Tablet separation is traditionally used in pharmaceutical practice to select the required dose of the drug if the dosage form with the required dose is not available. It is also used to reduce the cost of therapy. Although such practice brings certain economic benefits, there are doubts as to the accuracy of the dosage, adherence and clinical results of the therapy.

Sometimes separation of the tablets is necessary. This is a recognized method of obtaining the required dose if it is not available in the form of a finished dosage form, which can occur in a number of circumstances:

Sometimes this practice is caused by economic reasons. The current pricing policy is such that many drugs have similar or similar unit prices. Thus, the cost of the cure can be reduced by almost 50% by separating the tablets with a concentration which exceeds the 2 times necessary.

Opponents of this procedure put forward a number of arguments, the main one being the inability to guarantee the correct dosage of the drug. The correct division of the tablet is influenced by many factors, including its size, shape, characteristics, separation technique and devices used for this, the capabilities and experience of the person performing the operation. Even in tablets separated by a pharmacist, the dose may differ from the ideal. In one study, 5.7% of the halves of the tablets divided by the pharmacists were shown to differ from the ideal weight by more than 15% and only 7 (31.8%) of the 22 fragments met the standards of the American Pharmacopoeia. Not surprisingly, even larger differences are seen when patients share the pills themselves. However, how important is this fact? A number of studies have been undertaken to compare the clinical effectiveness of therapy in patients receiving the same dose of whole and divided tablet medication, in which there was no difference in effectiveness. of the two treatment regimens.

In addition, no negative effects of tablet separation practices on compliance were identified. A survey was carried out among 1,617 patients, all of whom noted no problem related to the separation of the tablets. In addition, only 4% of respondents said that the need to share pills had reduced their desire for treatment. A survey of patients participating in another study showed their willingness to follow the procedure if it led to a reduction in the cost of treatment, despite some drawbacks. In contrast, 97% of the volunteers who participated in the tablet separation study preferred to use official drugs with lower doses of the drug, and 77% were willing to pay for it.

Separation of tablets by pharmacists can increase compliance, but this procedure has certain material costs. It has been shown that separating a tablet takes an average of 5 seconds. Given the hourly cost of labor for a pharmacist (according to a Canadian study), the cost of separating a tablet is approximately 10 cents Canadian. In the event that the patient divides the pills on their own, obtaining preliminary instructions may reduce the error rate during the procedure, however, the pharmacist spends approximately 1 minute of working time explaining to each patient, which is equivalent to 1 Canadian dollar in monetary terms. Tablet separators cost from 6 to 10 Canadian dollars.

In addition, although the potential separation of tablets promises significant economic benefits, only for a small number of commonly used drugs, separation is not only possible, but also brings economic benefits. These drugs should have the following characteristics:

Of the 200 most commonly used drugs in Canada (1998 data), only 14 met the criteria listed above. A similar study in the United States found 11 of these drugs. These include ACE inhibitors (enalapril, lisinopril), statins (atorvastine, lovastine, pravastine), antidepressants (cialopram, paroxetine, nefazadone), antipsychotics (olanzapine, risperidone) and several other drugs ( warfarin, clonazazepam, doc.

As practice shows, separation of the tablets is done more often for clinical than economic reasons. The economic advantage of separating the 11 most exposed drugs in the United States does not exceed 2%.

To summarize the above, we can conclude that the introduction of tablet separation in mainstream practice as a means of reducing the cost of therapy is not economically justified and can create a number of problems, such as drug misuse, incorrect drug dosing associated with tablet separation errors and reduced adherence. Such a practice should only be applied in certain clinical situations in order to select the necessary dose of the drug.