Share tablets
and Christiane Fux, medical editorMartina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
More about the experts
Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.
More posts by Christiane Fux All content is checked by medical journalists.There are various reasons why patients want or have to share their tablets: First and foremost, this allows the dose of the active ingredient ingested to be reduced. This may be necessary in elderly patients or children, for example, if the desired drug is not available in a lower dose.
With some drugs, the dose should be increased slowly at the beginning of the intake ("creep in") and gradually reduced at the end of therapy ("taper off"). Even with active ingredients whose dose has to be continuously adjusted, you often have to split tablets.
In addition, many patients have difficulty swallowing large tablets. And last but not least, sharing tablets can reduce costs: some drugs are much cheaper in double doses than in single strengths.
Difficult halving
Dividing tablets is often very difficult, even if the tablets have a score line. Often there are two halves that are of different sizes, sometimes also broken dust and smaller fragments. In the end, the patient may take more or less active ingredient than planned.
Tablet sharing is less suitable for people with disabilities, such as poor eyesight or reduced dexterity.
Not divisible
However, not all tablets may be divided. Above all, the properties of the active ingredient, the dosage form, the size and shape of the tablet and the nature of the score line are decisive. Attention: Some tablets do not have a real break notch, but only a "decorative notch". This is actually only intended as an ornament and no indication that you can share the tablets!
»Sensitive or unpleasant ingredients
The thin coating of some film-coated tablets is intended to prevent the active ingredients contained in them from being inactivated by light, oxygen or moisture. This protective cover is destroyed when it is shared, which can impair the effectiveness of the tablets. You should therefore not crush such film-coated tablets. The same applies if the film coating is intended to mask the unpleasant taste and / or odor of the active ingredients. Something that tastes bitter or disgusting is reluctant to swallow and some people then forget one or the other dose.
»CMR agents
Tablets with CMR active ingredients, i.e. those that are carcinogenic (C = carcinogenic), mutagenic (M = mutagenic) or harmful to fertility (R = toxic to reproduction), are also unsuitable for sharing. These include, for example, cytostatics (agents that kill cells, for example against cancer), antivirals (agents that kill viruses) and retinoids (e.g. agents against severe acne). When dividing tablets, broken dust and suspended particles are often produced that can be inhaled. This is particularly problematic with CMR active ingredients because they can cause serious side effects even in the smallest amounts.
“Enteric-coated tablets
In the case of enteric film-coated tablets, the coating prevents the active ingredients from being released in the stomach - either so that they are not destroyed by the aggressive gastric acid (e.g. proton pump inhibitors) or, in turn, attack the gastric mucosa. Instead, the active ingredients are only released in the intestine, as desired. However, this only works if gastric juice-resistant film-coated tablets are swallowed whole - so the protective coating remains intact. So: Do not share tablets that have an enteric coating (see package insert).
" Extended-Release Tablets
With some film-coated tablets, a sustained-release coating means that the active ingredients are not released in one go, but gradually. However, this controlled release will be disrupted if you split the tablets.
The situation is different with sustained-release tablets, in which the slow release of active ingredients is not achieved through a coating, but rather a matrix in which the active ingredients are stored. You can usually cut such tablets in half along their score line. However, you should not crush them further or crumble them in a mortar. To be on the safe side, follow the instructions in the package insert.
“Multiple units
The term multiple units refers to tablets made of granules or particles (e.g. pellets) that are coated with an enteric or retard film. This means that every active ingredient-containing particle inside the tablet is covered by a protective film and not the tablet as a whole. This may therefore be halved at the score line (but not chewed or ground up).
“Capsules and sugar dragees
In the case of capsules, the active ingredients (and auxiliaries) are enclosed in a gelatin shell. With hard capsules the content is solid, with soft capsules more or less liquid. Both are not suitable for sharing. The same applies to coated tablets in which the active ingredient core is coated with a layer of sugar.
Divisible? The quick overview!
| drug | Divisible? | annotation |
| Tablets - rapidly disintegrating | Yes | |
| Film-coated tablets - soluble in water | Yes | Note the properties of the active ingredients (e.g. sensitivity to light, bitter taste) |
| Film-coated tablets - enteric-coated | no | |
| Film-coated tablets - retarded | no | |
| Retard tablets (matrix) | partially | Do not grind; Note the information in the package insert |
| Retard tablets (multiple units) | Yes | Don't grind |
| Gastro-resistant tablets (multiple units) | Yes | Don't grind |
| Gelatin capsules | no | |
| Sugar dragees | no | |
| after R. Quinzler, W.E. Haefeli |
The right dismantling technique
There are various methods by which tablets can be divided as precisely as possible into two equally sized halves without tools:
1) Convex tablets with a very deep score or a large angle: Place the tablet on a hard surface with the score facing up. Then press briefly and forcefully with your finger on the upper, notched side.
2) Flat tablets large enough to be gripped with your thumb and forefinger: Hold the tablet with the score facing up between your thumb and forefinger of both hands. The nails of the thumbs start opposite the score line on the underside of the tablet. Now press the tablet halves briefly and forcefully with your index fingers down over the edge of the nail on your thumbs until they break apart.
3) Another, but not so good, technique for cutting flat tablets in half is as follows: Hold the tablet to the right and left of the score line between your thumb and the long side of the forefinger. Then break it in half by bending the tablets up or down.
4) Tablets that are flat on one side and have a large angle score line on the other: place the tablet on a hard surface with the notch facing down. Then, briefly press the flat top of the tablet with one finger to cut it in half along the notch.
Tablet divider
If you want to divide tablets that do not have a score line or are difficult to cut in half despite the notch, a tablet divider is useful. With this device, tablets can be reliably halved or quartered. To do this, carefully read the instructions in the enclosed instructions for use. Your doctor or pharmacist can also show you how to use a tablet divider correctly so that the tablets are broken down without a lot of broken dust. Some pharmacies even offer their customers to divide their tablets in half with a divider.
Kitchen knives, scissors or the like are no alternative to tablet dividers. They are completely unsuitable for dividing tablets - you usually only get pieces of unequal size and in the worst case you will injure yourself!
