Diana A van Riet-Nales1, Myrthe E Doeve2, Agnes E Nicia2, Steven Teerenstra3, Kim Notenboom4, Yechiel A Hekster3, Bart J F van den Bemt5. 1. Medicines Evaluation Board, Department of chemical pharmaceutical assessment (DAR/AN/MD) resp. Pharmacotherapeutic Group 3 (ST) resp. Scientific Board (YH), Utrecht, The Netherlands. Electronic address: da.v.riet@cbg-meb.nl. 2. Medicines Evaluation Board, Department of chemical pharmaceutical assessment (DAR/AN/MD) resp. Pharmacotherapeutic Group 3 (ST) resp. Scientific Board (YH), Utrecht, The Netherlands. 3. Medicines Evaluation Board, Department of chemical pharmaceutical assessment (DAR/AN/MD) resp. Pharmacotherapeutic Group 3 (ST) resp. Scientific Board (YH), Utrecht, The Netherlands; Radboud University Medical Centre, Department of Health Evidence (ST) resp. department of clinical pharmacy (YH, BB), Nijmegen, The Netherlands. 4. National Institute for Public Health and the Environment (RIVM), Centre for Health Protection (GZB), Department of Public Health Effects, Bilthoven, The Netherlands. 5. Radboud University Medical Centre, Department of Health Evidence (ST) resp. department of clinical pharmacy (YH, BB), Nijmegen, The Netherlands; Sint Maartenskliniek, Department of pharmacy, Nijmegen, The Netherlands.
Abstract
INTRODUCTION: Tablets are frequently subdivided to lower the dose, to facilitate swallowing by e.g. children or older people or to save costs. Splitting devices are commonly used when hand breaking is difficult or painful. METHODS: Three techniques for tablet subdivision were investigated: hand breaking, tablet splitter, kitchen knife. A best case drug (paracetamol), tablet (round, flat, uncoated, 500 mg) and operator (24-year student) were applied. Hundred tablets were subdivided by hand and by three devices of each of the following types: Fit & Healthy, Health Care Logistics, Lifetime, PillAid, PillTool, Pilomat tablet splitter; Blokker kitchen knife. The intra and inter device accuracy, precision and sustainability were investigated. The compliance to (adapted) regulatory requirements was investigated also. RESULTS: The accuracy and precision of hand broken tablets was 104/97% resp. 2.8/3.2% (one part per tablet considered; parts right/left side operator). The right/left accuracies of the splitting devices varied between 60 and 133%; the precisions 4.0 and 29.6%. The devices did not deteriorate over 100-fold use. Only hand broken tablets complied with all regulatory requirements. CONCLUSION: Health care professionals should realize that tablet splitting may result in inaccurate dosing. Authorities should undertake appropriate measures to assure good function of tablet splitters and, where feasible, to reduce the need for their use.
INTRODUCTION: Tablets are frequently subdivided to lower the dose, to facilitate swallowing by e.g. children or older people or to save costs. Splitting devices are commonly used when hand breaking is difficult or painful. METHODS: Three techniques for tablet subdivision were investigated: hand breaking, tablet splitter, kitchen knife. A best case drug (paracetamol), tablet (round, flat, uncoated, 500 mg) and operator (24-year student) were applied. Hundred tablets were subdivided by hand and by three devices of each of the following types: Fit & Healthy, Health Care Logistics, Lifetime, PillAid, PillTool, Pilomat tablet splitter; Blokker kitchen knife. The intra and inter device accuracy, precision and sustainability were investigated. The compliance to (adapted) regulatory requirements was investigated also. RESULTS: The accuracy and precision of hand broken tablets was 104/97% resp. 2.8/3.2% (one part per tablet considered; parts right/left side operator). The right/left accuracies of the splitting devices varied between 60 and 133%; the precisions 4.0 and 29.6%. The devices did not deteriorate over 100-fold use. Only hand broken tablets complied with all regulatory requirements. CONCLUSION: Health care professionals should realize that tablet splitting may result in inaccurate dosing. Authorities should undertake appropriate measures to assure good function of tablet splitters and, where feasible, to reduce the need for their use.
Authors: Diana A van Riet-Nales; Katarina Sundberg; Anthonius de Boer; Blanka Hirschlérova Journal: Br J Clin Pharmacol Date: 2020-10 Impact factor: 4.335
Authors: Diana A van Riet-Nales; Erwin G A W Römkens; Agnes Saint-Raymond; Piotr Kozarewicz; Alfred F A M Schobben; Toine C G Egberts; Carin M A Rademaker Journal: PLoS One Date: 2014-06-04 Impact factor: 3.240
Authors: Kim Notenboom; Herman Vromans; Maarten Schipper; Hubert G M Leufkens; Marcel L Bouvy Journal: Front Pharmacol Date: 2016-07-26 Impact factor: 5.810