Pill splitting a valid money saver for certain meds

Question: My bridge partner told me that she splits all her pills in half and saves money that way. Is this safe to do, and can I split my Lipitor pills?

M.B., Sanibel, Fla.

Answer: There's no easy yes-or-no answer. Pill splitting is an excellent way to beat the rising costs of medication, so long as the pill is OK to split. Some aren't because they have special coatings or they are sustained release (long-acting). Lipitor tablets (atorvastatin) and those of another popular cholesterol buster, Zocor (simvastatin), are often split because insurance companies insist on it for cost effectiveness. Doctors may also specify on prescriptions that the pills should be split as a way to save patients money. These two pills are not scored, however. Scoring means there's a line running down the middle of the pill where it snaps easily. I checked with my local pharmacy and the price difference for Lipitor was shocking. Thirty tablets of the 20 mg strength cost $125, whereas 15 tablets of the 40 mg strength cost $65. You get a 30-day supply either way, but breaking the 40 mg tabs saves a boatload.

As a general rule, scored pills are breakable. People save money by doing this because they buy the higher dosage of their medication, split the pills in half and instantly double their yield of medication with two lower-strength tablets. This works financially because some pharmaceutical companies price their medication the same, regardless of the dosage, so if you split the pills, you get twice as much drug for the same amount of dough. Insurance companies like this because it saves them money, too. Manufacturers intentionally score pills to make it easier for people to adjust their dosage up or down.

Pill-splitting blades are sold in any pharmacy. However, pill splitting isn't an exact science. Poor vision and fumbling fingers don't always allow a person to make a clean break in the middle of the pill (even when using a pill-splitting device), so you might underdose yourself one day and overdose the next.

With some medications like blood thinners (warfarin) or heart meds (digoxin), a subtle shift in medication levels in the bloodstream can be extremely dangerous.

See, I told you this wasn't an easy yes-or-no question.

I don't want you (or millions of other readers) taking it upon yourself to split every pill in your medicine cabinet. Clearly, you could hurt yourself. But where it is appropriate -- when the tablet is scored so you get a perfectly clean break -- and when your pharmacist or doctor approves, pill splitting is a way to help cut costs and keep you compliant with your medication program. I'm all for that.

One rule of thumb is to never, ever break, crush or chew any extended-release medications, prescribed or over-the-counter. Breaking certain meds -- such as OxyContin for pain, Ambien CR for insomnia, Glucophage XR for blood sugar, diet pills or Sudafed for coughs/colds -- can be extremely harmful. There are hundreds of other medications that should only be swallowed whole, so ask your pharmacist before breaking any medication.

This information is not intended to treat, cure or diagnose your condition. Suzy Cohen is the author of "The 24-Hour Pharmacist" with 15 years of clinical experience as a pharmacist. For more information, visit www.24-hourpharmacist.com.