Related Experiment Video
Updated: Aug 6, 2026
04:53
A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
Clinical inquiries. Which medications can be split without compromising efficacy and safety?
John Noviasky1, Vincent Lo, Diane D Luft
1St. Elizabeth Medical Center, Utica, NY, USA.
The Journal of Family Practice
|August 3, 2006
Summary
Splitting lisinopril tablets for hypertension and statin medications for cholesterol is effective. However, avoid splitting extended-release or enteric-coated tablets, as accuracy varies with the splitting method.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Evidence-Based Medicine
Background:
- Tablet splitting is a common practice to achieve lower or customized medication doses.
- Concerns exist regarding the efficacy and safety of split tablets compared to whole ones.
Purpose of the Study:
- To evaluate the effectiveness of split versus whole tablets for common medications.
- To identify tablet characteristics and factors influencing the accuracy of tablet splitting.
Main Methods:
- Review of evidence including randomized crossover studies and retrospective cohort studies.
- Analysis of observational studies on tablet splitting accuracy and factors affecting it.
Main Results:
- Split lisinopril tablets are as effective as whole tablets for hypertension (SOR: B).
- Split atorvastatin, lovastatin, and simvastatin are effective for cholesterol lowering (SOR: B).
- Extended-release, enteric-coated, or inaccurately splittable tablets are not recommended for splitting (SOR: C).
Conclusions:
- Tablet splitting is a viable option for certain immediate-release medications like lisinopril and statins.
- Care must be taken to avoid splitting inappropriate formulations, and splitting accuracy depends on technique and tools.
Related Concept Videos
01:22Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence
Generic intravenous (IV) drugs are considered bioequivalent to their branded counterparts due to their 100% bioavailability upon administration. However, variations in stability among different drug products can significantly influence their therapeutic performance, even if they are pharmaceutically equivalent.Cefuroxime, a prophylactic antimicrobial, is often used as a single-dose IV injection for patients undergoing coronary artery bypass grafting surgery. A 3 g dose typically provides...
01:20Factors Affecting Dissolution: Drug Permeability, Stability and Stereochemistry
Orally administered drugs primarily enter the systemic circulation via passive diffusion through the intestinal membranes. The drug's absorption is influenced by drug stability in the gastrointestinal GI tract, membrane permeability, the surface area available for absorption, luminal drug concentration, and residence time in the lumen. Drug permeability can be enhanced by adjusting the lipophilicity, polarity, or molecular size of the drug, promoting its passive transport across intestinal...
01:09Bioequivalence of Drugs: Drugs with Multiple Indications
The concept of therapeutic equivalence (TE) in drugs with multiple indications is complex. A generic drug may be therapeutically equivalent to a brand-name product for one specific indication, but this doesn't necessarily mean it's equivalent for all other indications. Evidence of TE in one patient group and bioequivalence shown in healthy volunteers can support—but not confirm—TE for other indications. However, definitive proof requires individual clinical studies for each indication due to...
01:13Bioequivalence studies: Biowaivers
In certain scenarios, in vitro dissolution tests can replace in vivo bioequivalence studies. This is particularly true when a drug product, though available in varying strengths, maintains proportional similarity in its active and inactive ingredients. In such cases, the need for in vivo bioequivalence studies for lower strength variants may be waived, provided dissolution tests and in vivo studies on the highest strength yield satisfactory results.Bioequivalence can be indicated through...
01:27Pharmaceutical Alternatives: Polymorphic Form-Related and Particle Size-Related Therapeutic Nonequivalence
Changes in polymorphic forms can significantly influence the bioavailability of poorly soluble drugs. Although the FDA defines pharmaceutical equivalence based on having the same active ingredient, dosage form, and route of administration, it does not automatically disqualify products with different polymorphic forms. This means two products with different polymorphs can still be deemed pharmaceutically equivalent. However, polymorphic differences can affect properties like wettability,...
01:21Factors Affecting Drug Response: Overview
When it comes to infants and young children, they are typically administered smaller doses of medication in comparison to adults. This is primarily because their organ functions still need to fully develop, meaning their bodies are not as efficient at metabolizing or eliminating drugs. Additionally, their blood-brain barrier is more permeable than in adults. As a result, high concentrations of drugs can easily penetrate the central nervous system (CNS), potentially leading to neurological...