Splitting prednisone tabs

[annekat]

I'm trying to taper down from 10mg. pred. I have 10mg. tabs and 1mg. tabs. Any kind of taper will involve splitting the 10mg. tabs, which I'm finding is not at all easy to do. My pharmacy has given me different sizes of the 10mg. tabs over these last few months, and some are easier to split than others. This time, I got tiny ones. They just crumble up into irregular pieces when I split them. I have a pill splitter from the pharmacy and also a tiny knife which should work OK. Of course, the pills are scored, but it doesn't seem to help. The splitter I have is cylindrical shaped with a blade in a hinged lid that comes down on the positioned pill. Is there a better kind? This is frustrating. The pill seems very dry. Would humidifying it slightly possibly help? I am grasping at straws, I realize. Any ideas? I don't have enough of the 1mg. tabs to just use those. I doubt my doc will be bothered to prescribe me 2.5 or 5mg. tabs at this point. He is already annoyed that I want to go as slow as I do. Thanks for any help; otherwise, I'll just split the pills however I can and keep careful track of the leftover part for the next day.

[gilders]

Is your pred enteric coated? I can imagine they will be difficult to split and not recommended as they will dissolve too soon.
My Dr is always happy to prescribe me any strength that I need.

[annekat]

I don't know what enteric is. They don't seem to be coated with anything. I've never had any pred coated with anything. Is most people's coated with something? I don't know what you mean about it dissolving too soon. I just swallow it with water and it has always worked fine, does what it is supposed to do.

Your doc is no doubt nicer than my doc. I only see him every two months and he might agree to a different kind of prescription then. But he just wanted me to alternate days, 10mg. and 5mg. and that would average out to 7.5mg. a day. He thought it was silly that I wanted to go just 1mg. at a time. He is not a true Wegs doc, but at least he was willing to let me do it my way according to what I have learned on this forum. Even with his suggested taper I would have to split the 5mg. pill. I have just cleaned my pill splitter to get rid of leftover residue and crumbs from previous splittings. Maybe that will help. I will look up "enteric" on google. Thanks.

[StephaniaWi]

I have broken them the best I could and it worked okay but not exact,I could break mine with my fingers which worked best but those tiny ones seems hard.If it wouldn't cost a lot,I would ask for 2.5, those would spare you the grief. I've been through prednisone withdrawal, just taper at your own rate, your doctor doesn't have to live through it.:smile1:

[annekat]

I have broken them the best I could and it worked okay but not exact,I could break mine with my fingers which worked best but those tiny ones seems hard.If it wouldn't cost a lot,I would ask for 2.5, those would spare you the grief. I've been through prednisone withdrawal, just taper at your own rate, your doctor doesn't have to live through it.:smile1: Thanks! Next time I'll ask him for the 2.5. I can see how it would be a lot easier, and having the 1mg. on hand, too, for more flexibility. I only saw him last week and I don't think he'd want to be bothered with another request for another denomination of pred. When I said I wanted to taper 1mg. at a time instead of 2.5mg at a time, he said it was "overkill". I told him I know lots of Weggies and many of them have to do it that way or even slower. I pointed out how much trouble I'd had going from 15 to 10mg., how long it had taken me to work my way down. So he agreed. He talks tough but backs down; I've seen it before. You are so right that he doesn't have to live through it! I'm sure he's dealt with pred tapers with other conditions, but doesn't have much WG experience and doesn't know how touchy the "Wegs dog" is or how easily woken up. I'll listen to my Weggie friends over him any day. For now I'll split the 10mg. tabs as best I can and save each remainder for the next day to combine with 4 1mg. tabs. Sure seems like a funky way of doing it, though...

[mishb]

My GP gave me 10's, 5's and 1's to make the whole thing easier.

Gosh don't we wish that those little tablets were coated, then we wouldn't have to taste them - on that odd occassion that you didn't quite swallow it the first time - yuck.:razz:

Anne, is it possible that you could tell the pharmacist that you need 9.5 or 9 and they could split them for you?
Otherwise it will be, halve the 10 and take the extra's in 1's and a half of 1 (as you said)

Not ideal, but eventually you will just be down to one tablet - maybe a 5 - so you should get these from your doc anyway. Saves having to take 5 x 1's - yuck again :razz::sad::ohmy:

[drz]

I got 5, 2.5, and 1 mg size when i was asked to taper down toward 5 MG and I think all but the 1 were scored to make splitting easy with a sharp knife. I split some 80 mg Pravastatin with a pill cutter since they are not scored at all. My pharmacist would get an order for any size pill I needed or wanted from one of my doctors since I never knew what I would run out of first. I was given general goals to work toward and given latitude to go at my own pace with .5 mg reductions every two or three weeks as it felt comfortable to proceed. It took a few months but I had no big problems from my taper down to 5 mg.

[annekat]

Thanks, Michelle and drz, I had a feeling you would chime in. Well, I've already got the pills and will just deal with it... yes, they are scored, but they still don't split evenly, unless I get lucky. When I have to refill them, I'll ask the pharmacist if he can do it differently. Or ask my doc next time I see him for a little more flexibility in sizes. I wonder if he has ever had to split a pred pill for himself... I doubt it. I'll just make sure I take a whole 10mg. pill over each two days plus four of the 1mg. each day for a total of 9mg./day, since that's the taper I've decided to try. If it goes well I might move to 8mg./day after two weeks. The doc implied that 5mg. would be what to shoot for and that would probably be a stopping point for awhile..... that seems to fit with what you are saying here, and sounds good to me.

[annekat]

Michelle, I wonder if I COULD get the pharmacist to split the 10mg. pills, if they have a better way of doing it than we do. Something to ask next time I'm in there... thanks! :smile1:

[Savva]

Do not try to humidify your pills! I split 5 mg pills with a knife. The knife must be sharp. I am not quite sure how to say this, but try to make little cutting movements until you go approximately slightly less than 1/2 of your pill. Then just push the knife (with uniform load) fast to split the pill. The edges of a cut pill might be rough, but I think it is the closed you can archive, using knife. The main problem is to precisely find the center of a pill to start cutting. If your pills are scored this is not a problem at all.
I am on 11.75 mg pred now. My doc tells me to taper it down by 1.25 every month (that is a quarter of a 5 mg pill). So that in Oct I will be on 10.5 mg. So I even manage to cut 5 mg pills to 4 pieces.

[gilders]

Is most people's coated with something?

Sorry for late reply, had to go to bed.
All of my pred has been coated. The only exception is the 1mg as they don't make these ones coated. Some tablets cannot work as stomach acid "kills" them, so they put a coating that dissolves in the more alkali lower intestines. Pred are not coated for this reason though. They are coated because steroids can damage your stomach lining, leading to ulcers. I guess 1mg isn't available as coated as it's such a small dose it shouldn't damage your stomach (although my Doc always puts me on omeprazole to protect my stomach when I drop down to lower dose pred).
I don't see why your Doc wouldn't give you the coated ones. Although all NHS prescriptions have a set price I have seen a report of the true cost of some of the more frequently prescribed drugs. Pred (coated) was one of the cheapest by a long way, so it can't be a cost issue.

My doc has also told be to alternate before, but it was lower doses. An example being when I was dropped from 2.5mg to 2mg, he said for a fortnight I should alternate between the 2.5mg and 2x1mg, then just take 2x1mg until I tell you to drop again. He likes to take it really slow once we get to 5mg.

[Wegetarian]

Gosh don't we wish that those little tablets were coated, then we wouldn't have to taste them - on that odd occassion that you didn't quite swallow it the first time - yuck.:razz:


I always take my Pred with coffee, I think it covers the taste well so I don't notice anything. I do agree it leaves a foul taste if taken with water.

[annekat]

Thanks, Savva, those sound like good tips. Nope, I would not have tried to humidify my pills unless someone said it might work.... and then, I would have only tried it with ONE.....just a nutty idea that crossed my mind. Yes, the pills are always scored but even with my small hands it is hard to manipulate something so small. I just wish the pharmacy had given me the bigger 10mg. pills as they have in the past. They were much easier to split without them disintegrating to bits. I will manage with what I've got.

[Alysia]

Hi Anne. If you want to take, for example 9.5 mg you should take them like this:
day 1: 10mg
day 2: 9 mg
day 3: 10 mg
day 4: 9 mg
etc. same with other doses.

[annekat]

Gilders, it sounds to me like Michelle's pred pills aren't coated, either, and I suspect most aren't. The subject of coated pills has never come up with my doc or, from what I've seen, on this forum. Perhaps in the past before I joined. The non-coated ones are fine with me, I don't have stomach issues at this dosage, and most of us get something for that at the higher doses. But I would like to hear from others, whether their pills are coated or not. I'm not worried about cost at this point, if it was necessary; I just don't feel that it is, at least in my case.

[annekat]

Thanks, Alysia. Yes, I've been considering different ways to do it and that one involves not always having to split the pills. But right now I'm going for 9mg., not 9.5, so I guess am stuck with splitting all the 10mg. pills. It will work out. I'll just save the leftovers from the split, even if its not a perfect split, and take it the next day, so it all evens out.

[Savva]

My pills are not coated.

[gilders]

I've done a bit of research and I've come across some reports that now say the risk of ulcers and dyspepsia (indigestion) is less likely than previously thought so long as given with omeprazole (or similar). I was last on Pred a few years, so I guess recommendations may have changed since.
I'll have to see what I receive next time I'm on Pred.

[Savva]

Gilders, omeprazole is what I take from day one. I have undergone 2 endoscopies already and results always seem to be well. I thought you guys have some similar to this. Anyone else take omeprazole?

[Dirty Don]

I take pantaprazole...Protonix...all in same family!

[drz]

I take pantaprazole...Protonix...all in same family!

Me too, the others did not seem to work for me.

[pberggren1]

Don't forget people to take your acid blocker at least 1 hour away from pills and food.

I have never tasted pred, it goes down much too fast to even hit the tongue......lol

[Barbara N]

I don't know what enteric is. They don't seem to be coated with anything. I've never had any pred coated with anything. Is most people's coated with something? I don't know what you mean about it dissolving too soon. I just swallow it with water and it has always worked fine, does what it is supposed to do.

Your doc is no doubt nicer than my doc. I only see him every two months and he might agree to a different kind of prescription then. But he just wanted me to alternate days, 10mg. and 5mg. and that would average out to 7.5mg. a day. He thought it was silly that I wanted to go just 1mg. at a time. He is not a true Wegs doc, but at least he was willing to let me do it my way according to what I have learned on this forum. Even with his suggested taper I would have to split the 5mg. pill. I have just cleaned my pill splitter to get rid of leftover residue and crumbs from previous splittings. Maybe that will help. I will look up "enteric" on google. Thanks.

I have some new 30mg Pred and they are large and horrible. They start to dissolve right away and then get stuck on the roof of my mouth, I have to keep putting it in and out and the taste is so awful I dread getting p in the morning because I don't want to take these hard to swallow pills. I asked my doctor and she said she would prescribe the other ones, after I finish theses,, the ones Anne needs, that are easy to split and go down easy, and yes they are coated with something, just so they have enough time to get down the throat.

[Dirty Don]

Instead of cutting, try crushing them in a container of some sort, then add to a liquid to drink...more work, but less taste.

[Barbara N]

Gilders, omeprazole is what I take from day one. I have undergone 2 endoscopies already and results always seem to be well. I thought you guys have some similar to this. Anyone else take omeprazole?

Every one in Spain does, it is the most prescribed drug in the country.

[Debbie C]

Michelle, I wonder if I COULD get the pharmacist to split the 10mg. pills, if they have a better way of doing it than we do. Something to ask next time I'm in there... thanks! :smile1:

Anne, most pharmacy's will split them for you.

[Debbie C]

Barbara,I was taking omeparzole 40 mg. a day , I just saw my gastrologists and he wants me to try 60 mg, Dexilant and 290mcg if Linzess. I also have to have a ct scan of my abdomen ,he's thinking a may have an ulcer...go figure !!! Any one else taking any of those drugs....I hate trying new things (drugs )

[annekat]

Anne, most pharmacy's will split them for you. Thanks, Debra.... I might ask them. I can sort of imagine them rolling their eyes at the idea of splitting all those little pills. But maybe not. Otherwise, I'll just deal with it the way it is.... it doesn't seem that bad just to split a pill unevenly but take the whole thing over two days. The 9mg. pred, down from 10, doesn't seem to be bothering me at all, so maybe I can go lower soon.

[gilders]

Barbara,I was taking omeparzole 40 mg. a day , I just saw my gastrologists and he wants me to try 60 mg, Dexilant and 290mcg if Linzess. I also have to have a ct scan of my abdomen ,he's thinking a may have an ulcer...go figure !!! Any one else taking any of those drugs....I hate trying new things (drugs )
Debra, are you on Pred at the moment? If so, then enceric coated tablets would be best for you.

[gilders]

Just a quick update regarding enceric coated pred.
I'd previously mentioned that mine were always coated, but also said that I've not been on them for quite a few years now and perhaps coated ones are no longer first choice.
Well I can now confirm that with my recent confirmation of a relapse the pred I'm back on (8x5mg/day) are the coated ones, plus I'm back on omeprazole. Actually they are now called gastro-resistant, but are the coated ones.

[annekat]

I'm not sure if you thought the coated ones would be easier or harder to split. To me, it seems they would be harder, as the coating would be more resistant than the non-coated surface, unless it would somehow hold the substance together better and keep it from crumbling. Aside from that issue, I'm happy with the non-coated ones, as I don't feel I have stomach issues. I just cleaned my pill splitter of any residue from previous splittings and am finding it works better that way.

More importantly, I'm very sorry to hear that your relapse has been confirmed and that you are back on pred. I'm anxious to hear what else they decide, in terms of an immunosuppressant. I can only hope and pray that this relapse will be more minor than previous disease activity you've had, and can be controlled somehow without further damage to your kidneys. I'm wishing for the best outcome for you.

[gilders]

I'm not sure if you thought the coated ones would be easier or harder to split.
No Anne. I also think they would be harder to split. It was just that people were talking about Pred and it sounded like they were the coated ones. I was surprised to hear this and wondered if there any advantage to it, as the cost for non-coated wasn't much different.

So long as people aren't having any gastro issues with non-coated then I guess there's no need for them (except to prevent problems in the first place).

[annekat]

Thanks, gilders. I actually had never heard of the coated ones or read about them on here. But I honestly don't know, maybe they are used by quite a few on here. They do sound like a great idea for those with gastric issues, for sure, or as you say, for prevention of such issues.

[Anth]

When I was splitting my pills I found a bigger knife worked better.. so you don't saw at it. just put the knife directly on the middle mark and push down firmly.

[drz]

When I was splitting my pills I found a bigger knife worked better.. so you don't saw at it. just put the knife directly on the middle mark and push down firmly.

A very sharp knife cuts through the pills. A very dull knife tends to shatter them into pieces. A good sharp knife cuts through pills rather easily with little pressure.

[Wegetarian]

About splitting hairs - I mean tabs. I've recently gone down to 30mg per day and all I had were 40mg tabs. I noticed it was difficult to cut the tabs into quarter pieces so I asked for 5mg tabs from my doc. So this is fairly convenient as I can take a half of a 40mg tabs (they have that line in the middle so its quite easy to break them into two almost equal pieces).

However the doc treating me thinks it would be better to take exact amounts. I.e. I should buy a box of 20mg tabs, take one of them and two 5mg tabs. Do you guys think its worth the hassle to get the 20mg tabs? Even if I don't split the 40mg tab exactly in the middle the two day average would still be 30mg for my dose as I'd take the rest of the pill next day... I'll probably still call the doc I get the pills from to get some 20mg... just wondering how exact those dosages are as many seem to take some on alternating days.

[Rose]

I posted this comment here in April. Just to say that I had great results w reducing from 5mg of pred this way and suffered no effects. I did it do slower than planned and got down to 1.5mg. However I have gone back up to 5mg daily as I had started to feel a bit achy a few weeks ago but now realize it was probably the UTIs


In South Africa there is nothing less than 5mg tabs. I have tried in the past to quarter the 5mg tabs but they just disintegrated. My Rheumatoloist said it was not such a bad idea to stay on 5mg and as I had no option this is what I have done for the past 4 years. The other day I again asked at the pharmacy about the 1mg tabs, thinking they may now be available. They still are not available but I had a very helpful pharmacist and I told him about my problem trying to reduce and the tabs disintegrating when i tried to split them. He suggested that I take a 5mg tab, crush it, add 50ml of tepid water and stir until dissolved, then measure out 45ml of the solution which would give me 4.5mgs of pred. This is what I have been doing for the past 4 days and so far so good. I intend to stay on this for a few weeks and then reduce to 4mgs (40ml). If all goes to plan I hope to be off the pred in about 3 months or so.



Last edited by Rose (http://www.wegeners-granulomatosis.com/forum/posthistory.php?p=67353); 04-01-2013 at 09:53 PM.

It worked for me and I will stat reducing again soon. Could not believe the increase in appetite just going from 1.5mg to 5mg. Must say though, it is a bit of a hassle.

Rose

[Rose]

Hi Wegetarian

I think on those highish doses it is not too important to be so precise. Take your 30mgs in the combination that suits you and if a tab does not break exactly in the middle i dont think it is such a big thing ....at those doses. It is when you get down to 10mg and below I would say (definitely getting below 5) you have to be very precise. Reducing from 5mgs to 4 is a problem (if you dont have access to 1mg tabs) but with the plan I posted above I actually was able to reduce by 1/4 mg at time and stayed there for quite a few weeks before reducing again. Anyway, that is my opinion and as long as they split pretty evenly, I dont think there will be a problem.

[annekat]

Rose, Don has also posted about pulverizing the pred and dissolving it in water and then measuring it to get the correct dose. It seems lke a good idea, but yes, a lot of trouble. It sure would make it easier to have all the denominations of pills available to everyone.

Wedgie, I wish my doc was more like yours; mine is very loose about it and thinks I should be able to go from 10mg. straight to 7.5mg by alternating 10mg. with 5mg. I argued with him and got my way; he prescribed me some 1mg. pills to use at my own discretion and said i could pace myself, so I am currently at 9mg. and may be ready to try 8mg. soon. But I still have to split the 10mg. pills, unless next time I can talk him into prescribing the 5mg. pills and maybe the 2.5 mg pills, too. I doubt he will have much patience with that. They don't seem to have a lot of sympathy for us having to split pills, maybe because they don't have to do it themselves.

At your dosage level, I would agree with Rose, it is probably not as important that you be all that precise, even though your doc seems to want you to be. My doc is at the other end of the spectrum, thinking my body can adjust to the alternating and the faster taper. But in your case, I wouldn't think using tabs which may not be perfectly split would be a big deal at all, as long as you are getting the dosage over the two days. However, you might as well get the 20mg. tabs since you can; the easier the better. But either way would work. I think we should all just get a "kit" of all the different size tabs to work with, especially when we get below 10mg. In a perfect world!

As for splitting the tabs, I have not found a knife that works perfectly, even if sharp, no matter what size. I have a pill splitter that also does not work perfectly. However, I just discovered this morning that it makes a difference how I press on the splitter. First I have to line up the pill in the splitter as perfectly as possible by eye, with the scored line corresponding with where the blade will strike. Then I found that if I press right over the pill instead of elsewhere on the mechanisim, I will get a perfect split. Or at least I did this morning. I know there are different types of splitters. Some experimenting is in order with these.

[drz]

I have pred in 20, 10 5, 2.5, and 1 mg sizes and have used them all to taper down from 70 mg to 5 mg. I favor having them in size that makes taking the correct dosage the easiest, but it is important to keep the sizes straight and not get them mixed up. I currently am taking two 2.5 mg due to some screw up in getting my prescription renewed. They might have been out of 5 mg size or the insurance company wouldn't allow a refill on the 5s but would on the 2.5 size so that is what i got. I was taking one 5 mg before so I have to careful to remember to take two and not one as they look almost identical. There is usually some loss when you cut pills of any size but this is not usually a big concern when cutting larger strength pills. I am currently cutting 80 mg pravastatin into half to get 40 mg per day since my dosage was decreased and I had a three month supply of 80 mg. The main thing is to get correct dosages recommended by the prescribing physician.

[annekat]

That's why there should be a "tapering kit" available with plenty of all the different sizes of pills in it.... would make it so much easier for us! But not for them, I suppose. I had no trouble getting 100 1mg. tabs when I still had a lot of 10mg. tabs left. But I wouldn't be surprised if the insurance refused to fill all sorts of different ones at one time.... I don't know how it works, perhaps should ask the pharmacist for some clarification.

[Wegetarian]

I went to pick up the 20mg pills today, kind of feels silly since I have so many 40mg's left. Dunno. Anyway, its easier to take one 20 and 2 x 5's than to split. I'll be using the 20's for quite a while. Guess I'll have a lot of 40's that I won't need though, but its not the end of the world. I doubt the insurance company will mind, I mean I was supposed to use the 40's anyway but was told to switch.

They were quite easy to split by hand, although some time I wasn't thinking and cracked the pills not by the scored line but had the pill the other way around and ended up with a bunch of small pieces in which case its obviously impossible to get anything close to 20mg.

[annekat]

I'm still having some trouble splitting the 10mg. pills, with a pill splitter or a knife or whatever, regardless of the scored line. I asked at my Rite Aid pharmacy, and no, they don't split pills for people. I can work with it the way it is, but next time I see my doc will ask for a prescription for some 5mg. pills to use along with the 1mgs. to make it easier to taper without a lot of messing around.

[drz]

I'm still having some trouble splitting the 10mg. pills, with a pill splitter or a knife or whatever, regardless of the scored line. I asked at my Rite Aid pharmacy, and no, they don't split pills for people. I can work with it the way it is, but next time I see my doc will ask for a prescription for some 5mg. pills to use along with the 1mgs. to make it easier to taper without a lot of messing around.

Have you tried a razor blade or really sharp knife like a filleting knife?

[annekat]

Have you tried a razor blade or really sharp knife like a filleting knife? Yes, and my pill splitter has something like a razor blade in it. It works best if I push on it a certain way, but it is always chancy. Might be the make-up of these particular pills, the binders they put in them to hold them together or whatnot. They are very small, too, for 10mg. pills, and I had much better luck with the bigger 10mg. pills that were a different color, sort of pinkish tan, I guess, instead of white. I have to take whatever the pharmacy gives me, and I guess they get them from more than one supplier or brand, thus the different sizes and colors.

[pberggren1]

I have always just got 1mg, 5mg, and 50mg pred tabs and they are always the same white ones. The only pills I ever had to split were the Nexium ones.

[annekat]

I have always just got 1mg, 5mg, and 50mg pred tabs and they are always the same white ones. The only pills I ever had to split were the Nexium ones. I guess the bigger ones I had were more of a pastel orange-tan, not so much pinkish. I'd like to have a selection of different ones for easier tapering. The pharmacy says insurance is getting more difficult about covering more than one prescription dosage of pred, or other drugs, at the same time. But if something isn't approved for that reason, they say they can over-ride it. Next time, I'd like to just get 5mg instead of 10mg, and continue getting the 1mg. I think that will work for me. Plus, pred is a cheap drug, so I can just pay for it myself if it is a problem.

[RangersWife]

My doctor told me that spliitting a pill more than once makes it impossible to keep the dose accurate. Some pharmacies will split them for you so it's more reliable.

[annekat]

My doctor told me that spliitting a pill more than once makes it impossible to keep the dose accurate. Some pharmacies will split them for you so it's more reliable. I asked at my pharmacy, Rite Aid, and they said they do not split them. It is manageable if you keep track of both, or all, parts of the pill you split, and make sure you take them all within the number of days alotted. Or come up with an alternating plan to get the correct average dose that you are going for. Or manage to get all kind of pills in different denominations... 1mg., 2.5mg, 5mg, and 10mg. A pharmacist told me that some insurance is touchy about that, handing out all kinds of different pills of one med... but they did give me 1mg. and 10mg. at the same time, and I haven't tried yet with any others. It's true that splitting the pills is a pain and I'd like to get around having to do that.

Oh, and I just looked at my own post above and reminded myself that pred is a cheap drug, so it wouldn't be a big deal to pay for some additional denominations of it myself, if the doc would prescribe them but the insurance wouldn't cover them.