Also, there are plenty of tablets which simply should not be cut in half because they've got a slow-release coating. If you split it, you expose a bare face of the tablet, and you get dosed at the wrong rate. Your doctor may have a legit medical reason for not getting you to split the tablets himself in that instance.

Err, hang on, your link at the bottom just takes me back here! I'm trapped! Help!

@Sockatume: Thank you, I was just going to say that.

I'm sure there may be other reasons not to just split your pills, but that would be the main one.

@Another barrier is that some meds aren't scored for halving. If not, it can be pretty hard to accurately divide the pill, even using a splitter.

Heres the correct link

[www.panhandleparade.com]

I would think that in a world where we remove drugs from shelves because people don't read the and follow the directions properly, it would be difficult to convince a doc to prescribe a pill that is an overdose waiting to happen.

Personally, I think the whole thing is just silly, but so are a lot of things, including that pesky tag telling me I can't blow dry my hair whilst actively showering... damn.

I would be putting, "ask your physician if you can switch over to $4 medications" way before splitting pills in half.

If your physician is truly above board, he's going to write you a script for 1/2 the number of pills you normally get and then have the instructions say, "split pill in half." At this point, a good pharmacist will say, "you know what, instead of giving you 100mg tabs, I'll give you 50s and double the script because it's safer."

No one wants to envision a scenario in which you can no longer communicate your "secret prescription" and a hospital worker assumes that the doubled rate printed on your bottle is your actual RX.

Don't forget the number one rule: Don't get sick!

I'm Sorry. when you said Dr. Mario, this image came flooding back...

@Sockatume: It's a Trap!

My sister told me that she does this. She got a prescription for the half strength (normal pills) and it was the same cost as for the full (double her dose) strength pills that she had been cutting in half. She told the nurse practitioner to put her back on the full strength ones. Saves her something like $150 a month.

My question is why are pills priced by the dose instead of by the number of mg of the active ingredient?

@Stephmo: $4 meds are great, but that only works for generics. If your drug is less than about 10 years old, you're SOL.

Prescriptions are very expensive. Know the NNT (number need to treat) for the disease process. For example, sinusitis with antibiotics has a published NNT of 8, ie 8 people will have to be treated with antibiotics before one person gets better. Ask your doctor if these prescriptions can be permissive: ie if you are not better in X days, can you fill them at that time. That is the current recommendation for immunocompent children with ear infections. Finally, get yourself a good up to date primary care provider. After the 2-3 visit, they will be your advocate and can keep you healthier and with a lower cost. Repeat examinations obviate many a CAT imaging. If you invest in a PCP, you will be healthier, wealthier, and wiser.

Pill-cutting is a time-honored technique for saving money on prescriptions.

@B1663R: What if Nurse Toadstool wants to touch my genitals?

@Necoras: Probably pharmaceutical economics. Either they're gaining the financial benefit of charging the high-dose rate for low-dose pills, or less cynically, the low-dose rate is normal and they don't want the PR fallout of doubling the charge for people who need a higher dose.

@Necoras: Could depend on what's being paid and how. If it's a copay for insurance it's usually determined that you'll pay X for a "one month supply." And a "one month supply" tends to get defined as a specific number of pills for a particular medication and is entirely unrelated to the size of the dose.

@Necoras: Because manufacturing costs are almost always the biggest chunk of any product. The materials cost pale in comparison to the buildings, wages, ginormous golden parachute payments to moronic CEOs, etc.

In my plan (using Medco online prescription service), drugs with dosages from 10mg to 200mg are almost exactly the same price.

Any of your popular online drug information services will note for a particular pill if it can be divided. It's usually OK unless the pill has SR or XR or other indicator of a sustained release formulation.

Even then, the regular formula will be 100x's $$$ cheaper than the sustained release version. Most companies put out the SR version because their patent on the regular version has expired and they can re-patent this new formula.

@theblackdog: I'm down for that.

Related: I recently had to up a dosage on my migraine meds. I get bad side effects when I do, so I tend to up slowly, and in the smallest amount I can, so since it came only in 15, 25, & 50 mg (& a bunch higher) I was going from my current 50 mg to 65 mg. Except that my insurance, in its infinite wisdom, would not allow that, because 15 mg is a different Rx than 50, so my Dr couldn't give me a scrip for 65 mg.

BUT - the pharmacy called and said I could go up to 75 mg, by taking not a 50 and a 25, because that would also 2 different pills. Nope, now I have to get a whole bunch of 50's and each day take 1.5. At least they threw in the free pill splitter.

It's not a big deal to me, I can split a pill just fine. It's just the idiocy of a drug company refusing to allow a doctor to prescribe the appropriate dosage without requiring a ridiculous copay...

I'm a pill splitter. I had been on 1000 mg and we decreased my dose to 500. I just continue to refill the 1000 and save myself the cost. And yes, it is a pill safe to split, thank you all for being concerned about my health.

My mail order pharmacy suggested the pill splitting plan as a money saving plan in a mailing I received from them.

@MooseOfReason: Ah, the savings we'd see if the US "health-care" system (looking at you, Internal Revenue Code) encouraged people to stay healthier in the first place...

@Necoras: Generally they aren't, but consumers aren't seeing the real price at the pharmacy. You're seeing your copay. So in most cases, this only works if you have insurance to begin with.

@subtlefrog: Find a new pharmacy. There is nothing wrong with your doctor writing TWO scripts and put in the instructions of the 50mg "take with 25mg pill to equal 75mg" and vice versa on the 25mg script. I filled scripts like that tons of times in retail and we do it all the time in the hospital.

The pharmacy should be able to call your insurance company and request an override of the inevitable rejection because you are using the two strengths to equal one dose.

@aftercancer: Actually, splitting pills isn't always safe. It depends on the pill and the mechanism by which the dose is delivered. Those which are safe to split often have an indention in the middle of the pill to facilitate splitting. Oxycontin is a great example of why its not always good to split a pill, its meant to be a slow release mechanism but the splitting of the pill interrupts that and you get a massive hit of the medication which is not the intended dose.

I do love that rules 1, 2, and 3 are just plain old common sense. I imagine a lot of cost cutting measures are plain old common sense

@simplekismet: Stuck at this pharmacy - school insurance plan. That said, they DID call the insurance plan, and tried all sorts of permutations, and no way, no how would they cover it as one Rx. But I've had them reject all SORTS of things, so really, not much should surprise me anymore (but somehow sometimes, it still does...).

@subtlefrog:

Remind me of when I needed a 3 month prescription for malaria pills. The pharmacy called the insurance company, and they could only fill one month + one extra month. Anything more than that had to be paid out of pocket.

I said thanks, I hope I don't catch malaria on the OTHER SIDE OF THE WORLD during that 3rd month and then you, the insurance company, will be on the hook for thousands and thousands of dollars in malaria treatment when I get back.

Luckily, I didn't catch malaria.

@You know what ole' Jack Burton always says: Pills are too small, pills are gels, center of pill should not be exposed to the air (I made that one up)...

My doctor ordered Lipitor at double strength and told me to cut it in half. When I asked my pharmacist for a pill cutter she asked me why. I told her to cut my Lipitor pill in half as told by my doctor. She told me in no uncertain terms that what my doc and I was doing was insurance fraud. I think she was just upset that she would only get my money every other month.

@Rectilinear Propagation: I like it though. That will be my reason.

@Sockatume: Also.. I have trouble swallowing pills in general, but for some reason a pill cut in half is even harder to swallow.

Jaggaddy edges I guess.

/Made up spelling

@ZahavahJagalagala:

It kind of IS insurance fraud. Assuming your doctor wrote on your prescription 1 per day, but he actually told u to take 1/2 a day, the prescription is going to last twice as long. However, the insurance company does keep track of how many days it is supposed to last. Every prescription submitted to insurance has to include a days supply.

Ultimately, you will be submitting to your insurance a "30 day" prescription when it is actually going to last 60 days. I'm not sure what the legal definition of fraud is, but that may come close to it.

@ZahavahJagalagala: Nosy, nosy, nosy. Standard issue response to such inquisitive (read intrusive) questions is "don't worry about it". Also, I don't see how this is insurance fraud...especially on your part. After all, you are just following the doctor's orders. Personally, I'd switch "harmacies" if possible.

@ZahavahJagalagala: That's not insurance fraud. In fact, it saves the insurance company a bunch of money. It may hurt the pharmacy and the drug companies and any wholesalers but it doesn't hurt the insurance company. Doesn't even make sense. Insurance companies love it when people do this.

I used to have pills that I cut in half, my doc had no problems prescribing the double dose. But, even better is finding out that one of my drugs is on Wal-mart's cheapo list. Used to pay $10/month now I pay $6 for a 90 day supply.

@ReubenAstacus: Way to spoil the fun with your "intended doses"

@ZahavahJagalagala: Insurance companies mandating a certain pill size can neither be legal nor ethical. That pharmacist should have her license revoked.

@Kimaroo: I seriously can't swallow tablets without choking myself 1/3 of the time. Everything needs to come in caplet format so I DON'T DIE.

(Fascinating fact: regular strength tylenol is IMPOSSIBLE to find as a caplet or capsule. You can only get extra strength that way.)

@simplekismet: The full price for 60 pills of my daily Rx is less than double the full price for 30 pills. Quite a bit less. There's no per-pill pricing; it's definitely per-Rx pricing, and I find it very odd, particularly since you can't "take advantage" of the savings.

(My insurance company and pharmacy both give me helpful statements of how much the "full retail" cost of the Rx is.)

@KerryFlayer: I like the NNT info there, especially since my understanding is that the US is increasingly out of step with the rest of the industrialized world on things like antibiotics for pediatric ENT infections. Unfortunately, I'll have to counter with the problems of reality on the PCP--I like mine just fine, and am extraordinarily lucky on being able to see her twice a year when most people can only get in once. In the event of illness, there will be no way that she's the one I'll get to see. That's an unfortunately common reality of managed care--the PCPs are among the most managed of all. I think the preventative maintenance/known norms idea is great, but the health care systems I know simply don't permit enough access to the PCP to allow that to happen.

That looks like one hell of a suppository.

@Eyebrows McGee (now with more baby!):
Fry: "I can't swallow that"
Professor: "Well then Good News! It's a suppository."

More seriously, I take an acne medication on a daily basis. I swear the pills are meant for horses. I choke myself every other day on the stupid things. And what's worse, they're incredibly bitter and completely destroy my sense of taste if they don't go down quickly enough.

@lannister80: @theblackdog: You know Nurse Toadstool is also a guy, right?

@Eyebrows McGee (now with more baby!): I believe that all pills should be the same size, shape, and flavor (!guilty pleasure!) as caplet Advil.

Advil tastes awesome, I don't know why.

@starzshine:

Yeah, try asking your doctor for a double dose of pain meds so you can cut it in half... Won't exactly work out too well... Personally I think that one should be paying the same price for different dosages. You are getting more or less, shouldn't the cost reflect that? Let us not bring up the fact they only fill bottles up a tenth of its actual size...

A word of warning on generic drugs - my wife was born with a brain disorder that requires her to take an anti-seizure medication. Under my company's medical plan, we are required to have recurring prescriptions filled through their online pharmacy. About three months ago, they switched manufacturers of her pills, and they were noticably different - her old ones were very hard and solid, and the new ones where definitely soft and crumbly (they would almost dissolve in your hand).

She's been taking them for a few weeks and last week...blam. Massive seizure while she's at work. I have to go grab her and drop her off at home, then I spent the rest of the day making sure she's okay. We went to her neurologist and brought the pills with us and he told us that was the problem - the FDA regulates the chemical composition of the drug, but they are allowed to be anywhere from 75% to 125% of the absorbtion rate of the brand name drug. So what had happened was these generics were being absorbed too quickly and processed by my wife's body too quickly resulting in the seizure. I was pretty po'd to say the least.

The neurologist wrote us a prescription for the brand name drug and filled out the "no substitutions" box, and I had to pay a pretty hefty co-pay when it was filled. Still, I'd pay the whole amount if I had to as long as my wife doesn't have any more seizures.

So, a word of warning to you all out there....

@Stephmo: Is a pharmacist allowed to double the script? My understanding was that they had no authority to go against doctor guidelines. Granted, your scenario seems significantly better than "just hoping" that there won't be problems down the line with other people getting involved in your dosing...