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ISMP Medication Safety Alert

Penny wise/Pound foolish? Breaking tablets to save money may be dangerous.

Many medications cost the same no matter what strength is prescribed; for example, a Mevacor® (lovastatin) 40 mg tablet costs the same as a Mevacor 20 mg tablet. The reason is so that consumers who have to take larger doses don't have to pay more than patients who take lower doses. It sounds like a great idea, but the latest trend to save money is to have the physician prescribe the higher dose and then cut the tablets in half or quarter to make smaller doses. The problem is that some medications should not be split because they are specially coated to be long-acting or to protect the stomach. Also, if the tablets aren't split evenly, the patient might not be getting the exact dose. Finally, patients might forget and take whole tablets instead of half.

We recommend that, if the medication can be split, the physician writes specific directions on the prescription; for example, "Take 1/2 tab daily." Have your pharmacist cut all the tablets for you, or buy a pharmacy pill cutter and do it yourself when you fill the prescription. And don't try to cut anything into less than a half tab--the dose will not be accurate.

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