Tablet splitting practice in Jordan

Abstract

Objectives To investigate the practice of tablet splitting and the frequency of using different techniques for tablet splitting at outpatient pharmacies in Jordan. Methods A structured questionnaire was used to interview adult patients who were prescribed at least one medication in a half‐tablet dosage at two main outpatient pharmacies in the north of Jordan. Key findings A total of 491 patients were interviewed. The most commonly split medication was aspirin 325 mg (38.1%) followed by warfarin 5 mg (3.3%). The most common reason for tablet splitting was physician's order (41.2%). Additionally, (24.0%) of respondents sometimes skipped their doses due to tablet splitting difficulties. The majority of participants (n = 312, 63.5%) used their hands to split tablets. More than a tenth of the participants discarded parts of their tablets when splitting did not result in equal parts from their perspective. Conclusion Tablet splitting practice resulted in drug waste and medication non‐adherence. Pharmacists are encouraged to educate other healthcare providers and patients about the practice of tablet splitting and when it is acceptable and when it is not.

Effect of different splitting techniques on the characteristics of divided tablets of five commonly split drug products in Jordan

“…Most patients in Jordan use their hands to subdivide tablets. 15 However, the results of this study showed that hand subdivision produced half tablets that do not pass the weight uniformity test in the cases of warfarin, candesartan, and carvedilol. However, subdivision of tablets using the tablet cutter produced half tablets that were accepted for four of the five studied drugs in the current study.…”

“…In 2017 the tablet subdivision practices in Jordan as well as the frequency of using different techniques for tablet subdivision were investigated. 15 The results showed that the majority of participants (63.5%) subdivided their drug products by hand, followed by kitchen knife (14.3%) and tablet cutter (9.0%). In addition, It was found that warfarin 5 mg, levothyroxine 50 μg, levothyroxine 100 μg, candesartan 16 mg, and carvedilol 25 mg are among the ten most commonly subdivided drug products.…”

“…In addition, It was found that warfarin 5 mg, levothyroxine 50 μg, levothyroxine 100 μg, candesartan 16 mg, and carvedilol 25 mg are among the ten most commonly subdivided drug products. 15 The objective of this study was to investigate the accuracy, variability, and weight uniformity of half tablets produced by subdividing five commonly split medications in Jordan by different tablet subdivision techniques.…”

“…14 Several techniques such as by hand, by knife, by tablet cutter, or by teeth can be used in order to subdivide tablets. 15 Several studies have investigated the accuracy of different tablet subdivision techniques. 7,8,16 For example, van Riet-Nales et al investigated the accuracy of tablet subdivision associated with the use of three subdivision techniques.…”

Concerns regarding tablet splitting: a systematic review

“…Concern that splitting could pulverise (turn to powder) a meaningful proportion of the tablet was raised in 29 articles. 1 , 2 , 9 , 13 , 28 , 29 , 31 , 34 , 43 , 46 , 50 , 57 , 72 , 74 , 77 , 81 , 82 , 92 , 101 , 110 , 118 , 121 , 122 , 124 , 125 , 128 , 133 , 134 , 137 The resulting loss of mass could potentially lead to incorrect dosage, and contamination/health concerns for those unwittingly exposed to the residue. 72 , 121 , 128 If tablets fragment to a large degree they may even need to be discarded, leading to increased healthcare costs.…”