Psycho-Babble Medication Thread 13721

Shown: posts 1 to 9 of 9. This is the beginning of the thread.

 

Get ready for splitting headaches.

Posted by Rick on October 23, 1999, at 18:50:48

O.K., sorry for the mudane topic (if anyone's bothering to read this), but I have the darndest time trying to split any of my pills besides BuSpar. Even though I use a typical, drugstore-bought pill splitter, my 5mg. Pindolol is impossible to break in half evenly without fragments or crushing -- despite the fact that it is scored down the middle! As for my 0.5mg Klonopin, a small piece usually seems to break off upon slicing -- unless I cut AGAINST the score, but in that case the cute little "K" cutout in the middle leaves me with two unequal pieces.

Does anyone know whether
1) There is a superior splitter available (please provide either brand name or place to order by mail), or
2) Whether some pharmacists will pre-split your pills, or
3) Whether anyone offers a class in effective splitting techniques?

Now, Medscape recently reported on a psych journal article suggesting pdocs cut costs by having patients split AD's. So get ready for your own splitting headaches. But, heck, the two pills I'm having trouble cutting are ALREADY the smallest available doses. And, darn it, I want that little fragment of Klonopin that broke off to end up in my brain, not down the drain!

Thanks in advance for any suggestions.

Rick

 

Re: Get ready for splitting headaches.

Posted by Noa on October 23, 1999, at 20:30:43

In reply to Get ready for splitting headaches., posted by Rick on October 23, 1999, at 18:50:48

I notice that some pills split better just by breaking them with thumbs and forefingers than using the pillcutter, which makes them shatter and crumble. At the moment I am lucky only to be splitting one pill (cytomel). The others I take whole. But there have been other times when I was taking split pills and had similar problems to what you describe.

 

Re: Get ready for splitting headaches.

Posted by Bob on October 23, 1999, at 21:27:02

In reply to Re: Get ready for splitting headaches., posted by Noa on October 23, 1999, at 20:30:43

Maybe someone needs to make a pill guillotine....

I've done pretty well in the past, but perhaps because I'll do all the splitting I need to do at once instead of every day (or every other day). Maybe practice makes perfect.

It's not the pdocs who make the money, tho -- it's the HMOs and their prescription plans. For example, when I was on 150mg/day of zoloft, my plan wouldn't cover 90 50mg pills for a single prescription. They'd force me to get 100mg pills since the 100mg pills cost almost the same as the 50's (and not twice the price, as you might expect).

The other problem is the result of the splitting. Can't remember the report's source, but I recall hearing that splitting pills, even well-split down a score line, can result in widely varying dosages from day to day.

Feckin' HMOs ...
Bob

 

Re: Get ready for splitting headaches.

Posted by JohnL on October 24, 1999, at 4:48:34

In reply to Get ready for splitting headaches., posted by Rick on October 23, 1999, at 18:50:48

Hi Rick. I've often wondered the same thing. I don't know the answers to your questions.

With that in mind however, I really don't think small inaccuracies in dosage are going to make any difference. Say for example the 5mg Pindolol breaks unevenly into a 2mg piece and a 3mg piece. Both of those doses are so small I don't think it's even relevent.

I sometimes vary the dosage by small amounts on purpose. I have alway felt it simulates real life better than a pure steady state. For example, I used to take Zoloft. I found it worked better when I took 100mg one day, 125 the next, then 100 the next, and so on. It worked better than 100 everyday or 125 everyday. I do the same now with Prozac and find it makes a positive difference when the dosage has subtle ebbs and flows rather than a continuous steady state. As long as the fluctuations are at or above the therapeutic level.

If exact dosages are important though, there are very accurate weight scales (like a triple beam) that could be used. That's how drug dealers measure out the tiniest fragments of a gram or less of whatever illegal drug they're peddling. I think those scales are expensive though. Not worth what I think are irrelevent discrepencies in dosage accuracies. The inaccuracies of concern here seem too small to make any difference to me. Don't get a splitting headache over it. :)

 

Dosage variation/manual dexterity/HMO's

Posted by Rick on October 24, 1999, at 11:26:57

In reply to Re: Get ready for splitting headaches., posted by JohnL on October 24, 1999, at 4:48:34

Thanks for the input, guys. Noa, Bob and John L have all offered interesting tips, and raised some thought-provoking sideline issues.

John L, your thoughts on the benefits of dosage fluctuation reminded me of something that happened last week. I take the Klonopin for Social Phobia, and have settled into a regimen where I take 0.75 grams upon waking, and then take another 0.75 in two unevenly divided doses at work. One day last week I forgot to take my Klonopin to work, but it turned out to be a really GOOD day in terms of dealing with symptom-inducing situations. And I never DID take the remainder for that day. (That night I came down with my first cold in eight months, but I really don't think it's related.)

I'd be interested to hear what others think about moderate dosage fluctuation -- intentional and otherwise -- on a maintenance med. To me, your reasoning made a good deal of sense, not to mention providing some relief from worry over "splitting headaches".

Rick

> Hi Rick. I've often wondered the same thing. I don't know the answers to your questions.
>
> With that in mind however, I really don't think small inaccuracies in dosage are going to make any difference. Say for example the 5mg Pindolol breaks unevenly into a 2mg piece and a 3mg piece. Both of those doses are so small I don't think it's even relevent.

> I sometimes vary the dosage by small amounts on purpose. I have alway felt it simulates real life better than a pure steady state. For example, I used to take Zoloft. I found it worked better when I took 100mg one day, 125 the next, then 100 the next, and so on. It worked better than 100 everyday or 125 everyday. I do the same now with Prozac and find it makes a positive difference when the dosage has subtle ebbs and flows rather than a continuous steady state. As long as the fluctuations are at or above the therapeutic level.
>
> If exact dosages are important though, there are very accurate weight scales (like a triple beam) that could be used. That's how drug dealers measure out the tiniest fragments of a gram or less of whatever illegal drug they're peddling. I think those scales are expensive though. Not worth what I think are irrelevent discrepencies in dosage accuracies. The inaccuracies of concern here seem too small to make any difference to me. Don't get a splitting headache over it. :)

 

Re:HMO's are Pills

Posted by Noa on October 24, 1999, at 18:24:02

In reply to Dosage variation/manual dexterity/HMO's, posted by Rick on October 24, 1999, at 11:26:57

There have been times when I have been on a dosage that doesn't divide evenly by the pill strengths available, so the doc would write two scrips so I could combine, say 75 mg. pills with 37.5 mg. pills. Each scrip costs $20 (I know I shouldn't complain, at least I have coverage and some people have to pay the full price, which is HUNDREDS OF DOLLARS). So I asked my doc to write the scrip all in one size so I don't have to pay two copays. The HMO balked because they don't like to let people take smaller pills. But my doc did get them to agree. This issue is a problem for people who have a hard time swallowing pills, and have managed to learn how to swallow smaller pills, but the HMO wants them to take the big horse-size ones.

 

Re:Guillotine

Posted by Noa on October 24, 1999, at 18:25:09

In reply to Re:HMO's are Pills, posted by Noa on October 24, 1999, at 18:24:02

My pill cutter does look something like a guillotine.

 

Re:Guillotine ... and variable dosage

Posted by Bob on October 24, 1999, at 23:57:09

In reply to Re:Guillotine, posted by Noa on October 24, 1999, at 18:25:09

> My pill cutter does look something like a guillotine.

Well, the blade on mine does, but I want the little wooden frame to lock the pill into place, and I want some little string to pull to engage some sort of spring-loaded blade (couldn't depend on weight for the cutting force) to snap down and chop it off -- I think it'd be a great visualization strategy if I could picture the CEO of my HMO being in there instead of the pill.

As for variable dosage, 1mg difference may not sound like much, but I think you need to think about proportion and not brute size. That 3mg pill has 50% more medicine than the 2mg pill does. Now, if I lost a few milligrams to pill dust and fragments in splitting a 100mg zoloft tab, I wouldn't be concerned. On the other hand, the way I respond to clonazepam I was quite concerned about splitting my 1mg tabs -- if one of those half-tabs turns out to be .35 to .4mg instead of .5mg, then I'm losing 20-30% of the dose I need.

Thank goodness I'm up to a full tab now. Phew.
Bob

 

Re:Guillotine ... and variable dosage

Posted by JohnL on October 25, 1999, at 4:41:59

In reply to Re:Guillotine ... and variable dosage, posted by Bob on October 24, 1999, at 23:57:09


> As for variable dosage, 1mg difference may not sound like much, but I think you need to think about proportion and not brute size. That 3mg pill has 50% more medicine than the 2mg pill does. Now, if I lost a few milligrams to pill dust and fragments in splitting a 100mg zoloft tab, I wouldn't be concerned. On the other hand, the way I respond to clonazepam I was quite concerned about splitting my 1mg tabs -- if one of those half-tabs turns out to be .35 to .4mg instead of .5mg, then I'm losing 20-30% of the dose I need.
>
> Thank goodness I'm up to a full tab now. Phew.
> Bob

Like I said though, "as long as the fluctuations are at or above the therapeutic level". And you're right, with meds that involve very small amounts as therapeutic doses, the issue becomes more important. And even though 3mg Pindolol is 50% more than 2mg, both amounts are so small compared to therapeutic doses it has to be irrelevent. Even so, I wouldn't be cutting the pills in a way or in a place where I could lose dust/small fragments. That stuff can be licked up on the finger or scraped up and mixed in juice or whatever. No need to waste it.

The idea of the fluctuating dose is an extension of an idea discussed in Dr Bob's Tips. There is a discussion of irregular Prozac dosing (once, twice, three times a week instead of daily) to minimize sexual side effects. Something about avoiding a steady state. I always had that in the back of my mind. It praticularly applied to Prozac's long half-life, but I wondered if the concept could be modified and applied to shorter half-life meds.

When I was titrating up on Zoloft, I couldn't tolerate making the leap from say 50mg everyday to 75mg everyday. So I would do 50mg one day, 75 the next, 50 again, and so on until the 75mg didn't seem like such a huge jump anymore. Then I would stay at 75 for a while. Then start the same process with 75mg/100mg. But somewhere along the line I realized I was having better days when I was in the mode of alternating doses and not at a steady level. Donb't know why. But like I said, it was in the back of my mind and one day I just made the accidental connection. Could be hocus pocus, could be for real. Whatever works, right?


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