Tablet splitting practice among patients in Kemaman, Terengganu: An exploratory study on practical issues and their association with medication adherence.
Keywords:tablet cutting, splitting technique, medication splitting, medication adherence
Introduction: The practice of tablet cutting is influenced by tablet shape and size, splitting technique, device used and human competency. Difficulties upon tablet cutting could affect patients' medication adherence, resulting in overdose or under-dose therapy. This study aimed to; 1) evaluate patients' practice in tablet cutting, 2) identify problems associated with tablet cutting, and 3) assess the association between tablet cutting related difficulties with medications adherence.
Method: A cross-sectional survey was conducted among patients and caregivers aged over 18 years old, with prescription written at least one medication required to be split. Data were obtained from eight health clinics across the Kemaman district from July to September 2020. Trained pharmacists conducted face-to-face structured interviews. This study used a validated questionnaire consisting of three sections: the sociodemographic, practice of tablet cutting and medication adherence. Descriptive and non-parametric tests (SPSSv.26) were used for analysis with p<0.05 set as statistically significant.
Results: The study recorded 383 returned questionnaires with a response rate of 95.8%. The most common technique used was kitchen knife (40.5%) followed by hand breaking (35.8%), scissors (12.8%) and tablet cutter (7.3%). 64.2% perceived they achieved an equal half split after cutting their medications. 25.3% claimed medication to be ruined or broken after splitting. 12.8% took the whole tablet instead of following the required dose because of splitting difficulty and 25.1% discarded parts of their tablets when splitting did not result in equal half based on their perspective. There was no association between practical problems of tablet cutting with medication adherence.
Conclusion: In conclusion, knife is the most favourable tablet splitting technique but there is no consensus on the best technique for tablet splitting. In order to overcome problems encounter by patient on tablet splitting, healthcare providers should make every effort to use commercially available oral tablet if available. However, if tablet splitting is still necessary, counselling by pharmacist is compulsory to ensure quality of medication and to optimize patient’s adherence as well as medication therapy.
Akram, A., Moawia, A.T., Zain, A.S., & Zainab, A. (2018). Tablet Splitting: Public Perception and Quality Attributes of Two Common Cardiovascular Drugs. Research Jour. Of Pharm and Tech., 11(12): 5562- 5568. Doi:10.5958/0974-360X.2018.01012.0.
Arnet, I., & Hersberger, K.E. (2010). Misleading score-lines on tablets: facilitated intake or fractional dosing? Swiss Med Wkly;140(7-8):105–10.
Ashrafpour, R., Ayati, N., Sadeghi, R., Namdar, S.Z., Ayati, N., Ghahremani, S., & Zakavi, S. R. (2018). Comparison of Treatment Response Achieved by Tablet Splitting Versus Whole Tablet Administration of Levothyroxine in Patients with Thyroid Cancer. Asia Oceania journal of nuclear medicine&biology,6(2),108–112. Doi: 10.22038/aojnmb.2018.26793.1187.
AstraZeneca. (2019). Betaloc ZOK : Package leaflet. Sweden: AstraZeneca AB.
Best Practices for Tablet Splitting. (2013). Food and Drug Administration. Retrieved December 1, 2020, from https://www.fda.gov/drugs/ensuring-safe-use-medicine/best-practices-tablet-splitting.
Bosworth, H.B., Brown, J.N., Danus, S., Sanders, L.L., McCant, F., Zullig, L.L., Olsen, M.K. (2017). Evaluation of a packaging approach to improve cholesterol medication adherence. Am J Manag Care;23(9): e280–6.
Carnaby-Mann, G. & Crary, M. (2005). Pill Swallowing by Adults With Dysphagia. Arch and Otolaryngol Head Neck Surg.131: 970-975. Doi: 10.1001/archotol.131.11.970
Chaudhri, K., Kearney, M., Tanna, G.L.D., Day, R.O., Rodgers, A., & Atkins, E.R. (2019). Does splitting a tablet obtain the accurate dose? : A systematic review protocol. Medicine. 98. e17189. 10.1097/MD.0000000000017189.
Clark, T.R. (2002). Tablet splitting for cost containment American Society of Consultant Pharmacists, August 2002. Retrieved from www.ascp.com/advocacy/briefing/tabletsplittingcontainment.cfm
Denneboom, W., Dautzenberg, M.G.H., Grol, R., & Smet, P.A.G. (2005). User-related pharmaceutical care problems and factors affecting them: the importance of clinical relevance. J. Clin. Pharm. Ther. 30, 215–223. doi: 10.1111/j.1365-2710.2005.00636.x
Elliott, I., Mayxay, M., Yeuichaixong, S., Lee, S. J., & Newton, P. N. (2014). The practice and clinical implications of tablet splitting in international health. Tropical medicine & international health: Tropical Medicine and International Health, 19(7), 754–760. Doi:10.1111/tmi.12309.
Eserian, J.K., Lombardo, M., Chagas, J.R., & Golduroz, J.C.F. Actual versus expected doses of half tablets containing prescribed psychoactive substances: a systematic review. Prim Care Companion CNS Disord. 2018;20(1):17r02211. Doi: 10.4088/PCC.17r02211
Freeman, M.K., White, W., & Iranikhah, M. (2012). Tablet Splitting: A Review of Weight and Content Uniformity Part 1 of a 2-Part Series. Next month: Table Splitting—A Review of the Clinical and Economic Outcomes and Patient Acceptance. The Consultant Pharmacist, 27(5):341–52. Doi:10.4140/TCP.n.2012.341.
Gee, M., Hasson, N.K., Hahn, T., & Ryono, R. (2002). Effects of a tablet-splitting program in patients taking HMG-CoA reductase inhibitors: analysis of clinical effects, patient satisfaction, compliance, and cost avoidance. Journal of Managed Care Pharmacy. 8:453–458. Doi: 10.18553/jmcp.2002.8.6.453.
Gharaibeh, S.F., Tahaineh, L.M., & Khasawneh, A.H. (2018). Tablet splitting practice in Jordan. Jour. Of Pharmaceutical Health Services Research, 9: 373- 379. Doi: 10.1111/jphs.12258.
Grissinger, M. (2010). Tablet Splitting—Only If You "Half" To. Pharmacy and Therapeutics, 35(2): 69–70.
Habib, W.A., Alanizi, A.S., Abdelhamid, M.M., & Alanizi, F.K. (2014). Accuracy of tablet splitting: comparison study between hand splitting and tablet cutter. Saudi Pharm J; 22:454–9. Doi: 10.1016/j.jsps.2013.12.014.
Marquis, J., Schneider, M. P., Payot, V., Cordonier, A. C., Bugnon, O., Hersberger, K.E., & Arnet, I. (2013). Swallowing difficulties with oral drugs among polypharmacy patients attending community pharmacies. Int J Clin Pharm;35 (6):1130–6. Doi: 10.1007/s11096-013-9836-2.
Mosena, M.S., & Merwe, E. (2009). The appropriateness and risks of tablet splitting. SA Pharmaceutical Journal. 76. 30-36.
Novartis (2005). Diovan: International Package leaflet. Switzerland: Barbara Bolliger.
Quinzler, R., Szecsenyi, J., & Haefeli, W.E. (2007). Tablet splitting: patients and physicians need better support. European Jour. Of Clin. Pharmacology, 63: 1203-1204. Doi: 10.1007/s00228-007-0382-5.
Samsiah, A., Othman, N., Jamshed, S., Hassali, M.A., & Mohaina, W.M.W. (2016). Medication errors reported to the National Medication Error Reporting System in Malaysia: a 4-year retrospective review (2009 to 2012). European Jour. Of Clinical Pharmacology, 72(12):1515-1524. Doi:10.1007/s00228-016- 2126-x
Shah, R. B., Collier, J. S., Sayeed, V. A., Bryant, A., Habib, M22221. J., & Khan, M. A. (2010). Tablet splitting of a narrow therapeutic index drug: a case with levothyroxine sodium. AAPS PharmSciTech, 11(3), 1359–1367. Doi:10.1208/s12249-010-9515-8.
Verrue, C., Mehuys, E., Boussery, K., Remon, J.P., & Petrovic, M. (2010). Tablet-splitting: a common yet not so innocent practice. Jour. Of Advanced Nursing, 67:26-32. Doi: 10.1111/j.1365-2648.2010.05477. x.
Wright, D. (2002). Tablet crushing is a widespread practice but it is not safe and may not be legal. Pharmaceutical Journal; 2
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