How to Split Pills Safely to Reduce Medication Costs

Many people in New Zealand and around the world are cutting pills in half to save money on prescriptions. It sounds simple-break a 40mg tablet into two 20mg doses and pay less. But what seems like a smart trick can turn dangerous if done wrong. The truth is, splitting pills can save you hundreds a year… or land you in the hospital. It’s not about being cheap. It’s about knowing which pills are safe to split, how to do it right, and when to say no.

Why Pill Splitting Saves Money

Pharmaceutical companies don’t price pills by the milligram. A 40mg tablet of atorvastatin might cost $4.27, while two 20mg tablets cost $3.48 each-totaling $6.96. Split the 40mg tablet, and you get two doses for less than half the price. That’s a 38% savings on just one medication. For someone taking three or four split pills a day, that adds up to over $1,200 a year.

This isn’t just theory. A 2022 Kaiser Family Foundation study found nearly 1 in 7 Medicare beneficiaries split pills to cut costs. Seniors and low-income patients are the most likely to do it. The reason? Many drugs follow a broken pricing model: higher doses cost less per milligram. So if your doctor prescribes 20mg daily, buying a 40mg tablet and splitting it saves money-if it’s safe to split.

Not All Pills Can Be Split

This is where things get risky. The FDA says you should never split pills unless the package insert says it’s okay. That’s not a suggestion. It’s a warning backed by real harm.

Here are the pills you should never split:

• Extended-release tablets (like metformin ER, Adderall XR, or OxyContin): These have a special coating or matrix that controls how the drug releases over hours. Cut them open, and you get a full dose all at once-risking overdose.
• Enteric-coated pills (like omeprazole or aspirin EC): These are designed to pass through your stomach and dissolve in the intestine. Splitting them exposes the drug to stomach acid, making it useless-or irritating your stomach lining.
• Narrow therapeutic index drugs (like warfarin, digoxin, levothyroxine, or tacrolimus): These drugs work in a very tight range. A 10% dose change can cause serious problems. One patient split their Synthroid and ended up with a TSH level so high they needed emergency treatment.

If you’re unsure, check the package insert. Look for the words “do not crush or split.” If it’s not clear, ask your pharmacist. Don’t guess.

The Right Way to Split a Pill

If your pill is safe to split, here’s how to do it right:

1. Get approval first. Talk to your doctor or pharmacist. Ask: “Is this pill FDA-approved for splitting?” and “Is there a lower-strength version available?”
2. Use a pill splitter. Not a knife. Not your fingernails. Not a pair of scissors. A dedicated pill splitter-those small plastic devices with a V-shaped holder and a retractable blade-costs $3 to $10 at any pharmacy. They hold the pill steady and cut cleanly.
3. Split it right before you take it. Once you cut a pill, it starts to degrade. Moisture, heat, and air can break down the active ingredient. Don’t split a week’s supply. Split one at a time.
4. Check the halves. If one piece is crumbly, uneven, or stuck to the splitter, throw it out. You’re not getting the right dose.
5. Wash your hands and the splitter. After each use. Dust from pills can build up and contaminate the next one.

A 2007 study in the Journal of the American Pharmacists Association found that using a pill splitter kept dose accuracy within 5-15%. Knife-splitting? That jumped to 25-72% variation. That’s not a small error. That’s the difference between a safe dose and a toxic one.

What Happens When You Do It Wrong

People don’t always realize how dangerous this can be until it’s too late.

One Reddit user split their amlodipine tablet-a time-release blood pressure drug-and ended up in the ER with dangerously low blood pressure. Another split their Synthroid and had to get emergency blood work after their thyroid levels went off the charts. Between 2018 and 2023, the FDA recorded 127 adverse events directly tied to improper pill splitting.

Even when people think they’re doing it right, they’re not. In a 2010 study, 94 volunteers split 25mg hydrochlorothiazide tablets. Forty-one percent of the halves varied by more than 10% from the target dose. Twelve percent were off by over 20%. That’s not a mistake-it’s a hazard.

When Splitting Doesn’t Save Money

It’s not always cheaper. Sometimes, the math doesn’t work.

For example, sertraline: a 100mg tablet costs $0.12. A 50mg tablet costs $0.08. Splitting the 100mg tablet saves you nothing. In fact, you’re better off buying two 50mg tablets.

Lisinopril is another story. A 20mg tablet costs $4.00. Two 10mg tablets cost $4.50. Splitting saves you 11%. That’s worth it.

The key is to check prices. Use GoodRx or your pharmacy’s price list. Compare the cost per milligram. If the higher-dose tablet costs less per mg, splitting makes sense. If not, don’t bother.

Better Alternatives to Pill Splitting

Pill splitting should be a last resort. Before you cut a pill, explore other options:

• Pharmacy discount cards: Programs like GoodRx or SingleCare can cut prices by 30-70% on many medications.
• Manufacturer patient assistance programs: Most big drug companies offer free or low-cost meds to people who qualify based on income. You can apply online in minutes.
• Ask for generic versions: Many brand-name drugs have generics that cost 80-90% less.
• Ask your doctor about alternative meds: Sometimes, a different drug in the same class is cheaper and just as effective.

A 2023 IQVIA report found patient assistance programs offer an average 53% savings-better than splitting, and zero risk.

What to Do If You’ve Already Been Splitting Pills

If you’ve been splitting pills without checking with your doctor or pharmacist:

• Stop immediately.
• Check the name of each pill you’ve split. Look up the manufacturer’s website or call your pharmacy to confirm if it’s approved for splitting.
• Bring your pill splitter and your medication list to your next appointment. Ask: “Which of these are safe to split?”
• If you’ve had symptoms like dizziness, irregular heartbeat, or unusual fatigue, tell your doctor. It could be related to inconsistent dosing.

Final Thoughts: Safety Over Savings

Pill splitting isn’t evil. It’s a response to a broken system. Medication prices are high. Many people are choosing between food and prescriptions. But saving money shouldn’t mean risking your health.

The safest approach is simple:

• Only split pills your doctor or pharmacist says are safe.
• Only use a pill splitter.
• Split one pill at a time.
• Check prices before you split.
• Ask about alternatives first.

If you’re unsure, don’t split. Call your pharmacy. They’re paid to give you this advice. And if your pharmacist says no, they’re not being difficult-they’re protecting you.