halving tablets. . .

[Mr Pharm S]

Can anyone clear up what the legal stance is on halving tablets.

Should we be dispensing tablets with the dose take half a tablet daily?

Are we and the GP breaking the product license agreement?

What about M/R tablets? does that mess up the releasing of the drug? (ISMN tablets, Monomil ivaxx brand, has in the P.I.L. that half a tablet may be given at the beginning of treatment as long as the tablet isnt crushed or chewed!)

Should we be contacting GPs to get them to change the Rx to allow a dose to be given in full tablet form? What if the dose they want to give isnt available in a full tablet?

Sorry for so many questions I really would like to clear up this grey area of daily dispensing!

Cheers guys!!!

[Rafael]

Re: halving tablets. . .

Should we be dispensing tablets with the dose take half a tablet daily?
Yes why not? sometimes we get such dosage and i see no problem with it.

Are we and the GP breaking the product license agreement?
not sure what do you mean here :P
What about M/R tablets? does that mess up the releasing of the drug? (ISMN tablets, Monomil ivaxx brand, has in the P.I.L. that half a tablet may be given at the beginning of treatment as long as the tablet isnt crushed or chewed!)
NEVER BREAK DOWN MR TABLETS, that's what we have been taught at uni, because of the reason you listed.

Should we be contacting GPs to get them to change the Rx to allow a dose to be given in full tablet form? What if the dose they want to give isnt available in a full tablet?

if it's to break an MR tablet on the beginning of treatment i.e 1st day, then dispense it as i believe they dr wanted them to get a moderate release kinetics rather than fast vs slow. if the dosage for a longer time, ring the prescriber.

Sorry for so many questions I really would like to clear up this grey area of daily dispensing!

btw don't take my msg so seriously, i am not a p'cist yet
Cheers guys!!!

[lamzee]

Re: halving tablets. . .

I was asked to cut proscar into quarters once for baldness........

[ramroum]

Re: halving tablets. . .

We always dispense Imdur (ISMN M/R) as half a tab... at hospital !!!!
I questioned it once and I was told that it was ok !!!!

What about tablets which are not scored, can patients break them in halves using the special tabs cutter??

[Fleegle]

Re: halving tablets. . .

I think this is one of those cases where common sense has to prevail. Halving tablets has always been part of the job, and I have never heard of anyone being lynched for doing it.

A favourite round here is Centyl 1.25mg (No K) so 2.5mg tabs require to be halved. I usually do this myself, and label "Take half a tablet daily. (TABLETS ARE ALREADY HALVED)".

It has worked so far.....I hope!

[johannes]

Re: halving tablets. . .

Hi,
in such cases first i consult the manufacurer's information.
In some cases modified release preparations can be split but not crushed.
Think omeprazole mups is such a thing?

I came across Lamzee's case. Turning a proscar into 4 propecias.
The problem with this is safety for the personel once the coating of the tablet is broken. We used the tablets to prepare capsules. (Legally this means manufacturing?) So dosing and handling for patients and carers is better.
(Ironically the patient was 22, but proscar was cheaper than propecia. - Regulations grrr)

[Steve G]

Re: halving tablets. . .

There are different ways of making an M/R tablet. ISMN M/R tabs work by a wax matrix, and splitting them in half preserves the matrix and you retain the modified release. ISMN M/R tabs are the only M/R tabs that I know can be split.

Breaking tablets would be outside the product license, but is widely done. In many cases you have a choice between breaking a tablet, which does have a product licence, and using an unlicensed special.

[Sir_Dispensalot]

Re: halving tablets. . .

in the past i've been asked to do it for mds trays - nothing worse when you get a crumbly tablet that just turns to powder in your pill splitter

[Zoggite]

Re: halving tablets. . .

. ISMN M/R tabs are the only M/R tabs that I know can be split.

Priadel (both strengths) and Tegretol Retard tablets can be split, too, and they're scored; there are probably more M/R tabs that can be split, but I can't think of them now.

[SolomonQ]

Re: halving tablets. . .

I follow the rule that if the tablet is scored, its ok to split it, even if MR, but wouldnt just do it if a normal Rx say, asked for a dose of 100mg priadel.

For a MDS id have to make sure the tablet split more or less equally. We've had nurses/carers requesting us to split any tablets that need to be, because they're not allowed to. I think this might be because of the product license business.

[Sir_Dispensalot]

Re: halving tablets. . .

We've had nurses/carers requesting us to split any tablets that need to be, because they're not allowed to. I think this might be because of the product license business.

sort of solly - it's more to do with the handling of medecines regs - carers have to do a course in the safe handling of meds before being allowed to administer them to service users - mds trays bypass these regs because the carer doesnt have to directly handle the meds from a packet for the patient (as you could probably appreciate a massive source of error for the pt.) .

The course costs money, of course, so a lot of care companies aren't willing to fork out for it so ask that all their service users are on an MDS or have a relative to give them their meds.

[SolomonQ]

Re: halving tablets. . .

i see what your saying, but in this case the carer was actually giving the medicine out of the MDS to the patient, the problem was paracetamol 500mg CAPLETS which were scored. the patient could swallow a whole tablet easily so the carers were breaking it in half for her, but then they got told they are not allowed to do that,

A nurse also recently told me, she wasnt allowed to apply even a plaster to a patient if she's visiting to administer the meds and the patient has previosly cut themselves accidently, and it needs attention.

my faith in these so called carers is quite low, quite recently one gave a morning dose to a patient at both morning and evening, somehow the carer misread the MDS box that was labelled quite nicley (one of those pillmate boxes), thankfully the patient was ok, i think that particular carer got away with a warning.

[Sir_Dispensalot]

Re: halving tablets. . .

i see what your saying, but in this case the carer was actually giving the medicine out of the MDS to the patient, the problem was paracetamol 500mg CAPLETS which were scored. the patient could swallow a whole tablet easily so the carers were breaking it in half for her, but then they got told they are not allowed to do that,

still same guidelines set i'm afraid - the breaking of the tablet comes under the 'handling of meds' specifications - ie the carers aren't allowed to chop/snap/break anything coming out of the mds before giving to the patient. BUT a good opportunity for an MUR or phone call to gp to ask about different form eg dispersible tabs if the patient is having swallowing difficulties - if the pt is struggling with paracetamol caplets, what other meds might they struggle swallowing?

just something to get the ol' brain juices flowing

[Sir_Dispensalot]

Re: halving tablets. . .

my faith in these so called carers is quite low, quite recently one gave a morning dose to a patient at both morning and evening, somehow the carer misread the MDS box that was labelled quite nicley (one of those pillmate boxes), thankfully the patient was ok, i think that particular carer got away with a warning.

Nothing wrong with care companies providing the treatment plans they have for their service users are carried out properly - the carer involved in your case mustn't have read the care plan properly or the company involved wasn't following proper SOPs and updating the service user's care plan...

(sorry i get this chapter and verse from Lady_Dispensalot - she works for a care company)