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20. Tablet Splitting

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  • HadIt.com Elder


a. VISNs are permitted to establish tablet splitting programs for both inpatients and

outpatients; however, tablets are to be split for inpatients only when the required dosage is not

available in a commercial package.

b. Determination of patient suitability for a tablet splitting program must be individualized

according to a patient's unique capabilities. Patients who express a desire not to participate in a

tablet splitting program must be permitted to receive full tablets.

c. All patients in a tablet splitting program must be provided a tablet splitter and must be

educated regarding its use.

d. Tablets are not to be split into more than two pieces, unless specifically designed for that


e. To ensure appropriateness, all medical center tablet splitting programs must be approved

by the VISN’s Formulary Committee.

f. Tablets may be split outside of a formal tablet splitting program to achieve an intermediate

dose not available with marketed strengths, or at the request of an individual provider.

g. The following requirements must be followed whenever tablet splitting is instituted.

(1) Tablets that must not be split are:

(a) Sustained release preparations (unless scored and designed to allow tablet splitting);

(b) Enteric coated tablets;


February 26, 2009 VHA HANDBOOK 1108.08

© Products that crumble easily;

(d) Products that cannot be split consistently into equal parts unless small fluctuations in the

delivered dose do not alter clinical effect (i.e., some HMG-CoA RIs);

(e) Products with a narrow therapeutic index, unless required for therapeutic reasons, or

titration, or where the required dose is not commercially available;

(f) Products in which tablet splitting would result in the destruction of the release

mechanism of the individual drug; and

(g) Products that are not either scored or round in shape.

(2) Any patient who is otherwise able, but is unwilling to participate in a tablet splitting

program, must be provided whole tablets if they are commercially available. Patients with

caregivers with similar reservations also need to be provided whole tablets.

(3) The patient or caregiver needs to be able to demonstrate:

(a) An understanding of the purpose for splitting medication;

(b) An understanding of the intended dose and treatment regimen; and

© The physical ability (e.g., coordination, adequate vision, etc.) to easily and accurately

split the tablet.

(4) Medications eligible for tablet-splitting must have an associated message tagged in the

master drug file that alerts the provider that the dose is being provided as a split tablet, unless

otherwise ordered. This message must appear on the screen in the Computerized Patient Record

System (CPRS) when one of the tagged medications is selected for prescription.

(5) Tablet splitting is to be considered only when it is clinically appropriate and after

determination of patient suitability and willingness to participate.

(6) If the patient is not willing or is unable to split tablets utilizing the intended device, the

provider must notify the pharmacy of the need to dispense whole tablets.

(7) Patients must be provided tablet splitting devices, free of charge, as often as necessary.

Written instructions on its use must be provided with each splitter.

(8) Directions on the prescription label must reflect the exact product and dosing

instructions. To avoid misunderstanding, providers need to prescribe the medication strength

and dose in milligrams(mg) (e.g., simvastatin 40 mg. tablet. Take 20mg [one-half tablet] daily).

One-half is to be spelled out on the label to avoid misreading “1/2” as 1-2 tablets.


VHA HANDBOOK 1108.08 February 26, 2009

(9) When the dose of a drug that is currently being split is changed, the new dose must be

clearly explained in writing to the patient by pharmacy. NOTE: This is to ensure the patient

does not continue to split a tablet if it is no longer warranted.

(10) The dosage strength of the whole tablet is to be printed on the label as part of the

product name.

h. If tablets are to be split for inpatients, the pharmacy must split the tablet to be dispensed in

the most ready to administer dose for the nurse, doctor, pharmacist, or other health care team

member approved to administer the medication.

i. Split tablets for inpatient use must be bar coded in order to be recognized as the

appropriate final dose in the Barcode Medication Administration (BCMA) system.

SOURCE: http://www1.va.gov/vhapublications/ViewPub...asp?pub_ID=1834

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When I split the oval meds, one piece comes out like a three quarter moon and the other piece is about a quarter moon.


If the pill is not scored or round - it is not supposed to be split.

If that's not the problem then check the blade on you splitter to see if it's

bent or a little chunk is broken off the cutting blade.


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  • HadIt.com Elder

Glad to see that someone mentioned the little machines that can split the pill for you. The tooth method can get a little sloppy/ slurpy. I have a friend that has no insurance or access to VAMC. Has to buy his meds on the open Rx market. His Dr. writes a script for twice the strength. Rx charges by quantity. This save him twice the money. Just get a good splitter. it's worth the extra cost to get a good one.

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  • HadIt.com Elder
The VA gives out splitters free.

#1 Free doesn't mean that it's better. From the complaints reported so far, including teeth splitting. :o I would consider looking outside the VA and buy a better one.

#2 Also as you know , it wasn't free... You've earned it.

Gen. Powell, once said "You break it, you buy it". This applies to those who served in uniform.

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After several minutes of discussion with a very nice polite lady in the VA pharmacy, summed up by me inquiring if she needed the page and paragraph of their book. We agreed that the client determines if they want to split pills or not! My next refill will be the "150 mg pills not 100 Mg's to split"



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Does anyone know that if I get my meds by mail, and if the pills are to be split in half, if I call the Pharmacy in Fayetteville,AR will they also mail me the splitter? Or do i have to pick it up in person? I have to pay a co-pay because the drug is not part of my SC disability.. It is Cialis.

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  • HadIt.com Elder

I can tell you now the splitters from the VA are likely to be cheap ones that do a poor job of splitting. Good ones don't cost much from Walgreens/ Walmart etc.

You can call the VA pharmacy on their 800 number & ask if they will send you the splitters, but you will likely need it refered from your doctor.

Also, you can opt out of pill splitting altogether. Just call your Doctor & let them know you do not wish to split your pills. They will then need to prescribe the right dosage.

Hope this helps.

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Does anyone know that if I get my meds by mail, and if the pills are to be split in half, if I call the Pharmacy in Fayetteville,AR will they also mail me the splitter? Or do i have to pick it up in person? I have to pay a co-pay because the drug is not part of my SC disability.. It is Cialis.

The VA will give u a pill splitter, when u go to the VAMC just asked anyone that work there for one.


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  • Content Curator/HadIt.com Elder

The pill splitters I got from the VAMC were really flimsy. The clear cover was made from the same kind of plastic used in CD cases, which crack or break pretty easily. I just gave up with the frustration and bought a really nice pill splitter that also crushes tablets too.

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  • HadIt.com Elder

Bearing in mind, during all this discussion about "splitting pills" that there are the occasional instances wherein YOUR "optimum dosage" may very well fall between the dosages manufactured by the pharma company.

I am a good example. I have a med that I take that is only manufactured in 100mg or 200mg "splittable" tablets. My "optimum dosage" (the dosage that helps keep my MDD controlled but doesn't cause my dick to malfunction) is 350mg.

I'm more than willing to split the pill, considering the alternative(s)! B)

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