Many people split their pills for various reasons, from attempting to save money to being unable to swallow, especially if they are older adults or have had a stroke (dysphagia).
One study suggests that 1 in 4 people cut their pills in half.
As a geriatric pharmacist, I see this a lot in my patients.
So, since this is a common practice, you’re probably thinking, ‘Surely, there’s no harm in cutting my Eliquis tablet in half, right?’ Well, not so fast.
Although it may seem like a simple solution to adjusting your dosage, the truth is that cutting Eliquis (apixaban) tablets in half can lead to potential consequences for your health.
In this article, we’ll delve into the formulation of apixaban tablets, FDA regulations and guidelines surrounding their use, and the potential consequences for you if you cut your medication in half.
We will also explore alternative options for dosage adjustment and discuss how you can effectively communicate your concerns with your healthcare provider.
Armed with this knowledge, you’ll be better equipped to make educated choices about your treatment plan while keeping yourself healthy and safe.
But first, I know some of you want the answer quickly. So, here it is:
Can you cut Eliquis tablets in half?
Yes, you can split Eliquis tablets in half, but you have to ensure that you are cutting the tablets evenly without disintegrating them.
To understand why, I encourage you to keep reading…
The formulation of Apixaban tablets
When examining the composition of apixaban tablets, you’ll find that they are film-coated and contain specific inactive ingredients designed for proper absorption by your body.
The film coating ensures the medication is protected from humidity and heat. Also, Apixaban by itself has a very bitter taste, and the film coating helps to make the drug easier to take orally.
When you cut the tablet, the film coating is damaged. However, this does not affect the medication’s efficacy from a therapeutic standpoint.
Cutting these tablets in half won’t necessarily alter their absorption rate, but rather, may cause uneven distribution of the active drug if the person doing the cutting is not careful and precise, leading to decreased efficacy or even harmful adverse effects.
FDA Regulations and Guidelines
In this section, we’ll dive into the FDA’s stance on splitting and crushing Apixaban tablets, shedding light on regulations and guidelines surrounding the practice.
The FDA provides oversight to ensure that medications are safe and meet regulatory compliance requirements.
When it comes to tablet-splitting practices, the FDA acknowledges that some tablets are scored, meaning they have a line down the middle to facilitate cutting them in half.
However, not all medications can or should be split, as doing so may alter their effectiveness or cause adverse effects.
For apixaban (Eliquis) specifically, the FDA doesn’t really say or recommend splitting the tablets (I explain more in the next section below).
Splitting an Eliquis tablet could result in suboptimal dosing, compromising its efficacy or leading to potential adverse effects associated with incorrect dosing adjustments. Again, more on this in the next section below…
What pills can be cut in half?
In most instances, pills that are scored can be cut in half, since the manufacturer formulated it this way.
Even then, always check with your doctor or pharmacist.
Why? Because the information gets confusing and contradictory, depending on the medication you are looking at.
For example, metoprolol succinate, a commonly used extended-release medication for the heart, can be cut along its score mark, BUT it cannot be crushed or chewed.
Another example is Sinemet CR 50-200 mg tablets, a medication used to treat Parkinson’s Disease. Although it is an extended-release formulation, it can be cut along its score mark. Just like metoprolol, it cannot be crushed or chewed.
However, most other extended-release pills cannot be cut…Confused yet?!
But, there is guidance…your doctor and pharmacist are always your go-to sources for accurate drug information.
If you cannot talk to them but need immediate assistance, there is a resource you can consult – just google your medication’s package insert and scroll down to the “How Supplied” section.
Many manufacturers will state here if the U.S. Food and Drug Administration (FDA) has approved the drug for splitting.
If you don’t see any information pertaining to splitting tablets in this section, it means that the FDA has not evaluated it fully. This is the case for Apixaban.
Read the FDA’s Best Practices for Tablet Splitting for more information.
So, what does this mean? Do you cut apixaban or not? Yes, you could technically cut Apixaban. However, my stance, based on my clinical experience, is to not do it.
Apixaban comes only in 2.5 and 5 mg strengths. Most people will be prescribed the standard dose of 5 mg twice daily.
The only likely scenario where you would need to take 2.5 mg twice daily is if you are at least 80 years old and either weigh 60 kg or less or have a serum creatinine level (blood test used to measure kidney function) greater than 1.5 mg/dL (133 micromole/L for our friends using SI units).
If you belong to this latter group of people, I suggest verifying with your doctor that they are going to prescribe the 2.5 mg dosage tablet.
However, I do understand that this may not always be possible because receiving the 5 mg tablets which can then be split may be more cost-effective for you. Either way, it is worth exploring all options.
Can Apixaban be crushed?
Just as Apixaban can be cut, it can also be crushed and safely administered. This is validated by the FDA in its prescribing information for Apixaban. In section 2.6 on page 6, under “Administration Options,” the FDA states:
“For patients who are unable to swallow whole tablets, 5 mg and 2.5 mg ELIQUIS tablets may be crushed and suspended in water, 5% dextrose in water (D5W), or apple juice, or mixed with applesauce and promptly administered orally. Alternatively, ELIQUIS tablets may be crushed and suspended in 60 mL of water or D5W and promptly delivered through a nasogastric tube. Crushed ELIQUIS tablets are stable in water, D5W, apple juice, and applesauce for up to 4 hours.”
This is drilled into every pharmacy student’s brain during pharmacy school – water or moisture is every drug’s greatest enemy, contributing to its ultimate degradation and loss of stability and therapeutic benefit.
So, if you do decide to crush the drug and mix it with a liquid, it must be taken within 4 hours. DO NOT STORE IT FOR USE LATER!
What pills should not be cut in half?
The following pills should not be split:
Timed-release or long-acting drugs: Cutting will destroy the timed-release effect, flooding your system with too much medication too quickly. Depending on the drug, this could be life-threatening!
- Enteric-coated drugs: Cutting into this coating removes the protection for your stomach, allowing the drug to irritate your stomach lining, causing potentially serious problems.
- Dose-specific prepackaged drugs: Include birth control pills or any other moisture or environment-sensitive drugs.
- Capsules: The drug inside the capsule is usually in powder form or coated, micro-encapsulated beads.
- Drugs taken more than once daily: These drugs will rise and fall in your system more rapidly, unlike once-daily medications. Splitting non-once-daily medications can result in improper dosing and lead to underdosing or overdosing.
- Oddly-shaped tablets: For obvious reasons! Imagine cutting a tablet with five sides!
- Small tablets: I don’t know about you, but I will most certainly struggle with splitting a pill half the size of my fingertip!
How to cut a pill in half?
If your pill can be split, there is a proper way to do it. Here are some tips for pill splitting:
- Use a specialized pill cutter like this one. The blade is sharp and cuts the pill evenly.
- Press down to cut quickly! Doing it slowly will crumble the pill.
- Only cut one pill at a time! The moment you cut into it, atmospheric moisture and heat will begin degrading it.
- Use clean hands! Don’t want your pills to become contaminated! (Don’t forget to clean your pill cutter too! – can use 70% isopropyl alcohol to wipe down and let it dry completely).
- DON’T use a butter knife, your teeth, or your fingernails to split your medication! Yes, I’ve seen this! It won’t yield a clean cut – Use a proper pill cutter.
- NEVER assume your pill can be cut – ALWAYS check with your doctor or pharmacist (Yes, I’m repeating this, but it’s for a good reason).
Risks associated with pill splitting
These are the reasons why I don’t generally like splitting pills. This is especially important from my perspective as a geriatric pharmacist working with older adults who are at risk for medication-associated adverse effects.
The reasons for this are many and outside the scope of this article.
My Polypharmacy and 2023 AGS Updated Beers Criteria articles cover these issues in more detail.
The most common risk is improper or inaccurate cutting of the pill. If you have cut pills before, you know what I mean.
It’s not that easy!
Improper cutting can lead to underdosing or overdosing on your medication:
- Splitting accuracy.
- Uneven tablet halves: If the tablet isn’t divided precisely in half, one dose may be too high and another too low, leading to inconsistent blood thinning effects.
- Inaccurate dosing: A lack of splitting accuracy could result in taking more or less than the prescribed dose, increasing the risk of bleeding or clotting complications.
This study found that close to 1 in 8 split pills were inaccurate more than 20% of the time!
Depending on the type and strength of the pill in question, the consequences can be serious!
Alternative Options for Dosage Adjustment
Don’t let the idea of splitting tablets cast a shadow over your treatment plan; there’s a silver lining with alternative options for dosage adjustment that can safely cater to individual needs.
Dosage customization is crucial in ensuring the effectiveness and safety of medications, especially when it comes to anticoagulants like Eliquis.
While pill splitting may not be recommended or safe for certain medications, such as Eliquis, your healthcare provider will work closely with you to determine the appropriate dose tailored to your specific condition and body weight.
As I mentioned above, if adjustments are necessary, consider discussing with your doctor or pharmacist about prescribing a lower-strength tablet rather than attempting to split the original tablet.
This ensures accurate dosing and reduces any potential risks associated with uneven doses due to inaccurate pill splitting.
Discussing Your Concerns with Your Healthcare Provider
It’s essential to openly address any concerns about medication dosing with your healthcare provider or pharmacy, as they’re the best resource for ensuring safe and effective treatment plans tailored to your needs.
The importance of communication cannot be stressed enough when discussing medications like Eliquis, as cutting the tablets in half may not provide consistent dosing and can lead to complications.
By fostering an open dialogue with your healthcare provider, you’re prioritizing your well-being and contributing to a better understanding of how different factors may impact your treatment.
- Express your concerns: Clearly explain why you feel the need to cut Eliquis in half or adjust its dosage; it could be due to side effects, affordability issues, or other reasons.
- Ask questions: Seek information on alternative options if available, potential risks associated with cutting the tablets in half, and ways to monitor treatment effectiveness.
- Be proactive: Follow up regularly with your healthcare provider and report any changes in symptoms or new concerns that arise during treatment.
Provider trust is crucial for maintaining a strong patient-provider relationship that fosters collaboration and shared decision-making.
Remember that they have the knowledge and expertise necessary to guide you through potential adjustments while considering various factors such as medical history, lifestyle habits, and individual response to medication.
Ultimately, working closely with them will help ensure you receive the most appropriate care and support for managing your health condition effectively while selflessly serving others.
Frequently Asked Questions
What are the common side effects of taking Eliquis (apixaban)?
When taking Eliquis, it’s important to be aware of the potential side effects that may occur. Some common Eliquis side effects include bleeding, bruising easily, nausea, and anemia.
It’s also possible to experience allergic reactions such as rash, itching, or difficulty breathing. If you notice any of these symptoms or have concerns about your health while on Eliquis, don’t hesitate to reach out to your healthcare provider for guidance.
Remember that by staying informed about potential side effects and taking action when needed, you’re not only looking after your own well-being but also contributing to a healthier community overall.
How long does it take for Eliquis to start working, and how long does it stay in the system?
Imagine a world where you could predict the precise moment a medication starts working its magic; unfortunately, we don’t live in that world.
However, when it comes to Eliquis onset, it typically begins to work within 2-4 hours after taking the first dose.
As for system clearance, Eliquis has an average half-life of about 12 hours. This means that after approximately 12 hours, half of the medication has been eliminated from your body.
Generally speaking, it takes around five half-lives for a drug to be considered fully cleared from your system—so for Eliquis, that would be roughly 60 hours or 2.5 days.
Keep in mind that individual factors such as age, kidney function, and weight can influence how quickly the drug is metabolized and eliminated from your body; so always consult with your healthcare provider for personalized information on how Eliquis will affect you specifically.
Yes, you can cut Apixaban in half, but pay close attention to how carefully you are cutting the tablet, and what tool you are using!
Better yet, ask your doctor if they would prescribe the right strength of Apixaban for you, so you don’t have to mess with cutting your own tablets.