Here’s the story. I took Paxil 10mg. It was perfect for me. I have panic attacks when I fly. Taking this med STOPPED them. OK… Long story short I lost my insurance and Paxil is very expensive so I switched to Imipramine. This is almost effective but has many side effects.
Anyway I was thinking…Paxil 30 pills @ 10mg cost $150.00. Paxil 30 pills @ 20mg costs $180.00. So I was thinking why not just get 20mg and crack them in half. They are solid pills scored down the center.
Thus saving money.
My doctor said “yeah this would work.” I also asked the pharmacist at Osco. She said “no, it is not going to work.” Usually I am apt to believe the pharmacist in these situations, but this strikes me as odd.
About 2 years ago my doctor gave me 10 vailum at 2.5mg. I got my prescription and I found only 5 pills. I asked the SAME pharmacist and she said “They don’t make 2.5 mg so just take the 5mg and cut it in half.” It is also a solid pill scored down the middle.
I can’t find anything on the Paxil website. I am just wondering if they are trying to sell me pills and make more money.
So who’s right here. I always assumed if the pill was scored that means equal parts in each section.
I have one of those nifty pill splitters and as long as they aren’t time released, I always try to get what ever medications I need in double the dosage and then split them.
I have no idea why the pharmacist said that if the drug is not in a funky sustained release formulation, such that the contents might spill out or something (sometimes sus. rel. vehicles are in gel caps with tiny pellets in them, from what I can see in my handy-dandy PDR here).
I don’t know much acout the chemical properties of paroxetine, and can’t tell much just by looking at the diagram here. The CR tabs have an enteric coating that controls release of the drug. The old formulation doesn’t, far as I can tell. I don’t think there’s really an issue with the cap needing to be in one piece to survive stomach acids or whatever. Very few oral drugs have that stringent requirement. I bet if you cut the CR caps in two, the only problem would be you would lose the “CR” aspect of the formulation, as long as this proprietary “Geomatrix” stuff inside isn’t a powder. The elimination half-life of the old formulation is about 20 hours; not especially quick or long, so no problems there, I wouldn’t think, if one 10mg q.d. worked for you before. YMMV, of course, as everybody metabolizes differently. Like I said, you did fine before, so no cause I can see to worry.
I think your idea is perfectly fine. In fact, it’s done a lot, as far as I can gather. For example, I hear guys are commonly splitting Viagra tabs in two because it works well enough and is, obviously, half as expensive as using the whole thing (Viagra is way expensive, and it’s tough to get insurance to pay for it). Never tried it myself, but if I got some Viagra, I would do that automatically.
If you are referring to the original Paxil, then there is no problem splitting the pills. In fact, some insurance providers mandated this for their subscribers. The controlled-release version is different, but I don’t think that’s what you are inquiring about. Some manufacturers charge the same per pill no matter the dosage, and HMO’s have caught on to this, so the HMO will encourage you to use the higher strength and cut the pill in half (e.g. Viagra, Zocor, Lexapro, Celexa, etc). Our pharmacy & therapeutics commitee (military) actually comissioned a study on some of these drugs, and found that they could save a lot of money by just having patients cut the tablet in half. I have no doubts that the manufacturers will increase prices accordingly.
If the score down the middle is fairly deep, and if simply snapping the pill along it give a clean break, with two equal halves, then yes, there is no problem. In fact, the pill was tested and passed qualifications in order to be used in this way, such that 50% of the active ingredient is found in each half (the active is evenly distributed), and each half weighs the same.
If the scoring is just a mark intended to give an identifying feature, then you CANNOT know that you will get 50% of the dose in half the pill. The product was never tested as such, and never had to meet drug-distribution requirements as the deliberately-breakable ones did. Therefore, the drug formulation might actually lead to agglomeration of the active ingredient in one part of the pill, but each and every individual pill is consistent in dosage. I would NOT recommend cutting such pills in half, and in fact, it might be dangerous in the cases of drugs to which people can be highly sensitive.
Wow, that price is way out of line even for a retail drugstore. I was paying about $95 for 30 Paxil CR 25mg at a CVS drugstore.
Cutting it in half is fine. As a matter of fact, when I decided the 25mg was making me feel a bit weird I started cutting the pills in half (the time release version) and they worked fine. I just went back to my doctor for a new script and when I told him that I was cutting the pills in half he wrote me a new script for regular Paxil 20mg. I just got a six month supply (90 pills) of the newly available generic version from drugstore.com for $201.97. Says right here on the label TAKE 1/2 TABLET DAILY.
mnemosyne, I can’t imagine any manufacturing process that would have the correct dosage in a full tablet and not be evenly distributed. The manufacturer is not mixing the active and inert ingredients one pill at a time.
(disclaimer: I am not a drug manufacturer or chemist.)
When I mentioned that I originally cut my Paxil dose in half by splitting the time release (CR) version, I did not mean to suggest that it is safe to cut all time release meds in half. I just happened to know enough about Paxil to know that it would be safe. The same may not be true for many other medications. If a medication says it should be taken whole you should check with your doctor before assuming that splitting it is safe.
In principle, you’re absolutely right. In practice, the formulation guys tell me the typical pill is mostly filler on the inside (the “inactive ingredients” which serve a variety of purposes), and the drug is essentially evenly distributed throughout. Nobody could think of an example where you would expect clods of drug to be all stuck over in one side in a tablet format; it defeats the delivery and formulation purposes if this is the case. But it’s 100% true: You need to have this tested and QC’ed stringently to be sure.
True - I doubt any drug out there is a large clump of active surrounded by inactive ingredients, but the point is, you can’t be sure. I have seen microscopic analyses of pre-compression blends (the step immediately before making the tablet) which had many small agglomerations of active…these didn’t appear to affect dose delivery, and this particular product was still in early formulation stages, but there was no reason to assume that this agglomeration wouldn’t still happen once compressed, and so the drug likely will never be made so as to be easily divided in half. The small agglomerations were actually a concern of the development team, but it’s enough to make me belive that it can happen in the finished product, even if approved by the FDA.
Since Paxil is a drug that has a wide range of doses (and it appears that the scoring is intended to allow for half-doses) I presume it’s safe to split it. However, a different drug with much more controlled doses, and which can have much more severe side effects, etc…I wouldn’t trust it. At the least, any illness that came from taking an unregulated half-dose probably shouldn’t be covered by insurance! And be aware that just because the generic says you can split it, doesn’t mean the brand name can be…they do not have to be 100% identical in formulation, they just have to deliver the same drug, in a similar manner, with similar side effects and similar other chemical criteria.
I am not an expert on this, I admit. Although I am interested in working in Formulation, I am just a physical chemist at this point. I have, however, tested drugs at all kinds of stages of development, and the stringincy of these tests is such that if something wasn’t tested, there’s probably a reason. Most of the time, it might not matter. But occasionally, it might.
BTW, generally the cheapest place to buy prescription medications is Costco, followed closely by SAMS. Interestingly, due to some quirk of the laws you do not have to be a member to use the pharmacy at either, and the price is the same.
As far as cutting the pills, I can see no danger in that even if the score down the middle is decorative. Even if you are a little off, taking 40% of a paxil one day, and 60% the next will not cause a problem. There is such a huge difference in how each individual reacts to a drug that the small differences in dose are inconseqencial. Also, think about the fact that essentially all drugs are given in doses divisible by 5. Do you really think they formulate them so that 20mg is the exact correct dose. It’s really done because it would be next to impossible for a physician to memorize correct formulations if one came in 18.7 mg and another drug at 21.6 mg.
For what it’s worth, my doctor is completely OK with this. I had to drastically taper down my Paxil dose because it interfered with another (temporary) medication, and my doctor and I decided that since I was doing OK on 10 mg, that I should just stay there. She doesn’t want me going any lower without intense supervision, though. I take half a 20 mg Paxil tablet each day. I do try to make sure that I don’t let the broken tablets get stale, that is, I try to take an already broken half if it’s in my bottle. But that’s probably just my compulsiveness kicking in.
IANA Doctor or Pharmacist, but it is possible that your pharmacist is legally prohibited from directing you to take medication other than as prescribed. If your prescription reads “take one 10 mg pill”, she may be prohibited by law from telling you to do anything but take one 10 mg pill, even if taking half a 20 mg pill will yield the same results. I suspect it’s the doctor’s call, not the pharmacist’s. If so, your doctor could write you a prescription that reads “take one half 20 mg pill,” and your pharmacist should be just fine with it.
