I think it’s possible that some medications work better if they dissolve slowly in your stomach, say, the time-release ones, for example. But others, like the generic Imitrex that I take, say that I shouldn’t split the pills, and I don’t know why that would be important. The cynical side of me says that the drug manufacturers and the insurance companies don’t want me to cut 100 mg pills into two 50’s because that way, I’d be getting more pills. (They’ll send me 9 pills per month, regardless of the strength, so ordering 100’s and cutting them in half doubles my investment and halves the pharma profit.) Is there a pharmalogical reason that I should not cut these pills? The physician information insert says nothing that I can understand that would provide me with an answer. Dopers?
Dunno, but I do exactly that with my migraine meds (Maxalt), on instructions from my doc (who basically said-- they cost a fortune and insurance companies limit them by the pill. I’m giving you the max dose so you can split them in half).
Some pills have outer coatings that are designed to dissolve at a particular rate and release the drug within over time. If you cut them in half, all the drug will be released at once.
Because of the coating. There are many drugs that will be inactivated in the stomach due to the high acidity, so they are coated so they won’t start dissolving until it is passed the stomach into the duodenum. With some of these medications, if you cut them they will be significant degraded by the stomach so that you might get none, or only a small amount of the dose absorbed.
Also, as you said, with some of the extended release drugs, if you damage the coating you might receive the full dose at once, instead of over time as they are meant. This could lead to high levels in the blood, and an increase in side effects or toxicity.
As a good rule, don’t cut any tablets that are not scored without talking to your local pharmacist first.
My experience with splitting Imitrex (under the supervision and approval of my neurologist) is that the stuff tastes amazingly bitter, is extremely hard to swallow when it’s like that (due to taste and beginning to dissolve and thus stick in your mouth), and is liable to make you throw up due to how bitter it is and how you might well be feeling nauseated due to the migraine anyway. So you really risk wasting the medication and making yourself feel worse.
If that’s the case for you, I understand why you wouldn’t split those pills. They certainly are bitter. However, I’ve always split 100’s, because 50 mg gave me sufficient relief, usually. Lately, I’ve discovered that I can sometimes even get relief from taking an even smaller dose. However, I’m wondering - i.e., my post - if I am interfering with efficacy to any degree. The “coating” explanation is compelling. How can I find out if it is the case with Imitrex?
I have seen some pills say that and they have no coatings. I like the way some pills now come in such odd shapes that it is very difficult to split them into two.
Like the OP said, I think it is a way to prevent splitting pills to save costs. Of course there are legitimate reasons, like time release or the drug can’t be dissolved in the stomach as the juices would kill it, so the coating makes it designed to dissolve later on.
I notice now that your post said generic Imitrex; I was splitting the brand name version, with my neurologist’s permission, due to cost issues (expensive pills + insurance would only pay for so many pills per month, but dose didn’t matter). I would suggest you talk to your physician and see what s/he thinks, if you haven’t already.
If you’re getting your relief, then its reasonable to assume you’re getting your required dosage from the split pills?
The main reasons are that a pill might not contain an evenly distributed dose of the medication. More info here:
From there:
“Care must be taken in identifying drugs that may be safely split while still delivering half the dose with the same or similar efficacy. Generally scored pills may be safely split however time release and capsule supplied drugs should not be split. Split pills may be uneven and thus the amount per dose may vary.”
I’ll add that I’m not sure about the shape of the generic form(s), but brand-name Imitrex is shaped like an equilateral triangle. So you have to split it at the midpoint of one side and get it lined up properly so that it carefully bisects down the opposite point. You may well break off the tips or split them unevenly.
Checking out the potential side effects of sumatriptan, I see a lot of GI effects. I suspect that the chance for stomach upset all the way up to bleeding ulcers might be one reason that splitting the tablet is not the wisest move, and that my neurologist’s caution to tell him if I had any problems afterwards was including looking after that possibility.
I’ve also seen instructions where some pills should be swallowed whole, not chewed, would the reason for that be along the same line, not to damage the coating prematurely, I’ve always wondered.
In this case almost definitely yes. Time release coating.
Imitrex doesn’t work on me so I have no idea how it tastes, but my friend Vicki can take it, and halves her pills, and crunches each dose up and puts it into a generic gelcap she buys at a health food store [people use them for capping up herbs] as the taste makes her throw up.
Pretty much every tablet has some sort of coating,even if it’s just a thin film. These films can have different effects on the way the tablet is dissolved and how it releases the active ingredient to the body.
Sumatriptan succinate is absorbed by the upper GI tract, but is extensively metabolized in the stomach. Bioavailability through oral doses is actually very low; about 15%. The shape and coating of Imitrex (and generic!) tablets are specifically designed to help the drug survive stomach acid and allow the maximum availability to the body at the pH/intestinal location in which it is absorbed. Crushing, splitting or otherwise damaging the tablet results in the drug being exposed immediately to stomach acid and undergoing a first pass metabolism that makes the drug more unavailable to the body and therefore more unable to treat the symptoms for which the patient is taking it. For those patients who cannot handle the taste, may I point out that Imitrex is available as an injection.
Altering any drug alters the intended release profile of the drug. Only scored medications have been tested to show that they behave as intended once split. No one ever has, nor ever will, test a drug’s release, absorption and metabolism profile for delivery in a form in which it is not intended to be taken. Symptom treatment, side effects and risks have not been studied in clinical trials or have their results approved for use by regulatory bodies. By taking a drug in a manner other than intended, (general) you are taking a risk with your health.
Drugs say do not split, do not crush, do not [whatever] because they have not been tested under those conditions. You can ask your doctor (or even pharmacist) for permission to do these things, but keep in mind that they do not have access to the decades of lab and clinical trial work that went into making these drugs.
No, I do not, nor have I ever, worked for GSK.
This is the reason.
If you want to read up more for yourself, try googling imitrex bioavailability. I didn’t read any of the stuff that came up, but you might find some interesting information.