Tablet Splitting

Policy issue:  Tablet splitting has received media attention for its potential cost savings (eg. since tablets of different dosages often cost the same, splitting a stronger dose tablet in half may save up to 50% of the cost) and for dose titration, should tablets in low enough doses not be available.  While tablet splitting may confer certain benefits, the VHA Chief Patient Care Services Officer wanted documentation of its safety before institutionalizing such practices in VHA. 

Assessment:  In 2000, VATAP reviewed the literature for evidence of increased risk or reduced safety in the practice of tablet splitting.

Tablet Splitting, May, 2000

Current status:  There is no national VHA Directive on tablet splitting.  However, many VA facilities promote tablet splitting provided that quality of care can be maintained or improved and appreciable cost savings can be realized.  VHA's Pharmacy Benefits Management Strategic Healthcare Group recommends against dividing non-scored sustained release preparations, enteric-coated tables, and tablets that crumble easily.  They further recommend reporting adverse events associated with divided tablets through local Pharmacy and Therapeutics Committees.  

Related information:

VA Pharmacy Benefits Management Strategic Healthcare Group: http://www.pbm.va.gov/