The practice of dividing tablets: An uncertain act

Pareja David; Manrique Clara; Gualdron Diego; Contreras Heidy

doi:https://dx.doi.org/10.26650/IstanbulJPharm.2022.054

Araştırma Makalesi

DOI :10.26650/IstanbulJPharm.2022.054 IUP :10.26650/IstanbulJPharm.2022.054 Tam Metin (PDF)

The practice of dividing tablets: An uncertain act

David Galvis Pareja, Clara Ines Manrique, Diego Rojas Gualdron, Heidy Contreras

Background and Aims: Tablets can be split by patients for a number of reasons, using various instruments. Tablets can be scored or unscored; if scored, they may be split into pieces, and in spite of guidelines to do so patients are still at risk of resultant drug dose fluctuations, or being exposed to toxic or subtherapeutic doses. The aim of this study was to investigate differences in weight between halves of tablets, split by different populations and with different devices. Methods: 3-factor full factorial design (3 runs) was used with participants: patients, caregivers, nurses, medical doctors, and pharmacists; instruments: scissors, tablet cutters, knives, hand; drugs: losartan, clonidine, metoprolol, and warfarin. The risk of unequal tablet splitting was estimated and analyzed for each factor and their interaction with linearized generalized models. Results: Differences in weight were found to be above 15% and 25% of the theoretical weight as in general, the highest weight variations after splitting were found in clonidine with patients using scissors. The overall risk of non-equal tablet splitting was 22.5% for deviations > 15% and for > 25%. Conclusion: In this study, no tablet was split into halves of equal weight; based on these findings, splitting tablets is a questionable practice.

Anahtar Kelimeler: Splitting tablets, Equal weight, Amount, Patients, Risk

Referanslar

Arnet, I., & Hersberger, K. E. (2010). Misleading score-lines on tab-lets: Facilitated intake or fractional dosing? Swiss Medical Weekly, 140(7-8), 105-110. https://doi.org/smw-12953 google scholar
Cook, T. J., Edwards, S., Gyemah, C., Shah, M., Shah, I., & Fox, T. (2004). Variability in tablet fragment weights when splitting unscored cyclobenzaprine 10 mg tablets. Journal of the Ameri-can Pharmacists Association: JAPhA, 44(5), 583-586. https://doi. org/10.1331/1544-3191.44.5.583.cook google scholar
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: TM & IH, 19(7), 754-760. https://doi.org/10.1111/tmi.12309 google scholar
FDA. (2013). Best Practices for Tablet Splitting. https://www.fda.gov/ drugs/ensuring-safe-use-medicine/best-practices-tablet-splitting google scholar
Haywood, A., & Glass, B. D. (2011). Pharmaceutical excipients -where do we begin? Australian Prescriber, 34(4), 112-114. https:// doi.org/10.18773/austprescr.2011.060 google scholar
Johnson, J. A. (2012). Warfarin pharmacogenetics: A rising tide for its clinical value. Circulation, 125(16), 1964-1966. https://doi. org/10.1161/CIRCULATIONAHA.112.100628 google scholar
Palcso, B., & Zelko, R. (2018). Different types, applications and lim-its of enabling excipients of pharmaceutical dosage forms. Drug Discovery Today. Technologies, 27, 21-39. https://doi.org/10.1016/j. ddtec.2018.04.002 google scholar
Rowley F. (s. f.). Minimize Bisect Risk: Part I. Oct 06, 2006. https:// www.pharmamanufacturing.com/articles/2006/188/ google scholar
Shah, R. B., Collier, J. S., Sayeed, V. A., Bryant, A., Habib, M. J., & Khan, M. A. (2010). Tablet splitting of a narrow therapeutic index drug: A case with levothyroxine sodium. AAPS PharmSciTech, 11(3), 13591367. https://doi.org/10.1208/s12249-010-9515-8 google scholar
Spiller, H. A., Klein-Schwartz, W., Colvin, J. M., Villalobos, D., John-son, P. B., & Anderson, D. L. (2005). Toxic clonidine ingestion in children. The Journal of Pediatrics, 146(2), 263-266. https://doi. org/10.1016/j.jpeds.2004.09.027 google scholar
Thompson, C. A. (2012). New term will distinguish tablets known to split in half. American Journal of Health-System Pharmacy: AJHP: Official Journal of the American Society of Health-System Pharma-cists, 69(19), 1619-1621. https://doi.org/10.2146/news120071 google scholar
United States Pharmacopeial Convention Inc. (2018). USP 41-NF 36. En United States Pharmacopeia and National For-mulary. https://www.deutscher-apotheker-verlag.de/shop/produkt/9783769270228/usp-41-nf-36-the-united-states-phar-macopeia-and-national-formulary-2018 google scholar
Veronin, M. A., & Youan, B.-B. C. (2004). Medicine. Magic bullet gone astray: Medications and the Internet. Science (New York, N.Y.), 305(5683), 481. https://doi.org/10.1126/science.1097355 google scholar
Verrue, C., Mehuys, E., Boussery, K., Remon, J.-P., & Petrovic, M. (2011). Tablet-splitting: A common yet not so innocent practice. Journal of Advanced Nursing, 67(1), 26-32. https://doi.org/10.1111/ j.1365-2648.2010.05477.x google scholar

Atıflar

Biçimlendirilmiş bir atıfı kopyalayıp yapıştırın veya seçtiğiniz biçimde dışa aktarmak için seçeneklerden birini kullanın

DIŞA AKTAR

APA

Pareja, D.G., Manrique, C.I., Gualdron, D.R., & Contreras, H. (2022). The practice of dividing tablets: An uncertain act. İstanbul Journal of Pharmacy, 52(2), 143-147. https://doi.org/10.26650/IstanbulJPharm.2022.054

AMA

Pareja D G, Manrique C I, Gualdron D R, Contreras H. The practice of dividing tablets: An uncertain act. İstanbul Journal of Pharmacy. 2022;52(2):143-147. https://doi.org/10.26650/IstanbulJPharm.2022.054

ABNT

Pareja, D.G.; Manrique, C.I.; Gualdron, D.R.; Contreras, H. The practice of dividing tablets: An uncertain act. İstanbul Journal of Pharmacy, [Publisher Location], v. 52, n. 2, p. 143-147, 2022.

Chicago: Author-Date Style

Pareja, David Galvis, and Clara Ines Manrique and Diego Rojas Gualdron and Heidy Contreras. 2022. “The practice of dividing tablets: An uncertain act.” İstanbul Journal of Pharmacy 52, no. 2: 143-147. https://doi.org/10.26650/IstanbulJPharm.2022.054

Chicago: Humanities Style

Pareja, David Galvis, and Clara Ines Manrique and Diego Rojas Gualdron and Heidy Contreras. “The practice of dividing tablets: An uncertain act.” İstanbul Journal of Pharmacy 52, no. 2 (Dec. 2023): 143-147. https://doi.org/10.26650/IstanbulJPharm.2022.054

Harvard: Australian Style

Pareja, DG & Manrique, CI & Gualdron, DR & Contreras, H 2022, 'The practice of dividing tablets: An uncertain act', İstanbul Journal of Pharmacy, vol. 52, no. 2, pp. 143-147, viewed 2 Dec. 2023, https://doi.org/10.26650/IstanbulJPharm.2022.054

Harvard: Author-Date Style

Pareja, D.G. and Manrique, C.I. and Gualdron, D.R. and Contreras, H. (2022) ‘The practice of dividing tablets: An uncertain act’, İstanbul Journal of Pharmacy, 52(2), pp. 143-147. https://doi.org/10.26650/IstanbulJPharm.2022.054 (2 Dec. 2023).

MLA

Pareja, David Galvis, and Clara Ines Manrique and Diego Rojas Gualdron and Heidy Contreras. “The practice of dividing tablets: An uncertain act.” İstanbul Journal of Pharmacy, vol. 52, no. 2, 2022, pp. 143-147. [Database Container], https://doi.org/10.26650/IstanbulJPharm.2022.054

Vancouver

Pareja DG, Manrique CI, Gualdron DR, Contreras H. The practice of dividing tablets: An uncertain act. İstanbul Journal of Pharmacy [Internet]. 2 Dec. 2023 [cited 2 Dec. 2023];52(2):143-147. Available from: https://doi.org/10.26650/IstanbulJPharm.2022.054 doi: 10.26650/IstanbulJPharm.2022.054

ISNAD

Pareja, DavidGalvis - Manrique, ClaraInes - Gualdron, DiegoRojas - Contreras, Heidy. “The practice of dividing tablets: An uncertain act”. İstanbul Journal of Pharmacy 52/2 (Dec. 2023): 143-147. https://doi.org/10.26650/IstanbulJPharm.2022.054

Cilt 52, Sayı 22022, S. 143-147

ZAMAN ÇİZELGESİ

Gönderim	09.06.2020
Kabul	10.12.2020
Çevrimiçi Yayınlanma	29.08.2022

LİSANS

Attribution-NonCommercial (CC BY-NC)

This license lets others remix, tweak, and build upon your work non-commercially, and although their new works must also acknowledge you and be non-commercial, they don’t have to license their derivative works on the same terms.

İstanbul Journal of Pharmacy

Araştırma Makalesi

The practice of dividing tablets: An uncertain act

PDF Görünüm

Referanslar

Atıflar

DIŞA AKTAR

APA

AMA

ABNT

Chicago: Author-Date Style

Chicago: Humanities Style

Harvard: Australian Style

Harvard: Author-Date Style

MLA

Vancouver

ISNAD

ZAMAN ÇİZELGESİ

LİSANS

PAYLAŞ