PL EN
REVIEW PAPER
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Tablet subdivision is a common practice among patients and doctors. Tablets can be divided into smaller parts to obtain the desired dose and adjust this dose to the actual needs of the patient. Manipulation of the drug dose is aimed at improvement of the effectiveness of pharmacotherapy, reduction of the occurrence of dose-dependent side effects, or minimization of treatment costs.

Objective:
The aim of the study is to discuss the available data concerning the problem of tablets subdivision, the precision of this practice and its safety for the patient.

Methods:
The following databases were searched: PubMed, Google Scholar, Embase using the appropriate key words: „splitting”, „subdivision”, „tablets”, „halves of tablets” (last search in June 2020).

State of knowledge:
Tablet subdivision is performed in the case of drugs requiring a gradual increase in the dose, and then, after a period of appropriate treatment, slowly reducing the dose in order to avoid the increased effects of the withdrawal syndrome resulting from the specific action of these drugs. This applies mainly to antidepressants, neuroleptics, hypnotics and sedatives, as well as anxiolytics used in psychiatric treatment. Parts of tablets are also easier to swallow, which is especially important for patients with swallowing problems (dysphagia). It is estimated that almost half of the population is unable to swallow tablets in full, mainly geriatric patients, children and patients with mental disorders.

 
REFERENCES (27)
1.
Jacques ER, Alexandridis P. Tablet scoring: Current practice, fundamentals, and knowledge gaps. Appl Sci. 2019; 9(15): 3066. https://doi.org/10.3390/app915....
 
2.
Bubić­Pajić N, Račić A, Gatarić B. Whole vs. Half­tablets: A case of Diazepam. Scr Med (Brno). 2019; 50: 153–160. https://doi.org/10.5937/script....
 
3.
Westmark S, Melgaard D, Rethmeier LO, et al. The cost of dysphagia in geriatric patients. Clin Outcomes Res. 2018; 10: 321–326. https://doi.org/10.2147/CEOR.S....
 
4.
Zaid AN, Ghoush AA, Al­Ramahi R, et al. Evaluation of the discrepancy between the European pharmacopoeia test and an adopted United States pharmacopoeia test regarding the weight uniformity of scored tablet halves: Is harmonization required? PDA J Pharm Sci Technol. 2012; 66: 20–27. https://doi.org/10.5731/pdajps....
 
5.
Somogyi O, Meskó A, Csorba L, et al. Pharmaceutical counselling about different types of tablet­splitting methods based on the results of weighing tests and mechanical development of splitting devices. Eur J Pharm Sci. 2017; 106: 262–273. https://doi.org/10.1016/j.ejps....
 
6.
Janiec W. Kompedium farmakologii. Warszawa: PZWL; 2015.
 
7.
Mascarenhas Starling F, Medeiros­Souza P, Francisco De Camargos E, et al. Tablet Splitting of Psychotropic Drugs for Patients with Dementia: A Pharmacoepidemiologic Study in a Brazilian Sample. Clin Ther. 2015; 37: 2332–2338. https://doi.org/10.1016/j.clin....
 
8.
Auricchio MT, Yano HM, Santos AP, et al. Evaluation of the content of atenolol tablets divided with a knife and homemade machine cutter. ACTA Paul Enferm. 2011; 24: 74–79. https://doi.org/10.1590/S0103­....
 
9.
Thong MY, Manrique YJ, Steadman KJ. Drug loss while crushing tablets: Comparison of 24 tablet crushing devices. PLoS One. 2018; 13(3): e0193683. doi: 10.1371/journal.pone.0193683.
 
10.
Seong S, Shin J, Kim D, et al. The effect of tablet splitting on the mass loss, uniformity, and stability: by hand or splitter? J Asian Assoc Sch Pharm. 2019: 8: 7–14.
 
11.
Habib WA, Alanizi AS, Abdelhamid MM, et al. Accuracy of tablet splitting: Comparison study between hand splitting and tablet cutter. Saudi Pharm J. 2014; 22: 454–459. https://doi.org/10.1016/j.jsps....
 
12.
Arnet I, von Moos M, Hersberger KE. Wrongly Prescribed Half Tablets in a Swiss University Hospital. Int J Clin Med. 2012; 3(7): 637–643. https://doi.org/10.4236/ijcm.2....
 
13.
Ashrafpour R, Ayati N, Sadeghi R, et al. Comparison of Treatment Response Achieved by Tablet Splitting Versus Whole Tablet Administration of Levothyroxine in Patients with Thyroid Cancer. Asia Ocean J Nucl Med Biol. 2018; 6: 108–112. https://doi.org/10.22038/aojnm....
 
14.
Wilczyński S, Koprowski R, Duda P, et al. Microtomographic studies of subdivision of modified ­release tablets. Int J Pharm. 2016; 511: 899–912. https://doi.org/10.1016/j.ijph....
 
15.
McDevitt JT, Gurst AH, Chen Y. Accuracy of tablet splitting. Pharmacotherapy. 1998; 18(1): 193–197.
 
16.
Eserian JK, Lombardo M. Evaluation of Quality Attributes of Propranolol Split Tablets: Focus on Dose Variability. Infarma – Ciencias Farm. 2017; 29: 371. https://doi.org/10.14450/2318­....
 
17.
Bridgeman PJ, Rynn KO. Medication reconciliation in the emergency department. Am J Health Syst Pharm. 2008; 65(24): 2325–2326, https://doi.org/10.2146/ajhp08....
 
18.
Green G, Berg C, Polli JE, et al. Pharmacopeial Standards for the Subdivision Characteristics of Scored Tablets. Pharmacopeial Forum. 2009; 35(6): 1598–1612. https://doi.org/10.13140/2.1.4....
 
19.
FDA (Food and Drug Administration). Guidance for Industry – Tablet Scoring: Nomenclature, Labeling, and Data for Evaluation. Cent Drug Eval Res. 2013; 5.
 
20.
Dülle M, Özcoban H, Leopold CS. Analysis of the powder behavior and the residence time distribution within a production scale rotary tablet press. Eur J Pharm Sci. 2018; 125: 205–214. https://doi.org/10.1016/j.ejps....
 
21.
Pereira GRS, Taveira SF, Cunha­Filho M, et al. The Effects of Fillers and Binders on the Accuracy of Tablet Subdivision. AAPS PharmSciTech. 2018; 19: 2929–2933. https://doi.org/10.1208/s12249....
 
22.
Rao Katakam LN. Split­Half Tablets: a Complete Review for Analytical Testing. Asian J Pharm Clin Res. 2019; 12(9): 27–38. https://doi.org/10.22159/ajpcr....
 
23.
Nagy B, Farkas A, Borbás E, et al. Raman Spectroscopy for Process Analytical Technologies of Pharmaceutical Secondary Manufacturing. AAPS PharmSciTech. 2019; 20(1): 1. https://doi.org/10.1208/s12249....
 
24.
Gómez DA, Coello J, Maspoch S. Raman spectroscopy for the analytical quality control of low­dose break­scored tablets. J Pharm Biomed Anal. 2016; 124: 207–215. https://doi.org/10.1016/j.jpba....
 
25.
Gut Y, Boiret M, Bultel L, et al. Application of chemometric algorithms to MALDI mass spectrometry imaging of pharmaceutical tablets. J Pharm Biomed Anal. 2015; 105: 91–100. https://doi.org/10.1016/j.jpba....
 
26.
Dingle TC, Butler­Wu SM. MALDI­TOF mass spectrometry for microorganism identification. Clin Lab Med. 2013; 33: 589–609. https://doi.org/10.1016/j.cll.....
 
27.
Helmy SA. Tablet splitting: Is it worthwhile? Analysis of drug content and weight uniformity for half tablets of 16 commonly used medications in the outpatient setting. J Manag Care Pharm. 2015; 21: 76–86. https://doi.org/10.18553/jmcp.....
 
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ISSN:2083-4543
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