RX for Readers: Splitting tablets

MG Oral Tablet: "The granules are homogeneous, as are the tablets, and as such, in practice, these tablets can be split."

Tablets 521 (photo credit: Courtesy)
Tablets 521
(photo credit: Courtesy)
I have been prescribed prednisone for a chronic condition. I was told to take 2.5 milligrams a day, but the smallest pill available in Israel is 5 mg. I was told that abroad one can get smaller dosages. A pharmacist told me I shouldn’t cut the pill in half, as the active ingredients in the pill are not distributed uniformly. Is this true? If so, does it make a difference? Why doesn’t the Health Ministry see to it that smaller dosages are available? – F.R., Tel Aviv
Howard Rice, a veteran pharmacist, comments:
In Israel, tablets of prednisone are manufactured by Rekah Pharmaceuticals in Holon. They are available (according to the Health Ministry’s Drug Index) in three strengths: 1 mg., 5 mg. and 20 mg. Abroad it can come as 1-mg., 2-mg., 2.5-mg., 5- mg., 10-mg., 20-mg., 25-mg. and 50-mg. tablets. It often happens that the required strength is less than 1 mg, or the weaning-off dosage requires a reduction of less than 1 mg.
When a tablet that is not enteric-coated, sustained-release, controlled-release or osmotically released, or if the medication is in capsule form, theoretically it can be ground up and made into capsules of exactly the dose required without in any way affecting the availability of the medication.
In rare cases, the grinding of the tablet can reduce its shelf life to about 25 percent – and that would also be if it were stored in a cool, dark place. This is often the practice in compounding pharmacies, and you could always ask the pharmacist to prepare it as such.
Having said this, when a tablet is made, one does so by making granules of the excipient (a pharmacologically inactive substance used as a carrier for the active ingredients of a medication) and active material. These granules are then poured over to fill dies, which are then pressed to form the tablet.
The granules are homogeneous, as are the tablets, and as such, in practice, these tablets can be split (albeit with a pill cutter to ensure a more accurate dose). This has been the practice in Israel for many years, and I have not heard or come across untoward effects from doing so. To ensure that no moisture is absorbed into the split tablet, naturally one should split them as required and not “build up a stock.”
I will nevertheless make inquiries at Rekah Pharmaceuticals to ensure that there has been no change in the formulations of prednisone.
I am a 38-year-old man, and I already suffer from lower-back pain. The doctor gave me some painkillers and advised me to rest. He said the pains should pass by themselves. Is this the best advice? – A.N., Ma’aleh Adumim
Dr. Uri Keinan , an orthopedist at Tel Aviv Sourasky Medical Center, replies:
You are not alone. Some 80 percent of the population will at some time suffer from this condition. It is the second-mostcommon complaint heard by general practitioners in the Western world. But there is some consolation: About the same percentage of these pains will go away without treatment within a month, and 10% more will pass within two months after the initial attack.
The reasons for lower-back pains are varied and could be connected with age. To diagnose it properly, a professional assessment has to be made. But there are two major reasons – mechanical or muscular pain, and neurological pain.
Mechanical pain is caused by too much of a burden on the muscles, ligaments and joints of the spine, and this is the most common cause of lower-back pain at any age.
Neurological pain is caused by pressure on the spine or on the base of the nerves, and the causes for its presentation vary according to age. Between age 20 and 40, the main cause is a herniated disc, but in older people, usually from 50 on, the pressure on the nerve is the result of several factors that cause the narrowing of the tunnel in the spine.
A herniated disc usually causes pain relatively suddenly. One or both of the legs may “fall asleep.” This may appear as the result of one-time exaggerated exertion or as the result of a “boiling point” of damage that suddenly causes the herniated disk. Pain may radiate to the legs. It usually gets worse with walking and eases when sitting.
The treatment for lower-back pain resulting from mechanical or muscle pain includes a day or two of rest, the use of pain relievers, heating pads or hot water bottles, massage and physiotherapy. But in most cases, it will go away, as I said, even without treatment.
If, however, the problem involves the narrowing of the spinal tunnel, conservative treatment is of limited use. Surgery may be needed. It is relatively simple, and recovery is quick. The chances of returning to normal function is very high. Consult an expert orthopedist for more details in your case.

Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to jsiegel@jpost.com, giving your initials, age and place of residence.