Are you…oh my…are you actually searching through your poop each time to see if the pills dissolved? Please tell me I have misunderstood this statement, because between the thread about the woman who burned her nose off self-treating her cancer and this, I don’t think I can sleep tonight…or eat my pre-bedtime chocolate…
Some pills are manufactured to make splitting or crushing difficult, yes. The reformulated Oxycontin tablets, for example, since breaking the controlled release mechanism via either splitting or crushing could result in the immediate release of a fairly strong narcotic agent in doses high enough to kill a person.
However, I can’t off the top of my head think of any products specifically formulated to put all medication in one end of a tablet/capsule but not the other.
Your understanding is incorrect. If I’m remembering my drug delivery coursework correctly, the pill making process generally HAS to result in statistically even distribution of the active drug product in order to satisfy FDA regulations in immediate release products. Controlled release products are naturally going to differ to some degree depending on what the specific release mechanism of the tablet/capsule is.
Never bad advice, and a good pharmacist should let you know any time your medication changes (be it from brand to generic, one generic to another, or if the doctor changed the medication to an alternative product altogether) anyways–assuming you stick with the same pharmacy, at any rate. I can’t tell you how many times a change not getting relayed to a patient has resulted in a later panicked phone call from a scared/anxious patient–usually right in the middle of a rush of activity in the store.
Actually, I can’t think of a single pill without several inactive excipients. Most dry drug products don’t exhibit all of the properties necessary for an active ingredient only tablet to work the way we want it to–ie, some products won’t compress into a solid tablet on their own, some will but won’t break down quickly enough in solution, some would result in the final tablet volume being too small to be practical, etc.
Actually, this happens more frequently than you might think. Tegretol XR tablets, as an example, release their active drug agent from a tiny hole in the otherwise non-dissolving outer layer, leaving a tablet shell behind in the process. Example parent gives their child Tegretol-XR to control the child’s seizures. For whatever reason they are examining the toilet bowl, see what looks like a tablet in the kid’s stool, and understandably freak out thinking their kid isn’t getting the medication necessary to keep them from seizing. Generally this results in an angry/panicked call to either the doctor or the pharmacy, though sometimes it results in the parent actually driving to the pharmacy with their kid in tow without the intervening phone call step, and could have been avoided with a quick counseling blurb from the releasing pharmacist upon learning the patient hadn’t been on this medication before.
But no, generally speaking, medication is not coated onto the surface of an inactive tablet core. We usually want immediate release tablets to break apart as they dissolve–it increases the surface area exposed to the solvent, which gets more drug into solution faster, which is necessary since the drug (usually) has to be in solution to get it into the body/bloodstream.
Tablets get split all the time, whether for a patient who needs a dose that isn’t manufactured in that strength, for children, or even for pets. For small pets, it’s very common to prescribe 1/4 of a tablet of a myriad of different medications. It would be dangerous to any of the above if the medication was not distributed evenly like it’s supposed to be.
I would think automation would make it very difficult to mix 2 separate halves of a pill then combine them into one, without a seam. Many of the pills I’ve taken, I can’t think of one I couldn’t cut except capsules. Especially tabs if they are scored. If you have questions about a pill, I’d ask your pharmacist. 
Most pills can be split or crushed, except for time release medications or enteric coated (EC) medication as those dissolve in your intestines. But always check with your Dr or pharmacist.
Of course it can be effective. As others have noted, some pills even have a score down the middle for that purpose.
I wouldn’t try it with anything where a slight over or under dose was critical, however, as even with a score there’s a risk of getting just a titch too much or little.
I have a medication for blood pressure that actually is widely touted as being a target for pill-splitting. It’s got a film coating, but I did the research and found that it’s just to make it easier to swallow and perhaps to protect the ingredients. So I make a point of always using the other half the very next day. Annoyingly, it isn’t scored, so I had to buy a pill cutter - and there are definite differences in size between the two pieces. Fortunately my BP isn’t that volatile, I’ve had reasonably consistent readings even with the variations.
If the pill is extended release, generally don’t split as that will negate the effect of the coating. I have photographic proof of how well the coating works, actually - I had an endoscopy a few years ago, and the report included photos of the handful of polyps / inflammation the endo saw… and a photo of one of my pills, which I’d taken several hours before the procedure :D.
Some extended-release pills may be OK to break; presumably if they’re scored, they’re formulated in such a way that this is permissible. The theophylline tablets I used to take were that way; if I broke one in half, the edges weren’t ragged, instead there were obviously little spheres on the edges. So apparently the pills were formulated with those encapsulated spheres in them, then held together somehow.
Interesting. I’d never tried pill-splitting with my thyroid meds, except for samples my doc gave me of Synthroid brand. My doc tended to change my thyroid dosage in VERY small increments, so if, say, she wanted me to go from 100 mcg/day (700/week) to, say, 775 mcg a week, she’d give me a scrip for 100 mcg pills, and a sample box of 75 mcg pills and say “take a half of this two days a week”.
I’ve also heard that thyroid meds are one of those where a generic is not always a good idea, unless you can be sure to get the same generic at each fill. Sufficient differences in absorbability, I guess. So if your thyroid levels are good using Brand X, Brand Y (same dosage) might turn up different blood test results.
Yes, thyroid medications are some of the (few) drugs where BRAND MATTERS. I’m not sure exactly why it’s allowed for them and everything else has to be bio-equivalent between brands, but you speak the Truth. If your pills look different from the last refill, make sure you check with your pharmacist to make sure dosage changes have been accounted for.
don’t worry-it was a very rare and disturbing event. Not anything one would go looking for. However, on a very few occasions something looked odd. Rather than investigate, we called the pharmacist and made a discreet inquiry. She commented that clearly she wasn’t the first to have asked the question…
Thanks.
Obviously I was confused on this whole issue.
Thanks for the explanation.
Essentially, the current recommendation is that generic substitution of levothyroxine products is ok, provided the substitution meets bioequivalence standards for that substitution. To be safe, if taking a patient from brand Synthroid to a generic, or from one generic to another, we generally suggest monitoring relevant thyroid labs more frequently until it is established that levels are stable.
Actually, the funny thing is that levothyroxine products not only have to meet bioequivalence standards like all other medications, but they have to meet them and stay within a narrower potency range. According to the FDA in answer to question 1 of this FAQ, all levothyroxine products must show a 95-105 percent potency specification throughout its shelf life with no more than 5% loss of drug potency from the time the medication is made to it’s manufacturing expiration date, vs the USP standard of 90-110 for all other drug products. More importantly, this rule applies to not JUST generic levothyroxine, but to brand products (Synthroid, Tirosint, etc) as well.
Truthfully, the jury is still somewhat out on this one. The FDA believes it’s narrowed potency changes and current bioequivalence tests are sufficient. Some physicians and organizations believe the tests for bioequivalence between brand and generic are deficient for this particular drug. Ultimately, for now, the recommendation to not change products you have already started (or to notify your doctor if you do change products) seems to give the most predictable results for narrow therapeutic index drugs like levothyroxine, so until some better data comes along, that’s where we are stuck.