A Florida pharmacist has hit upon an antidote to the skyrocketing cost of some prescription drugs: splitting the tablets in half.

David Parra, a clinical pharmacist at the West Palm Beach VA Medical Center, tells WebMD that tablet splitting of one popular cholesterol-lowering drug alone can save people more than $850 a year. If you’re taking multiple prescription drugs that lend themselves to the practice, the savings could be even greater.

He presented his findings at the annual meeting of the American Heart Association.

Many prescription drugs are available in higher-dose tablets for the same price as lower-dose tablets, he says. By splitting the higher-dose tablets in half, people can get their usual dose for about half the cost. For example, if someone’s doctor says he or she needs 20 milligrams of Zocor to lower cholesterol, the doctor can write a prescription for 40 milligrams and the patient can split the pill in half. That way, the prescription would last for 60 days.

The Department of Veterans Affairs saved $46.5 million in 2003 by having eligible patients split their tablets of the popular cholesterol-lowering statin drug Zocor, he says.

Parra’s study shows that taking split tablets of the cholesterol-lowering drug Zocor works just as well as swallowing them whole. The research was supported by the VA.

In a one-year study of more than 1,000 people with similar starting cholesterol levels, "bad" LDL cholesterol dropped to a similar degree (about eight points) in those who took the split tablets and those who continued on their whole tablets.

Importantly, the practice was safe, with no differences seen in adverse side effects in people who practiced the prescription tablet splitting.

Based on the study, the VA implemented the prescription tablet-splitting program throughout the network. In 2003, 86 percent of eligible Zocor prescriptions in VA nationwide were split. As an example of the potential savings to an individual, Parra notes that one pharmacy chain in his area charges $148 for a one-month supply of both 40-milligram and 80-milligram tablets of Zocor; the savings for one person prescribed 40 milligrams who splits an 80-milligram tablet could be more than $850 per year, he says.

Check With Your Doctor

Parra cautions that it is extremely important to check with your doctor before splitting prescription drugs as some medications, such as time-release or specially coated tablets, can be altered in the process. He says that one reason why statins are a good candidate for tablet splitting is that to be effective the dose doesn't have to be as exact as with some other classes of drugs.

Also, people who suffer from certain medical conditions, such as tremor or visual impairment, might find it difficult to split their tablets, he notes.

Sidney C. Smith Jr., MD, past president of the American Heart Association and director of the Center for Cardiovascular Science and Medicine at the University of North Carolina at Chapel Hill, tells WebMD that he thinks tablet splitting is one innovative way to slash the cost of prescription drugs.

People should also be aware of other cost-cutting measures, Smith says. For example, another study presented at the meeting this week shows that adding the fiber supplement Metamucil to your diet lowers LDL the same amount as doubling the dose of statin cholesterol-lowering drugs such as Zocor.

And ask questions, Smith advises. “Ask your doctor about other brands; find out what your program covers. And of course, ask how the cost varies from dose to dose before deciding whether to tablet split."

By Charlene Laino, reviewed by Brunilda Nazario, MD

SOURCES: American Heart Association Scientific Sessions 2004, New Orleans, Nov. 7-10, 2004.David Parra, PharmD, West Palm Beach VA Medical Center, Florida. Sidney C. Smith Jr., MD, past president, American Heart Association; director, Center for Cardiovascular Science and Medicine, University of North Carolina at Chapel Hill.