Splitting your pills - how to do it safely

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 afterward. I had forgotten to take the last dose of an antibiotic 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 bleary eyes, I staggered to the bathroom, filled a glass half full of tap water, tossed the tiny capsule into my mouth, and chugged it down. When I didn't feel the pill go all the way down, I drank another half glass of water to make sure, then went back to bed.

The next day I noticed my chest started burning every time I ate. Over the next couple of days, that burning sensation intensified. Eventually, every time I swallowed felt like a hot poker burning inside my chest. My doctor immediately sent me to the nearest Emergency Department to ensure I didn't have a heart attack. They discovered that my last antibiotic capsule had not ended up in my stomach, after all. It had instead stuck to the lining of my esophagus, burning a hole in it. With treatment, the burning gradually went away.

However, ever since, I have trouble swallowing pills. I usually use a spoonful of peanut butter or a bite of a banana to help them "slide down" safely. I'm not the only one who has trouble swallowing pills. Many people who struggle to take larger medicine tablets break them in half or crush them up first. But not every pill should be cut or crushed. Some tablets have special coatings that protect them from dissolving in your stomach. These coatings shield you from medicines that can provoke stomach upset or burning. They are also used to protect medications from being destroyed by exposure to the acids in your stomach.

Other pills are specially designed to release their contents slowly, over 12 or 24 hours. Cutting them will release the entire dose of medicine immediately instead of gradually. This can cause low blood pressure, drowsiness, dizziness, or problems with balance. Many tablets have a straight groove that runs entirely across one side of the tablet, called a score. If a tablet is scored, each half will always contain the same amount of medication when you split it along that line. A scoreline makes it easier to break the tablet, whether you do it with your fingers, a knife, a oneedged razor blade, or, a pillsplitting device.

While some capsules contain only powder, others have tiny 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 twisting them apart, then dividing them into empty gelatin capsules. The most commonly used gelatin capsule sizes are size 1, the length of a penny, and size 0, pronounced "ought," which is the length of a nickel. Online stores carry empty gelatin capsules, or your local community pharmacy could order them.

Here are 6 Tips on Cutting or Crushing Pills Safely:

1. Use the scoreline. If you see an indented line dividing a tablet in half, cutting or breaking there gives the evenest dose.

2. Use up any unevenly broken tablets close together. Unless you can cut each one in half perfectly, you will have uneven halves. Taking several bigger or smaller halves in a row can cause a temporary increase or decrease in your medicine level. Cutting a small amount at a time and using each uneven halfclose together "evens out" the differently sized doses.

3. Invest in a good quality pill cutter. Good pill cutters are easier to use and minimize pills breaking unevenly or, worse, crumbling. Many have compartments to 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. Break oblong tablets by placing your thumbnails along each side of the scoreline, quickly pushing IN and DOWN.

5. Twist gelatin capsules open, don’t cut them. For less mess, twist capsule halves back and forth before slowly pulling them apart.

6. Ask your pharmacist. If your medication costs the same, no matter the size of the tablet, cutting them in half should save you money. Your pharmacist can advise you if your pills or patches can be safely cut.

Dr. Louise Achey, Doctor of Pharmacy, is a 43-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog TheMedicationInsider.com. 2022 Louise Achey