Tablet Splitting: Public Perception and Quality Attributes of Two Common Cardiovascular Drugs

Abstract

Our study aims to assess the perception and public practice of tablets splitting, and to evaluate the weight variation, weight loss and drug content of manual and splitter-produced tablet halves from selected commercially available cardiovascular products, which are furosemide (F) and atenolol (A) tablets. A cross-sectional online survey was conducted on a sample of 309 participants from both genders aged over 18 years old. The survey included 10 questions to assess the public perception of splitting of tablets, manually or by a splitter. The second part of the study was an experimental analysis of furosemide scored uncoated tablets and atenolol scored coated tablets (brands F and A respectively). Both medications were split manually and by a splitter. The resulting split halves were subjected to weight variation test according to USP 2018 and drug content assays according to BP 2018. The percentage of weight loss and weight variation assessment were calculated, while chemical analysis involved the determination of drug content in the split halves of each tablets. The survey results revealed that 95.0% of participants were familiar with tablet splitting and most of them reported that the need for tablets splitting is related mainly to either dose adjustment (51.1%) or difficulty in swallowing (36.6%). The majority of participants split their tablets manually (68.1%) and many were unsure about getting exactly the half amount of drug after splitting (44.3%). The statistical analysis of the experimental part showed significant difference in drug content between both halves as following: F Manually, A Manually, A Splitter (p < 0.001) and F Splitter (p= 0.0078). However, there was no significant difference between the weights of right halves and left halves, but some tablets were observed to lose fragments upon splitting and deviate from the allowed range of each half. Customers are aware about tablets splitting and the majority perform this manually despite their doubts about the accuracy of the dose. If required, tablet splitter should be recommended for splitting scored tablets.