Should you split your pills?

Have you ever gone to bed and, just as you were falling asleep, a task left undone jumped out at you? It was over 20 years ago but I still remember it because of what happened afterwards. I had forgotten to take the last dose of an antibiotic that given to me to prevent infection after an outpatient procedure.
“I REALLY SHOULD finish the whole prescription,” I told myself as I reluctantly rolled out of bed.
Blinking my bleary eyes, I filled a glass half full of tap water, tossed the tiny capsule into my mouth and drank the water. Puzzled, it didn’t seem like the pill went all the way down, so I drank another half glass of water just to make sure, and went back to bed.
The next day I noticed my chest started burning every time I ate, and over the next couple of days the burning intensified until every time I swallowed drove a hot poker inside my chest. Sent directly to the ER to make sure I wasn’t having a heart attack, the doctors found that pesky antibiotic capsule stuck to the lining of my esophagus, burning a hole in it.
With treatment, the pain finally went away but ever since, I’ve have to use something to “slide” my pills down or I choke on them, usually a spoonful of peanut butter or bite of banana. But I’m not the only one with this problem. Lots of people have trouble swallowing pills, especially larger tablets, and try breaking their pills in half or crushing them up to get them down.
But not every pill should be broken up. Which pills are safe to cut or crush?
Some pills have special coatings that protect them from dissolving in your stomach, either to  protect YOU from a medicine that triggers stomach upset or pain, or to protect the medicine from being destroyed by exposure to the acids in your stomach.
Some medicines are designed to release their contents slowly, over 12 or 24 hours. Cutting one of these will release the medicine intended to last all day all at once, triggering exaggerated effects like drowsiness, dizziness and trouble with your balance.
Many tablets have a straight groove that runs completely across one side of the tablet, called a score. If a tablet is scored, when you split it along that line, each half will always contain the same amount of medication. The score line also makes it much easier to break the tablet, whether you do it with your fingers, a knife, a one-edged razor blade or, (easiest of all), a pill splitter.
While some capsules contain only powder, others have small beads of medicine that can be sprinkled on food or divided up into several doses. You can divide the contents of capsules with less mess by placing each half inside an empty gelatin capsule. Some health food stores carry empty capsules, but a local pharmacy could also order some for you.
The gelatin capsule sizes most commonly used are the 00, pronounced “double ought”, which is the length of a quarter, the 0 (ought) which is the length of a nickel, and the 1, which is the length of a penny.
Here are 6 Tips on Cutting or Crushing Pills Safely:
1.    Use the score line.
You should always cut or break tablets at the indented line that divides the tablet in half, called the score line.
2.    Don’t break or cut all of your tablets at once.
If you accidently break or cut a tablet so the halves aren’t even, try to use the 2 halves close together, so the dose will “even out” over the next day or two. Taking several bigger or smaller halves in a row can cause a temporary increase or decrease in your medicine level.
3.    Invest in a good quality pill cutter.
Good pill cutters are easy to use and avoid the frustration of cutting pills cut unevenly, crumbling, and contain the pieces so they don’t fly off the counter.
4.    Use a firm, quick cut or snap.
Going too slowly can cause the tablet to slip, creating an uneven split.
5.    Ask your pharmacist if cutting your pills could save you money.
When each dose of your medicine costs the same, you should save money by cutting them in half, as long as they CAN be safely cut.
6.    Twist gelatin capsules open instead of cutting them.
Twist the halves in place first before pulling them apart.

Dr. Louise Achey, Doctor of Pharmacy is a 40-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Check out her NEW website for daily tips on how to take your medicine safely.®2020 Louise Achey

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