Posted by Sunnely on August 14, 2001, at 23:17:37
In reply to Wellbutrin SR Side Effects and Pill Splitting, posted by Remi on August 14, 2001, at 5:35:00
Pill splitting is a relatively common practice and is often required by HMOs. Despite its commonality, a group of patients and one physician filed a class action lawsuit against Kaiser Permanente last December (2000), claiming that the HMO's mandatory pill-splitting policy endangers patients' health.
Many studies have shown that splitting pills-particularly splitting of psychotropic medications-offers great cost savings. A recent study of 12 new-generation psychotropic medications found that splitting pills can produce an annual savings of up to $1.45 billion, which represents approximately 10% of the retail sales of the drugs.
Pill splitting is useful when a lower dose of a particular medication is desired, particularly in the elderly population.
Also, when a patient is beginning a psychotropic medication, the psychiatrist may want the patient to begin at a lower dose. Pill splitting is also helpful in dose adjustment for a patient.
Doctors feel more comfortable with pill spitting when the pill has been scored and is designed to be split. Some pills, though, have a very hard or round surface and lack an indentation, making it difficult to split.
However, there are some formulations whose intent would be obviated by splitting. That would be the case with sustained-release formulations, such as venlafaxine (Effexor) XR, bupropion (Wellbutrin) SR, and divalproex sodium (Depakote) ER. These formulations are designed to permit gradual absorption of the medication. Splitting such a pill essentially destroys that goal. In that instance, there can be problems such as loss of efficacy and withdrawal problems.
Cost remains a driving force behind the practice. Sometimes HMOs take the initiative and require pill splitting to cut costs. Sometimes the patient requests it if they are paying for their medications out of pocket.
Some have even suggested that manufacturers reduce the costs of smaller tablets to prevent the need to consider such practices as pill splitting. In a statement, Kaiser said the real issue is "the skyrocketing cost of pharmaceuticals that too often puts life-saving medications beyond the reach of many patients," and spill splitting "can help preserve access to comprehensive, high quality drug benefits without impairing the quality of care."
The American Medical Association, the American Society of Consultant Pharmacists, and the American Pharmaceutical Association oppose policies that require pill splitting, citing health risks associated with improper dosing. In addition to psychotropic medications, antihypertensives (blood-pressure lowering drugs) and antibiotics are also commonly split.
>Can 100mg or 150mg pills be split to dial in a comfortable dosage w/o stomach harm? I prefer the SR due to the lower seizure incidence. I take a 100mg pill in am, then half of one in evening in hopes of spreading out the dosage and easing this side effect. I will probably drop to 100mg until I pass through this stage.
poster:Sunnely
thread:75031
URL: http://www.dr-bob.org/babble/20010814/msgs/75107.html