The practice and clinical implications of tablet splitting in international health.
OBJECTIVE
Tablet splitting is frequently performed to facilitate correct dosing, but the practice and implications in low-income settings have rarely been discussed.


METHODS
We selected eight drugs, with narrow therapeutic indices or critical dosages, frequently divided in the Lao PDR (Laos). These were split, by common techniques used in Laos, by four nurses and four laypersons. The mean percentage deviation from the theoretical expected weight and weight loss of divided tablets/capsules were recorded.


RESULTS
Five of eight study drugs failed, on splitting, to meet European Pharmacopoeia recommendations for tablet weight deviation from the expected weight of tablet/capsule halves with 10% deviating by more than 25%. There was a significant difference in splitting accuracy between nurses and laypersons (P = 0.027). Coated and unscored tablets were less accurately split than uncoated (P = 0.03 and 0.0019 for each half) and scored (0.0001 for both halves) tablets.


CONCLUSIONS
These findings have potential clinical implications on treatment outcome and the development of antimicrobial resistance. Investment by drug companies in a wider range of dosage units, particularly for narrow therapeutic index and critical dosage medicines, is strongly recommended.
Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK.
Ivo
I
Elliott
Mayfong
M
Mayxay
Sengchanh
S
Yeuichaixong
Sue J
SJ
Lee
Paul N
PN
Newton
D017028:Caregivers / Q000592:standards; D003906:Developing Countries; D016527:Drug Costs; D014943:Global Health; D017408:Guidelines as Topic; D006801:Humans; D007812:Laos; D004364:Pharmaceutical Preparations / Q000008:administration & dosage / Q000032:analysis / Q000592:standards*; D057184:Practice Patterns, Nurses' / Q000592:standards; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D013607:Tablets / Q000008:administration & dosage* / Q000032:analysis / Q000592:standards
D004364:Pharmaceutical Preparations; D013607:Tablets
Laos; Partir comprimidos; dose; dosis; essential medicines; fractionnement des comprimés; gamme thérapeutique; medicamentos esenciales; médicaments essentiels; rango terapéutico; tablet splitting; therapeutic range