Whether you're treating a chronic condition or trying to stock your medicine cabinet with the basics, medications can be pricey.
To cut costs, you may be considering splitting pills or taking a medication after it has expired (though staring down a bottle of Tylenol purchased during the Clinton administration can make even staunch stomachs uneasy). You may well be wondering if cutting pills or ignoring use-by dates is really safe.
As if often the case in medicine, that's a simple question with a long answer.
It's basic math: Cutting pills in half can make a bottle of medication last twice as long. And if you only need half a pill to get the job done, splitting seems to make sense.
Some medications lend themselves to being halved, but certain others should never be split, says Dr. Norman Tomaka, a clinical consultant pharmacist in Melbourne, Fla. Splitting extended-release capsules, for instance, would cause a dose that's intended to be administered over several hours to be ingested all at once. In some cases, that might result in nothing more than a stomachache. But with drugs such as anti-seizure medications that need to be constantly active in the body, a sudden dose that then tapers off quickly could pose serious health risks.
Liquid gelcaps and tablets that contain powder or granules should also remain intact, says Bill Soller, a professor of clinical pharmacy at UC San Francisco. In addition to being essentially impossible to halve, if broken these types of pills can create safety hazards. "A good part of this is common sense. I know someone who spilled the contents of a pill on the floor and the dog got it." (The dog in this case was fine.)
Cutting a pill in half also cuts the dose in half, and patients shouldn't reduce their dose of medication without consulting a doctor first, Soller says.
Pill splitting works best when a pill with double the dosage costs the same as one with half as much, says pharmacist Marilyn Stebbins, who runs an educational cost-saving clinic in Sacramento. She points to a common scenario: If a person taking 20 milligrams of a medication can get 40 mg pills for the same price, buying the higher dosage and splitting them will result in twice as many pills over time, without changing the person's prescription.
Though it seems counterintuitive from a business perspective, many companies do charge the same amount no matter the strength of the pill, in part because they don't want patients to get sticker shock every time their dose increases, Stebbins explains.
Anyone planning to cut pills in half should invest in a pill splitter, experts say. Pill splitters, available at most drugstores for about $5, reduce the likelihood of the tablet crumbling or splintering, which can happen when using knives and scissors. "Something like a steak knife, which can have a fairly sharp cutting edge, still puts so much pressure on top of that pill that you're crushing it at the same time that you're cutting it," Soller says.
Some pills are scored down the middle with a straight, indented line that makes them easier to split. But a pill doesn't need to be scored to be safely halved, Soller adds. Statin drugs for cholesterol and antidepressants such as Celexa can be split even though they aren't marked, he says. Because these medications are intended to build up slowly in the body, he explains, it doesn't matter if one half is slightly larger than the other.
Tomaka adds that pills should be split one at a time and that the remaining half should be taken the following day rather than splitting an entire bottle at once. This ensures that the inside of the tablets won't dry out or otherwise react with the air, he says.
In 1979, the Food and Drug Administration began requiring manufacturing companies to label medication with an expiration date.
Some pills have expiration dates lasting two years, but most new medications are good for about one year. These dates are based on lab tests that measure how quickly a drug breaks down under the conditions in which it's meant to be stored.
These tests, and the resulting dates stamped on bottles, represent the company's best estimate of how long a drug is guaranteed to be safe and effective. But medical and pharmaceutical experts agree that most medications aren't likely to stop working immediately after that date. "I don't know any particular instance where if you took a drug that was beyond the expiration date, there would be a safety problem the next day," Soller says.
The primary concern with expired medications is that they may have lost their potency, not that they may have turned toxic, Stebbins says. An exception, she notes, can be liquid medication or gelcaps, in which the product could potentially develop mold or become rancid, especially if left open or stored improperly.
Expiration dates are somewhat controversial. Some experts suspect that drug companies have used them as a way to sell more products; Soller notes that the staying power of some over-the-counter medications used to be a selling point for manufacturers. "The shelf life for Bayer aspirin was once 10 years," he says.
FDA tests of drugs stockpiled by the U.S. military have found that many were good for years past their expiration date — in a few cases, as long as 10 or even 15 years later. But Mansoor A. Khan, director of the FDA's division of product quality research, cautions that those results don't apply to the average consumer. He notes that the military keeps drugs in well-controlled conditions that are a far cry from a medicine cabinet in a steamy bathroom. "We cannot really ensure proper conditions for consumer products, which are stored differently, and opened and unopened," he says.
If you're concerned about pill splitting, expiration dates or any other medication issue, it's best to consult with a doctor or pharmacist on a case-by-case basis, Soller says. That way you can have "a reasonable assurance that you get what you paid for," he says. Without a dangerous surprise.