Tablet Splitting of Narrow Therapeutic Index Drugs: a Nationwide Survey in Taiwan

Overview

Journal Int J Clin Pharm

Publisher Springer

Specialties Pharmacology
Pharmacy

Date 2015 Sep 25

PMID 26399507

Citations 9

Authors

Chia-Lin Chou

Chia-Chen Hsu

Chia-Yu Chou

Tzeng-Ji Chen

Li-Fang Chou

Yueh-Ching Chou

Affiliations

Soon will be listed here.

Abstract

Background: Tablet splitting or pill splitting frequently occurs in daily medical practice. For drugs with special pharmacokinetic characters, such as drugs with narrow therapeutic index (NTI), unequal split tablets might lead to erroneous dose titration and it even cause toxicity.

Objective: The aim of this study was to investigate the frequency of prescribing split NTI drugs at ambulatory setting in Taiwan.

Setting: A population-based retrospective study was conducted using the National Health Insurance Research Database in Taiwan. All ambulatory visits were analyzed from the longitudinal cohort datasets of the National Health Insurance Research Database.

Methods: The details of ambulatory prescriptions containing NTI drugs were extracted by using the claims datasets of one million beneficiaries from National Healthcare Insurance Research Database in 2010 in Taiwan. The analyses were stratified by dosage form, patient age and the number of prescribed tablets in a single dose for each NTI drugs. Main outcome measures Number and distinct dosage forms of available NTI drug items in Taiwan, number of prescriptions involved split NTI drugs, and number of patients received split NTI drugs.

Results: A total of 148,548 patients had received 512,398 prescriptions of NTI drugs and 41.8 % (n = 62,121) of patients had received 36.3 % (n = 185,936) of NTI drug prescriptions in form of split tablets. The percentage of splitting was highest in digoxin prescriptions (81.0 %), followed by warfarin (72.0 %). In the elderly patients, split tablets were very prevalent with digoxin (82.4 %) and warfarin (84.5 %).

Conclusion: NTI drugs were frequently prescribed to be taken in split forms in Taiwan. Interventions may be needed to provide effective and convenient NTI drug use. Further studies are needed to evaluate the clinical outcome of inappropriate split NTI drugs.

Citing Articles

Concerns regarding tablet splitting: a systematic review.

Saran A, Holden N, Garrison S BJGP Open. 2022; 6(3).

PMID: 35193886 PMC: 9680753. DOI: 10.3399/BJGPO.2022.0001.

The effectiveness of split tablet dosing versus alternate-day dosing of warfarin: a randomized control trial.

Kaewsaengeak C, Pienputtarapong U, Tocharoenchok T Sci Rep. 2021; 11(1):24060.

PMID: 34912021 PMC: 8674310. DOI: 10.1038/s41598-021-03606-z.

Effect of different splitting techniques on the characteristics of divided tablets of five commonly split drug products in Jordan.

Gharaibeh S, Tahaineh L Pharm Pract (Granada). 2020; 18(2):1776.

PMID: 32377280 PMC: 7194171. DOI: 10.18549/PharmPract.2020.2.1776.

Comparing Two Methods of Tablet Manipulation to Adjust the Warfarin Dose in Paediatric Care.

Brustugun J, Birkedal Aas E, Tho I, Bjerknes K Pharmaceutics. 2020; 12(4).

PMID: 32325777 PMC: 7238213. DOI: 10.3390/pharmaceutics12040375.

Comparison of Treatment Response Achieved by Tablet Splitting Versus Whole Tablet Administration of Levothyroxine in Patients with Thyroid Cancer.

Ashrafpour R, Ayati N, Sadeghi R, Zare Namdar S, Ayati N, Ghahremani S Asia Ocean J Nucl Med Biol. 2018; 6(2):108-112.

PMID: 29998143 PMC: 6038971. DOI: 10.22038/aojnmb.2018.26793.1187.

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