Chronic pain 7/2/04

SLICE MEDICATIONS
BUY ONE, GET ONE FREE! How many times have you seen that slogan advertised by grocery stores or mass merchandisers?It exemplifies the quintessential American good deal.Years ago, when Viagra® was first introduced, some of my patients who hadbeen happy with the 50 mg dose started asking me for the 100 mgtablets. They explained that both the 50 mg and 100 mg tablet costabout $10 each.They wanted the 100 mg dosage so that they couldslice the tablet into two 50 mg parts—effectively doubling the num-ber of doses for the same cost.
Most consumers do not realize that some medications are pre- pared to be sliced into two equal parts. Known as scored tablets, theyhave an indentation in the middle so that they may easily be cut intotwo equal pieces. Many other tablets that are not scored can also besliced into two equal parts.
As we have seen, most of the cost of drugs goes into research, development, and promotional expenses. Because the manufacturingand ingredients are relatively inexpensive, different doses of a drug frequently cost the same. If you take a 40 mg daily dose of a medicationand the cost of the 80 mg tablet is identical to the cost of the 40 mgtablet—as it frequently is—you can divide the 80 mg tablet into twoparts and cut your cost by 50 percent.This is how you can buy one doseand get one dose free. Many drugs should not be sliced, however, andpatients must consult with their physician and pharmacist before slicing medications. Some drug companies, pharmacies, and managedcare plans may consider slicing medications to be inappropriate, but Ido not know of any laws that prohibit pill slicing.
From Drugs for Less. 2005. For more information please call 1-800-528-2550.
The Effects of Various Doses of Medications
Interestingly, doubling the dose of a drug usually does not double its
effect. Lipitor®, the best-selling drug in the world, with annual sales
approaching $10 billion, illustrates this point. Lipitor® is a choles-
terol-lowering drug that reduces the “bad” LDL cholesterol in the
body. A 10 mg dose of Lipitor® reduces LDL cholesterol by 39 percent.
Doubling the Lipitor® dose to 20 mg produces a reduction of LDL
cholesterol of 43 percent—only 4 percent more than the 10 mg dose!
Most other medications have similar “dose response” characteristics.
DOSES OF LIPITOR® AND PERCENT LDL REDUCTION
% LDL REDUCTION 20
LIPITOR® DOSE (IN MG)
Note: Lipitor® is available only in 10, 20, 40, and 80 mg doses, shown in bold in the graph above.
Savings on Different Doses
Pharmaceutical companies will sometimes set flat pricing—i.e., iden-tical pricing for different dosages—for some of their drugs in order todiscourage patients from switching to a different medication due tocost concerns when a higher dosage is needed.The prices for differ-ent dosages of Lipitor® obtained in early 2005 from the Costcoonline pharmacy are given in the following table with a cost per 10mg dose calculated. While the price paid for an individual 10 mgdosage varies widely, the price paid for a 20 mg, 40 mg, or 80 mgtablet is nearly identical.
From Drugs for Less. 2005. For more information please call 1-800-528-2550.
Prices of Lipitor®
PRICE PER 100 TABLETS
PRICE PER 10 MG
Let’s assume that you need a 35 percent reduction in your LDL cholesterol and are taking Lipitor®. As shown in the graph, a 10 mgdose of Lipitor® will accomplish the goal, and a higher dose of Lipi-tor® may be extra medication that is not required.Theoretically, if youpurchased 100 Lipitor® 80 mg tablets and neatly divided each tabletinto eight equal pieces, the $315.27 spent on the 80 mg tablets wouldprovide enough medication to lower your LDL cholesterol for morethan two years. From a practical point of view, you should not slicepills into eighths; however, an inexpensive pill cutter can readily slicetablets into halves.
Some thrifty patients split all of their medications. For example, 53-year-old George is a hard-driving businessman trying to keep hiscompany afloat. George takes Toprol-XL® for hypertension, Lipitor®for his high cholesterol, and Viagra® (even though he doesn’t reallyneed it). George owns his own company, and his health insuranceplan doesn’t have good prescription drug benefits. Knowing that adollar not spent on expenses, including prescription drugs, is an addi-tional dollar in profit, George splits all of his medications.
Like other patients mentioned earlier in the chapter, he splits his 100 mg tablet of Viagra® into two pieces as well as his Lipitor® 80 mgtablet into two pieces. His Toprol-XL® 100 mg tablets are scored, soit very easy to divide them into two tablets. George effectively cutshis drug bill in half, paying for one dose and getting one dose free. Hesaves more than $1,000 annually by doing this, money he puts into hisbusiness or his pocket.
If you choose to slice tablets, be very careful about the dose your doctor wants you to take. Use a pill cutter with a clear cover and a V-shaped tip to allow for careful positioning of the pill in the cutter.
From Drugs for Less. 2005. For more information please call 1-800-528-2550.
Medications That Should Not Be Sliced
Slicing tablets is not a useful technique for all medications. For example,
some drugs use different mechanisms to delay the release of the drug so
that the drug needs to be taken once daily. Many of these kinds of drugs
end in CD (controlled-delivery), CR (controlled-release), ER (extended-
release), LA (long-acting), SR (sustained-release), or XL (extended-
release).In most cases,slicing the tablet harms the time-release mechanism
and should not be done. Examples of time-released medications not suit-
able for slicing include the following: Cardizem CD, Effector XR, and
Glocotrol XL. Generic versions of each of these medications are available
in non-time-released formulations. Calan SR and Toprol-XL are among
the few time-released medications that are scored and suitable for slicing.
No time-released medications should be crushed or chewed.
Although slicing capsules is not practical, some authors encourage their readers to save money by opening a capsule, dividing the gran-ules into halves, then replacing half of the granules into a new cap-sule. I don’t advise anyone to try this technique because it is too easyto lose granules or to mismeasure them. Stick to dividing tablets.
In addition, antibiotics generally should not be split, and I do not favor slicing medications used to treat memory loss or psychosis.
Some common medications that are not suitable for slicing include:Nexium®, Prilosec®, Prevacid®, Celebrex®, Altace®, Aciphex®, andsublingual nitroglycerin.
Again, be sure to discuss slicing tablets with your physician before- hand.Your doctor will know whether your medications are suitablefor slicing and will need to write your prescription at a higher dosethan what you are supposed to take.
Medicines That May Be Sliced
BRAND NAME
GENERIC NAME
DOSES SUITABLE
GENERAL COMMENTS
FOR SLICING
From Drugs for Less. 2005. For more information please call 1-800-528-2550.
Medicines That May Be Sliced cont.
BRAND NAME
GENERIC NAME
DOSES SUITABLE
GENERAL COMMENTS
FOR SLICING
No tablets are scored.
The 180 mg tablet is
time-released and is
not suitable for slicing.
irbesartan/HCTZ 150/12.5, and 300/12.5 mg No tablets are scored.
1/500, 2/500, 4/500g, No tablets are scored.
Benicar HCT™ olmesartan/HCTZ 20/12.5, 40/12.5, The 10 mg and 20 mg tablets are scored.
From Drugs for Less. 2005. For more information please call 1-800-528-2550.
Medicines That May Be Sliced cont.
BRAND NAME
GENERIC NAME
DOSES SUITABLE
GENERAL COMMENTS
FOR SLICING
5/10, 5/20, 5/40, 5/80, No tablets are scored.
The 80 mg and 120 mg
tablets are scored. Calan SR®
is available as 120 mg,
180 mg, and 240 mg
sustained-release
caplets; the 180
mg and 240 mg caplets
are scored.
12.5, 25, 50, and 100 mg All tablets are scored.
The 20 mg and 40 mg tablets are scored.
From Drugs for Less. 2005. For more information please call 1-800-528-2550.
Medicines That May Be Sliced cont.
BRAND NAME
GENERIC NAME
DOSES SUITABLE
GENERAL COMMENTS
FOR SLICING
Slicing medications used
to thin the blood without
careful monitoring is
strongly discouraged
and may lead to serious
problems with the blood
being too thin or too
thick.
Detrol® LA is available
as 2 mg and 5 mg
capsules not suitable for
slicing.
40, 80, 160, and 320 mg No tablets are scored.
All tablets are scored.
Effexor XR® is
available as 37.5 mg,
75 mg, and 150 mg
extended-release
capsules not suitable
for slicing.
From Drugs for Less. 2005. For more information please call 1-800-528-2550.
Medicines That May Be Sliced cont.
BRAND NAME
GENERIC NAME
DOSES SUITABLE
GENERAL COMMENTS
FOR SLICING
All tablets are scored.
Glucotrol XL® is
available as 2.5 mg,
5 mg, and 10 mg
extended-release
tablets not suitable for
slicing.
500, 850, and 1000 mg No tablets are scored.
Glucophage XR® is
available as 500 mg
and 750 mg extended-
release tablets not
suitable for slicing.
50/12.5 and 100/25 mg No tablets are scored.
Inderal® LA is available
as 60 mg, 80 mg, 120
mg, and 160 mg sus-
tained-release capsules
not suitable for slicing.
From Drugs for Less. 2005. For more information please call 1-800-528-2550.
Medicines That May Be Sliced cont.
BRAND NAME
GENERIC NAME
DOSES SUITABLE
GENERAL COMMENTS
FOR SLICING
The 80 mg tablet is
extended-release and
not suitable for slicing.
Slicing medications used
to treat hypothyroidism
without careful
monitoring is discouraged.
Lotensin HCT® benazepril/HCTZ 5/6.25, 10/12.5, 20/12.5, and 20/25 mg All tablets are scored.
37.5/25 and 75/50 mg All tablets are scored.
Micardis HCT® telmisartan/HCTZ 40/12.5, and 80/12.5 mg No tablets are scored.
From Drugs for Less. 2005. For more information please call 1-800-528-2550.
Medicines That May Be Sliced cont.
BRAND NAME
GENERIC NAME
DOSES SUITABLE
GENERAL COMMENTS
FOR SLICING
Monopril® HCT fosinopril/HCTZ 10/12.5 and 20/12.5 mg No tablets are scored.
The 600 mp and 800 mg
tablets are scored.The
100 mg, 300 mg,
and 400 mg capsules
are not suitable for
slicing.
The 10 mg and 20 mg
tablets are scored. The
12.5, 25, and 37.5 mg
controlled-release
tablets are not suitable
for slicing.
2.5, 5, 10, 30, and 40 mg The 5 mg tablets are The 15 mg and 30 mg
tablets are scored.
Remeron® SolTab, a tablet
that disintegrates quickly,
is available as 15, 30,
and 45 mg doses and is
not suitable for slicing.
From Drugs for Less. 2005. For more information please call 1-800-528-2550.
Medicines That May Be Sliced cont.
BRAND NAME
GENERIC NAME
DOSES SUITABLE
GENERAL COMMENTS
FOR SLICING
112, 125, 150, 175, 200, Slicing medications used
and 300 mcg
to treat hypothyroidism
without careful
monitoring is discouraged.
eprosartan/HCTZ 600/12.5 and 600/25 mg No tablets are scored.
25, 50, 100, and 200 mg All tablets are scored and may be sliced into two equal pieces. They should not be crushed or chewed.
5/12.5 and 10/12.5 mg No tablets are scored.
The 2.5 mg and 5 mg tablets are scored.
Slicing VytorinTM produces
a dosage different than
the commonly
prescribed dosages.
From Drugs for Less. 2005. For more information please call 1-800-528-2550.
Medicines That May Be Sliced cont.
BRAND NAME
GENERIC NAME
DOSES SUITABLE
GENERAL COMMENTS
FOR SLICING
All tablets are scored.
The 0.5 mg, 1 mg, 2
mg, and 3 mg tablets
of Xanax XR® are
extended-release and
not suitable for slicing.
2.5, 5, 10, 30, and 40 mg No tablets are scored.
From Drugs for Less. 2005. For more information please call 1-800-528-2550.

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