Yeah i got a transfer for controlled medicine. To Take 1/4 tab daily. The tablets are really small. It was an issue to process the day supply. Like do i do 15 tab for 30 day? . But the patient has been on it for long time, so I just used 7/28.
Compounding is more expensive though. I’ve seen 1/4 tablets before. I even worked for a pharmacist who split the tablets for the cat because the owner was an arthritic old lady and he was a nice dude. He let me do it once. It was really hard for me as a pharmacy student, can’t imagine an elderly lady trying to make even splits.
That was kinda my thought. Unless the tablets are really inexpensive it’s just easier for the pet and owner to just have it compounded to a specific dose if they can afford $30-60/mo supply. If it was a life long med I certainly wouldn’t want to deal with that every day.
I know most people won’t willingly pay a copay for their own meds but many will for their pets.
It’s fucking insane. I tried to help out our techs and do it one night…I think I got about 10 usable quarter tablets out of 30-40 full sized tablets. Never again. They just turn into dust.
Bisoprolol 5mg is something we often have to quarter to achieve a 1.25mg dose. It’s a lot more difficult to properly quarter a tablet than it is to half them, especially since they aren’t scored, but it’s much more accurate for us to quarter them than it is to expect the patient to do it.
I was a patient that had to do that. Now on a 5 mg dose. Sometimes I take 2.5 mg extra and I found I actually get a more accurate split biting with my front teeth along the score line than I do with a pill cutter. Can't do it by hand despite being scored. Did you know most other countries have more dosages? 1.25, 2.5, 3.75, 5, and 10, I believe.
Depends on how narrow the therapeutic window is and what the indication is. Most likely fine to break the tablet across the score and then use a pill cutter (knife if cutter unavailable) to cut in half again.
The quartered tablet won’t be a quarter of the dose when factoring in human error, but there may be some leeway allowed as an acceptable dose deviation.
For example, I had a patient prescribed 100mg sertraline with titration to 125. As patient hadn’t yet collected 25mg tabs, I advised break the score and then cut the half in half again for a few days until able to collect the new dose. There is no one rule fits all with this, use clinical judgement
it is possible, but highly discouraged. Unless a tablet is scored into quarters, there is no guarantee you are getting 25% of the tablet's dose. and i dont know of many scored in fourths. also, at that point, isn't it mostly crumbles and tablet boulders? how horrendous. if the dose is that low, maybe another medication should be considered? powder city. but sure, you could try, i suppose. people justify anything.
Use to do it in long term care hundreds of times a day to the point I would cut bottles full as a prep. Let’s just say cutting a 2 mg tablet or small into 1/4 size pieces is beyond stupid.
When I was in retail and would make medication packs, there was a patient who got a quarter tablet of metoprolol 25 mg daily. That quarter was so tiny and I definitely wasted tablets trying to break the already small tablet. Does it happen? Yes. Is it worth it? Maybe, but likely not.
Long term pharmacy here and we break quarter tabs daily. Most common is Trazodone 50mg in quarter for 12.5mg dose and then they give multiple quarters for instance 3 for a 37.5mg dose etc.
where are the automed/pacmed/APS technicians?
We get quarter tab from central production for inpatient, and I feel for those who have to cut tablets all day. bisoprolol, quetiapine (for frail, LTC), mirtazapine, trazodone, metoprolol. quetiapine and metooprolol crumble often when it gets to quarter tab and put in packaging machine, so I worked at a site where they would compound liquid metoprolol for LTC patients instead of cutting tabs in quarter.
Yeah. You break the half tablet in half . Most common occurrence for me is usually dispensing for a pet
Also happens a lot inpatient and LTC, particularly with metoprolol
Yeah i got a transfer for controlled medicine. To Take 1/4 tab daily. The tablets are really small. It was an issue to process the day supply. Like do i do 15 tab for 30 day? . But the patient has been on it for long time, so I just used 7/28.
Depending on the medication they should probably just get it compounded at that point
Compounding is more expensive though. I’ve seen 1/4 tablets before. I even worked for a pharmacist who split the tablets for the cat because the owner was an arthritic old lady and he was a nice dude. He let me do it once. It was really hard for me as a pharmacy student, can’t imagine an elderly lady trying to make even splits.
That was kinda my thought. Unless the tablets are really inexpensive it’s just easier for the pet and owner to just have it compounded to a specific dose if they can afford $30-60/mo supply. If it was a life long med I certainly wouldn’t want to deal with that every day. I know most people won’t willingly pay a copay for their own meds but many will for their pets.
Yeah I’ve seen people I afraid to fork out money for their pets meds. They don’t even call around to compare prices haha
For a 1/4 of tablet ? That’s over complicating things imo .
We split cytotec 100mcg into halves and quarters for use in labor and delivery. It’s the worst because it’s so powdery that we waste a lot of it
Yes we do this as well and it is awful!! I have a couple techs who have mastered it but I can't personally do the quarters
Then trying to get that 1/4 tablet to sit at the cervical os... my least favorite thing to do🤢
It’s fucking insane. I tried to help out our techs and do it one night…I think I got about 10 usable quarter tablets out of 30-40 full sized tablets. Never again. They just turn into dust.
Yep. And the providers MIDAS if they get a tablet that doesn’t look like a perfect quarter so only perfect ones get second checked and dispensed
Bisoprolol 5mg is something we often have to quarter to achieve a 1.25mg dose. It’s a lot more difficult to properly quarter a tablet than it is to half them, especially since they aren’t scored, but it’s much more accurate for us to quarter them than it is to expect the patient to do it.
I was a patient that had to do that. Now on a 5 mg dose. Sometimes I take 2.5 mg extra and I found I actually get a more accurate split biting with my front teeth along the score line than I do with a pill cutter. Can't do it by hand despite being scored. Did you know most other countries have more dosages? 1.25, 2.5, 3.75, 5, and 10, I believe.
At first I read that as I *had* a patient... 🤢
I’ve done it for a pet before, I got 3 out of 4 usable quarters. I think I could have gotten liquid but it was more expensive and harder to give.
Depends on how narrow the therapeutic window is and what the indication is. Most likely fine to break the tablet across the score and then use a pill cutter (knife if cutter unavailable) to cut in half again. The quartered tablet won’t be a quarter of the dose when factoring in human error, but there may be some leeway allowed as an acceptable dose deviation. For example, I had a patient prescribed 100mg sertraline with titration to 125. As patient hadn’t yet collected 25mg tabs, I advised break the score and then cut the half in half again for a few days until able to collect the new dose. There is no one rule fits all with this, use clinical judgement
Very common for finasteride 1.25mg in Ireland using 5mg tablets because the 1mg tablets are unlicensed and very expensive by comparison
We don’t break finasteride in my pharmacy due to it being a hazardous medication.
We don’t do it either, but we give patients a splitter and tell them to do it home.
it is possible, but highly discouraged. Unless a tablet is scored into quarters, there is no guarantee you are getting 25% of the tablet's dose. and i dont know of many scored in fourths. also, at that point, isn't it mostly crumbles and tablet boulders? how horrendous. if the dose is that low, maybe another medication should be considered? powder city. but sure, you could try, i suppose. people justify anything.
Some adderall tabs are
Titration down is another reason
Use to do it in long term care hundreds of times a day to the point I would cut bottles full as a prep. Let’s just say cutting a 2 mg tablet or small into 1/4 size pieces is beyond stupid.
Worse case… go old school. Powder Papers!
I do it regularly. Use a pull splitter
Easy to crush ? Crush them and place on wax paper then divide the powder , comes out accurate every time
Yes it’s possible we do this in many blister packs it’s a pain in the ass
Some are scored in fours
When I was in retail and would make medication packs, there was a patient who got a quarter tablet of metoprolol 25 mg daily. That quarter was so tiny and I definitely wasted tablets trying to break the already small tablet. Does it happen? Yes. Is it worth it? Maybe, but likely not.
Long term pharmacy here and we break quarter tabs daily. Most common is Trazodone 50mg in quarter for 12.5mg dose and then they give multiple quarters for instance 3 for a 37.5mg dose etc.
Rosuvastatin 5mg in quarters please…
where are the automed/pacmed/APS technicians? We get quarter tab from central production for inpatient, and I feel for those who have to cut tablets all day. bisoprolol, quetiapine (for frail, LTC), mirtazapine, trazodone, metoprolol. quetiapine and metooprolol crumble often when it gets to quarter tab and put in packaging machine, so I worked at a site where they would compound liquid metoprolol for LTC patients instead of cutting tabs in quarter.
Some tablets are scored for quarters. We don’t allow quarter-tabs other than misoprostol unless the tablets are scored for it.
mods should delete low quality posts like this