the use of cream and sour cream are used, as well as dishes prepared from lean varieties of meat - rabbit, chicken, veal, lean fish, seafood. Eating chicken eggs is allowed, but no more than three eggs per week. Dairy products, in addition to cottage cheese, include kefir, low-fat milk, bifidoc, and acidobiphyllin.
Dishes should be prepared by steaming, boiling or stewing. It is permissible to bake foods without using oils and fatty sauces. Frying and smoking as methods of preparing dishes during and after treatment should be completely avoided.
The diet should contain a large number of fiber, which is rich in fruits and vegetables. Vegetables can be used to prepare salads, stews, juices and other dishes. Fruits are best consumed fresh. Fiber contained in vegetables and fruits “works” in the human intestines as an enterosorbent. It promotes excretion excess fat from the body.
You should also avoid drinking alcohol and smoking. Sometimes you can drink dry red wine in small quantities.

If you have hypercholesterolemia, you should stop smoking and alcohol

If therapeutic diet does not bring the desired result, the prescription of statins is indicated. However, a person taking statins must still adhere to dietary rules.

Indications for use

So, what indications for use must a patient have in order to be prescribed a drug containing Atorvastatin?

increased cholesterol caused by genetic factors and not controlled by diet;
hypercholesterolemia of mixed origin;
increased triglycerides in the blood;
for atherosclerotic changes in blood vessels to prevent ischemic complications;
secondary prevention in people who have suffered ischemic complications;
increased risk of developing ischemic complications in the absence of clinical manifestations in patients over 60 years of age, smokers, those with high levels of C-reactive protein, and others.

The use of Atoris in the above cases is usually long-term. How long should you take statins? The time course of treatment is selected individually in each case. Sometimes, statin therapy is combined with treatment with other drugs. pharmacological groups. For example, Atoris is often prescribed in combination with Cardiomagnyl. These drugs have good compatibility with each other and, in the absence of contraindications, are successfully used in the treatment of heart and vascular diseases.

Assignment Rules

Treatment with Atoris begins with the selection of an individual initial dosage. This takes into account the initial cholesterol level at the start of treatment, the presence of restrictions on the use of statins, and the individual characteristics of the body. In most cases, treatment begins with the prescription of Atoris tablets containing 10 mg of the active substance. Instructions for use of the drug Atoris contain information about the rules for prescribing the drug, which describes the sequence for determining the individual dosage. Two to four weeks after starting treatment with Atoris, a control blood test for cholesterol is prescribed. In case of positive dynamics, treatment is continued using the same dose.

If cholesterol levels have not decreased during this time, the dosage is increased to 20 mg.

When is Atoris banned?

Instructions for use of the drug Atoris describe a number of diseases and physiological conditions when the use of the drug is prohibited or highly undesirable. The main contraindications to prescribing the drug are:

The childbearing period in women who, due to various reasons do not use reliable contraceptive methods.
Women planning to become pregnant soon.
Period breastfeeding baby.

There is no information about the excretion of atorvastatin into breast milk.

The period of bearing a child.
Liver diseases in the active phase.
An increase in liver parameters by more than three times of unknown origin.
Previous history of diseases of the muscular system.
Severe renal dysfunction.
Some metabolic diseases.
Other.

The ban on the use of the drug during pregnancy is due to the fact that it is unknown whether Atorvastatin has a toxic effect on the fetus or not. Therefore, to avoid pregnancy complications, you should not use the medicine during this period. And if pregnancy occurs during treatment with Atoris, statin treatment should be stopped immediately. In addition, there is no data on whether the drug taken by a nursing woman can pass into breast milk. Therefore, statins should not be used when feeding a baby.

Medicines containing Atorvastatin and other statins can only be prescribed by a doctor! Independent use of these medications is strictly prohibited! Together with statins and special diet a specialist can recommend dietary supplements that help normalize lipid metabolism. Such additives include Atheroclefit Bio, Chitosan Evalar and other additives.

Since courses of treatment with statins are always long, if the dose is incorrectly selected or the dosage recommended by the doctor is exceeded, and also due to individual characteristics the body may experience adverse reactions from various organs and systems. The most serious complications of Atorvastatin therapy are allergic reactions and myopathic processes with the development renal failure. Therefore, the patient should be warned about the need to discontinue the drug and consult a doctor if signs of allergies or pain in muscles and bones appear during statin treatment. The attending physician will decide to replace the drug and prescribe all necessary procedures to eliminate symptoms of treatment complications.

Drug analogues and cost

Medicine from the group of statins

The pharmaceutical market currently offers a large number of drugs belonging to the group of statins. As active ingredients, drugs may contain Atorvastatin, Simvastatin, Rosuvastatin and others. All products are presented in a wide range, including the original drug and a number of generic drugs. For example, original drug containing Atorvastain is Liprimar. Other drugs, such as Atoris, Atorvastatin-Alsi, Torvacard, Atorvastatin-SZ, Tulip and others are generics. The cost of drugs depends on the price of the registered manufacturer's price, quantity dosage forms in consumer packaging and dosage of the drug.

Society Not every tablet should be broken

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 use of medications, and not due to 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 medications with clean 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 for the better) the effect sedatives and drugs containing paracetamol and lowering blood pressure (hypotensives). Alcohol can affect the absorption of almost all medications, however, this depends on the individual characteristics of the 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” of the drug 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 medications. 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 therapeutic effect 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 obtain 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-ACC, chewing or crushing it is not recommended: the coating protects the medicine from action of hydrochloric acid stomach or 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 a minute 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 present in it can completely destroy the medicine, and 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 the treatment of gastric and duodenal ulcers, when taken on an empty stomach, 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.

Besides active substance when absorbed in the oral cavity, it 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.

My other half: can I split the tablets in half?

Is it possible to crush the tablets, divide them into pieces and empty the contents from the capsules if you cannot swallow them whole?

The issue of splitting a tablet or opening a capsule before use touched many minds, but not everyone could decide to take such a step. Indeed, you should think several times before “breaking” the dosage form.

Tatyana Lapshina, pharmacist, biochemistry teacher (Moscow)

Such a production technology does not guarantee that the active substance is evenly distributed throughout the entire volume of the drug! This means that if you take half or a quarter of a tablet, you may exceed the single dose of the drug, which is fraught with severe side effects.

Important: the presence of special notches indicates the safety of the idea, this is a kind of “ green light” for these actions, but their absence is “red”.

With capsules, things are more complicated, because often the medicine that should be released in the intestines is placed in the capsule. And the main task of the enteric coating is to protect the contents from the effects of acid in the stomach.

It is impossible to determine by eye which shell the manufacturer placed the medicine in. Therefore, the contents of the capsule drunk without the shell may collapse under the influence of hydrochloric acid without having any effect. therapeutic effects on the body.

Summary: if you have a need and desire to divide the finished medicine into parts or open a capsule, consult a specialist: ask a doctor or, in extreme cases, a pharmacist at a pharmacy. Be careful - simply eating the contents of the tablet may not be enough to get the effect.

Comments

I also know about these features because I studied not to become a pharmacist, but to become a drug production technologist, and I am very ashamed that we have such pharmacists and pharmacists. Never trust such advice!!

What is more important here is the fact that it is almost impossible to divide a tablet into two equal parts that does not have a risk for this.

Taking this opportunity, I’ll add: it’s not because of a good life that our poor pensioners buy large dosages and then divide the pills into parts. But who can say why, in large dosages with the same package number, a large tablet sometimes turns out to be much cheaper?

Regarding what they wrote here, that in individual tablets there may be a different amount of active substance - there is no need to rush from one extreme to another.

It's better to eat 2 tablas to get the right dosage rather than dividing one into 2 or more parts.

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Is it possible to split antibiotic tablets in half?

When to split an antibiotic tablet:

You can divide only those tablets that have a mark on them. There is a division into two parts and into four.

When to split an antibiotic tablet:

A tablet is a solid, dosed type of medicine that is obtained by pressing the drug and excipients. When it enters the stomach, it first swells, then dissolves, allowing the active ingredient to be released.

Such a production technology does not guarantee that the active substance is evenly distributed throughout the entire volume of the drug. Accordingly, by taking half or a quarter of a tablet, a person exceeds the single dose of the drug, which threatens the occurrence of severe side effects.

You cannot split the tablets if there are no risks on them and it is not indicated in the instructions.
The drug in capsule form cannot be divided by pouring out the contents of the granule and taken without the shell. Such gelatin shells are specially created to ensure that the drug is absorbed in a specific part of the intestine. Therefore, the contents of the capsule drunk without the shell may be destroyed under the influence of hydrochloric acid, without having a therapeutic effect on the body.
Also, tablets containing two or more components in their composition cannot be divided. For example, Amoxiclav has a dosage of 250+125 mg. (250 mg Amoxicillin and 125 mg Clavulanic acid), 500+125 mg, 875+125 mg. Naturally, people have a question: if the pharmacy does not have a dosage of 500+125 mg, is it possible to use a double dosage of 250+125 mg. ? This is not possible, because for Amoxicillin we reach the required dosage (500 mg), but for Clavulanic acid it is exceeded, instead of 125 mg. it will be 250 mg, the final tablet will be: 500+250 mg. The consequences may not be predictable.

Attention! Before use medicines You should consult your doctor. The information is provided for informational purposes only.

Catad_tema Clinical pharmacology - articles

Catad_tema Pharmaceuticals - articles

Splitting tablets: When is it good?

Published on the website:

Source: empr.com

Splitting tablets is a common practice in clinical settings, especially for geriatric and psychiatric patient populations. This practice gives clinicians the opportunity to better tailor the regimen drug treatment, as well as the possibility of savings for the patient. However, halving tablets may not always result in accurate dosing. This may expose the patient to significant risk, especially if the drugs have a narrow therapeutic index.

In a new study published in the journal Managed Care and Specialty Pharmacy, researchers selected 10 tablets of each of 16 commonly prescribed drugs (bromazepam 3 mg, mirtazapine 30 mg, oxcarbazepine 150 mg, sertraline 50 mg, amiodarone hydrochloride 200 mg, bisoprolol fumarate 10 mg, carvedilol 25 mg, digoxin 0.25 mg, losartan 50 mg, glimepiride 4 mg, metformin hydrochloride 1000 mg, montelukast 10 mg, celecoxib 200 mg, ibuprofen 600 mg, meloxicam 15 mg and sildenafil citrate 50 mg). Participants separated the tablets using a knife (81.25% of the tablets were scored; 18.75% were not scored). The tablet halves were then assessed for content uniformity medicine using USP specification. In this study, the weight and drug content of half a tablet was considered equal to half the average drug weight of all whole tablets in the sample.

A total of 52 of 320 (16.2%) tablet halves failed to meet the USP for weight uniformity. For content uniformity, 48 of 320 (15%) tablet halves did not meet United States Pharmacopoeia (USP) specifications. Half tablets of bisoprolol, bromazepam, carvedilol, digoxin, losartan, and meloxicam failed the weight and content uniformity test, and half tablets of bromazepam, carvedilol, and digoxin showed the greatest loss of powder during division; tablet halves for other investigational drugs were tested.

The authors conclude that although tablet splitting may have its advantages, not all drugs are suitable for splitting and it is necessary to use various criteria for a particular drug and patient to evaluate whether this practice is safe. The authors make the following recommendations:

Tablets suitable for division:
A long period half-life
Big size
Flat, oblong, or oval shapes
Wide therapeutic window
Presence of notches

Tablets unsuitable for division:
Long-acting or enteric-coated formulations
Small size
Narrow therapeutic window
Easily crumbles or breaks
Bitter taste
Frequent dosage changes

In relation to the patient, the following characteristics must be taken into account:
Is the patient experiencing physical/cognitive difficulties?
Will there be too many pills to split?
Does the process of splitting the tablets make the regimen more difficult?

Material prepared by A. Dalinskaya

Comments(visible only to specialists verified by the MEDI RU editorial team)

In my opinion, almost everything.

For example, my child was prescribed the drug, but in the dosage of not a whole tablet, but only half, since he is small and one tablet is too much for him.

What about half and half, sometimes I had to divide the tablet into four parts and nothing.

Of course, this is not very convenient, but usually I cut the tablet with a regular knife and it turns out quite evenly.

You can safely divide tablets that are not coated. But covered ones, even with a characteristic stripe, should not be divided. The coating can not only hide the unpleasant taste or smell of the medicine, but also prevent the substance from being destroyed in the stomach, if its place of work is, say, in the intestines.

There is such a science - pharmaceutical economics. It has been calculated that if you buy drugs in larger dosages and divide them into 2-3 doses, it will be more profitable for the buyer - the patient.

Notch, dividing line, dividing line, depression on the surface of the tablet, and exists for this purpose.

There is one transverse - longitudinal risk on the tablet, yes cruciform. Some tablets are engraved with the name of the drug or dose. I respect manufacturers who care about the patient. But, we must remember that some drugs consist of microgranules If you divide them, some of the granules will be destroyed and the dose will be inaccurate.

There's more in the tablet chamfer- this is its processed edge.

It should be remembered that the drug Capsule form cannot be divided, pour out the contents of the granule and drink without the shell. Such gelatin shells are specially created to ensure that the drug is absorbed in a specific part of the intestine.

If the tablets have a dividing strip, then you can safely divide them.

Capsules cannot be divided at all, since they cannot be divided exactly. It is also necessary to remember that almost all capsules must dissolve in the stomach, they are intended for this.

Tablets in capsule form cannot be divided in half.. The capsule is specially designed to protect the active substance from absorption in the stomach until the capsule reaches the right place - for example, the intestines.

Tablets (not coated capsules) can be divided if this division is part of the treatment regimen and is recommended by a specialist. This is possible even if there is no special strip on the tablet itself. Yes, sometimes the halves turn out to be very different, but since it’s necessary... We even divided rectal suppositories in half.

Tablets: to divide or not to divide? Splitting tablets is an everyday practice and a common and common way to obtain the required dose in cases where the drug in the required dose is not available, or to reduce the cost of therapy. Division is often used to select, reduce the dose, and also if frequent adjustments are necessary. The lack of special dosage forms for children and the elderly is also compensated (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 have calculated that if 45% of the institution's employees who take cholesterol-lowering drugs joined a voluntary pill-splitting program as part of a federal program to reduce prescription drug costs, the university would save $1.3 million a year, and the employees themselves would save up to $190,000. $. 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 a negative effect 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; - lack of specific features associated with the release of the 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 with a special coating to prevent the release of the active substance in the stomach. If such tablets are divided, 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