Breaking tablets in half

I have been cutting tablets for years and my reason for beleiving that it is OK is that many persons alternate for instance 7.5 mg and 5 mg and also at lower doses. If you don´t get the exact amount of medicine one day, you will get it the next. I have even cut into 4 pieces when I have been under 5 mg. I was free from Pred a week before Christmas and feel fine. I also beleive what you say about a scored tablet being OK to cut into two pieces.

Greetings from \"the frontside\" (a Swedish joke about the west-coast) of Sweden. I have seen that you also live in Sweden even if you are British,

Ragnar

The Prednisolone tablets here in the UK (at least the ones that I am supplied with) are not scored so therefore we don't halve them and have been advised not to do so at the pharmacy.

However, a lot of useful information coming from you people in Sweden.

Had to have dental surgery last week with local anaesthetic. Learned that people on steroids undergoing a general anaesthetic have to increase their dose for several days to compensate for the shock to the system. However, this is not necessary for surgery under local anaesthetic.

My rheumatologist maintains that your own body's cortisol is not wiped out by the steroids, and that your own body makes about 7.5mgs a day. A few differing views seem to be coming from the experts it seems!

MrsO

The Prednisolone I get is made by Pfizer and is easy to find on their Swedish web site. I checked on the British Pfizer web site and although they say they are the biggest supplier to the NHS, Prednisolone is not on their list of available medicines. I guess it’s all tied up by rules, regulations and drug marketing.

Greetings from (as it says on the large sign on the E4 motorway as you enter the city) “The Capital of Scandinavia”. (Sorry Ragnar). 8)

davblo

They come in 10mg, 5mg, 2.5mg and 1mg.

Or am I missing something?

mrs K

Mainly we are just clarifying who does what and why, so we don’t end up talking at cross purposes. I didn't know at the start that you don't have \"scored\" tablets in the UK.

But there was the argument I mentioned earlier that if 100x2.5mg cost you the same price as 100x5mg (which they do here) then you may as well take the 5mg and cut them in half, thus getting more value for your money.

Also if you start on a higher dose and work down, you could well end up with left over tablets which you can’t use. (For example I have lots of 10mg left and I’m taking 7.5mg to 5mg at the moment.) If you can break the 10mg in half you can use them as 5mgs. Save money, save waste etc etc.

All the best; davblo

Re the mention of halving the tablets here in the UK, it has been mooted some time previously by people who when on a dose below 5mgs considered whether they could halve enteric coated tablets which line the stomach rather than take too many of the 1mg tablets which, of course, are not supplied with enteric coating. For instance if you are on a dose of 3mgs, you could question whether you could consider taking a 2.5 coated tablet and cutting a 1mg tablet in half so giving yourself some protection from the coated tablet. This had occurred to me as one of those people who are not able to tolerate the stomach protection tablets such as Omnaprazole and Lanaprozole. However, as I mentioned previously, our 1mg tablets are too small to halve unlike those mentioned by Davblo in Sweden and it is not recommenced to do so by my pharmacy. So in the meantime I eat a live yoghurt daily in the hope of receiving stomach protection that way. Do hope I haven't garbled this and it makes sense to you.

Mrs O

I take Actimel everyday since I started on steroids. Recommended by the chemist.

We, pmrfighters, also raised with the drug companies who make the steroids why were 1mg not coated.The answer, as best as I can explain for the reason for 1mg not being entric coated was that the actual make-up of the steroid dose for the 1mg would have to be altered to enable it to do what it is supposed to do. So the formula would have to be changed and that, I gather is a long long process.

Enteric coated take a longer time to work and dissolve not in the stomach, non enteric coated dissolve in the stomach.

But your chemist can explain this better than me. I am not a medical person - just someone who has had to learn more than she ever wanted to know about drugs, side effects, disabilities and changes of lifstyle.

mrs K

Oh, how I relate to your last sentence!!!

Mrs O

Three reasons to break tablets in half…

1. Save money

2. Save waste

3. Mix and match coated/non-coated

If the tablets are scored you can be sure you get half the dose in each half.

If the tablets are not scored you may not get the exact half dose in the first half; but if you take the other half the day after you get the right amount averaged over the 2 days.

All the best, davblo

I think I might be in for some fun though if I do try and cut our tiny 1mg tablets in half!

Keep well and best wishes to all our fellow sufferers out there.

MrsO

Have been reading all your postings with great interest being a fellow sufferer. Am intrigued that non-enteric get absorbed in the stomach and presumably the enteric get absorbed in the gut. What happens if you cut an enteric coated in half because you then have a bit of both - must be very confusing for ones innards....! I am trying to reduce from 6 to 5 mgs with very limited success so have started take 6 one day and 5 the next and will see what happens. I had the winter vomiting virus recently so the doctor came and injected me with steroid as I couldn't keep the tablets down. He also told me to increase my dose for a while so was painfree (bliss). But now I am back to the 6/5 and am loath to increase because of the weight gain etc. Apparently a dose below 7 gives you very little side effects. I also take an Actimel every day for the alkaline effect on your stomach.

Good luck to everyone. It certainly is a horrid illness and I wish the researchers would get a grip on it.

Margaret.

If any tablets are being cut in half then each half would be taken on consecutive days therefore adding up to the required dose over two days should one half be smaller than the other. For instance, I am trying (not very successfully at present!) to cope on 3mgs - as these are all 1mg uncoated tablets, I am thinking about taking a 2.5 coated tablet plus half a 1mg uncoated tablet as I have been led to believe by my GP that the enteric coated tablet would compensate for the uncoated half. The following day I would take the other half 1mg tablet thereby ensuring the full dose over the 2 days.

With regard to you taking 6 one day and 5 the next, if you read the earlier entry by Ragnar you will see that he says he only managed successfully to reduce once under 5mgs by taking for example 5mgs one day and 6mgs for the next two days and repeating this for the next 3 days, and then alternating between 5 and 6 daily for another week. He says he eventually came off the steroids by continuing in this fashion for the remaining reductions - he feels that the 1mg drop is too high a reduction all in one go. This makes sense to me as when I reduced from 4 to 3 a few weeks ago that is a 25% sudden drop.

I understand what you mean by watching the weight gain - its seems so unfair that you can't eat just what you want when on steroids without gaining drastically........as if just having PMR/GCA isn't enough to cope with.

You may well have replies from Mrs K and Davblo as well but hope this has helped with your query. Best of luck and to everyone else.

Mrs O

You probably misunderstood me. I cut the 2.5 mg tablets in four parts and after reducing under 5 mg, each time I reduced by 0.5 mg (really 1/4 x 2.5 = 0.6 mg).

In my case, I went from 5 to 4.5 mg and alternated between the new dose (4.5 mg) one day and the old dose (5 mg) two days. After a week I alternated new and old dose every two days and after two weeks, I took the new dose only. If you cannot cut the 1 mg tablets, I would imagine that you can alternate 5 mg and 4 mg in a similar way. For instance one day 4 mg, then two days with 5 mg and after two weeks alternating between 5 and 4 every two days. After a month go over to the new dose 4 mg. Then you have made a drop of 1 mg over one month. It may be too short for some persons, though - in my opinion. After some time alternating every two days, you could also choose to take the new dose for two days and then the old dose for one day and continue 1-2 weeks. In that case you go gradually over to the new dose during a longer period. I hope I haven´t made it too complicated.

[b:5a7f84fcf1]My advice is to avoid dropping by 1 mg at a time from 5 and below[/b:5a7f84fcf1]. If you do, spread out the period you taper. I have been off pred since a week before Christmas, but it took me a year to come below 5 mg when I tried to taper 1 mg at a time. Not until I tried the above spread-out tapering and 0.5 mg at a time, I could move on.

Ragnar

Mrs 0; from what you say your 1mg are very small, For comparison, I measured one of my 2.5mg and it is 8.5mm across and 2.5mm thick; just large enough to break between my thumbnails. Good luck with yours!

Margaret; I guess if you break a coated tablet in half, then the exposed surface will allow it to dissolve in the stomach, so it would be just the same as an uncoated one.

It seems we have reached a good consensus about what is involved in trying to get the best combination of tablets for the dose level and coated/non-coated we want.

Also, varying the dose slightly from day to day seems to be useful for making the adjustments even more subtle, and less of a jolt for the body.

For the record, my doctor who I saw a couple of weeks ago has a slightly different view. He prescribed 2.5mg tablets for me (the smallest I had previously were 5mg) and instructed me (according to the label on the bottle) to take one (2.5mg) per day for a month, then one every second day for a month, then (hopefully) stop. A rather coarse series of adjustments compared to what we have been discussing. But at least he considered the every-other-day variation as useful. (He completely missed the fact that I was back on 7,5mg per day having recently suffering from cold/flu).

I’m still interested in exactly what we are doing as we try to reduce the dose.

I’ve learned that we are fighting withdrawal from long term use.

I’ve learned that getting an infection (or other stress) requires that you raise the dose again.

But I still wonder about the underlying PMA; - are we hoping it has reduced and are “testing the water” or are we trying to “push it away” by combating the symptoms? Or both?

But that’s diverging from breaking tablets, so maybe time to switch back to “Increased pain when reducing steroid dosage” which is still going strong.

All the best; davblo

Oh, how you've got my little grey cells working - that was quite a mathematical lesson for me today! :? Thank you for taking the time to explain. I'm sure that everyone attempting to reduce below 5mgs finds it a problem and, no doubt, they will be helped by your welcome advice and proven remedy. Long may you continue to be pain-free.

Best wishes,

Mrs O