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Can Lipitor 10 mg tabs be cut in half and taken in half doses?
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Can Lipitor 10 mg tabs be cut in half and taken in half doses?

I ask because the Lipitor fullpage ads in national magazines say DO NOT BREAK TABLETS and they Lipitor website from Pfizer also says on the meds page DO NOT BREAK TABLETS but my doctor told me to break the 10 mg tabs in half and take just half each day. I wrote to Lipitor's PR department in NYC, a very polite letter, and they so far refuse to answer my emails, preferring to stonewall me, er, pillwall, me, which I do not understand why they would do that. I am a customer. I buy their pills. And they will not answer my simple question. I told Pfizer if they do not answer my polite consumer qusetions I will go to the New York Times and ask for a big news story about this to be written. PR should serve the customer, no? Or is Pfzier so big that they think the patients do not matter.

Reason i ask is my own cardiologist said it is OKAY to break the tabs in half, he even gave me a free pill cutter to cut the tabs, and said either the pill cutter or manually breaking them into two pieces is OKAY and he has been advising patients about this for over 5 years and that HE HIMSELF DID NOT EVEN KNOW of this rule, and he said maybe Pfizer doesn't want customers to save money, that it might all be a bottom line thing. Could that be true? I can't believe a pharm firm would but profits ahead of patients. So i made a blog and I am going to the New York Times with the story too, because Pfizer should not treat patients this way. Am I right or am I wrong? Please tell me before I have another heart attack! SMILE

the advert appeared in Atlantic Monthly magazine, huge two page color ad, that is expensive, that's alot of money to tell people DO NOT BREAK THE TABLETS.

PS: another doctor told me has been prescribing Lipitor for many years and never heard of this rule either.

What could the reason be for DO NOT BREAK THE TABLETS? A medical reason, like oxygen weakens the power of the meds? Or money? PLEASE DISH.
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Sally
***@****,
WW Communications Europe ,
" Ray" ,
", Neena"

dateSun, Apr 18, 2010 at 6:44 PM
subjectRe: URGENT, reporter , needs find PR dept to find out what LIPITOR pills should NOT be cut in half as per advert says, Docs say OK, why the ADVERT then?
mailed-bypfizer.com

hide details Apr 18 (6 days ago)


All

I am looping in Neena for background on this reporter and will suggest that the EU comms team can drop off this email chain unless someone objects

Thanks

Sally
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Neena to me
show details Apr 18 (6 days ago)


Dan - I do not have the answers (I am new to the healthcare industry). I need to talk to my colleagues and get back to you.
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, Neena to me, Sally OPR dtp PFIZER LIPiTOR
show details Apr 22 (3 days ago)


Hi Dan - so you're taking about an ad placed in the US. In that case,
I'll refer you to my colleague Sally who is based in NY and since you're
in the US. She'll the best person to help you out. I'm glad Lipitor
helped you. I think we were confused when you said that you were a
reporter in Taiwan so they referred you to me as I work with reporters
in Asia. Neena
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Neena to me
show details Apr 18 (6 days ago)


Hi Dan - I will talk to my colleagues tomorrow and then will get back to you. Neena

SO FAR NADA.....
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Have you asked a pharmacist? I trust them because they specialize in the chemistry of the medications. The doctors just prescribe them with the knowledge that this pill goes for that disease.

Some pills (and definitely capsules) have a protective coating on them so they dissolve in the proper part of the digestive system. If they dissolve too early, you may experience unpleasant side effects. Some are made to trickle into the system over a long period and they shouldn't be cut and damaged. My Diltiazem is a pill in a capsule so I should not remove it.

Try asking your pharmacist to see if your particular form of Lipitor can be cut.
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1045086_tn?1332130022
You should find this interesting.
"CalOptima initiated mandatory tablet splitting for Lipitor....."

http://www.caloptima.org/index.asp?content=pharmacylipitor
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Here's another one that answers specific FAQ's about tablet splitting.

http://www.firstcarolinacare.com/pharmacy/splittingfaq.htm

It would appear Big Pharma is rebelling against profit loss by advertising against pill splitting.  Profit drives everything in pharmaceuticals.  Sorry to disappoint you danbloom.

PLEASE NOTE THAT MANY - IN FACT, MOST - TABLETS SHOULD NEVER BE SPLIT OR CRUSHED UNLESS YOU ARE SPECIFICALLY DIRECTED TO DO SO.
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A book I have from my Doctors surgery states that cholesterol is made in the liver when we sleep. I have also seen reports stating that the more a person sleeps, the higher their cholesterol and the lower their good cholesterol. A study also showed how sleep devravation over a 5 day period reduced cholesterol levels. So, if we spit a statin pill, will it have the same desired effect? Everyone I know takes their statin in the evening, so I assume there is a reason for this backed up by research?
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Some pills have special coatings or time-release formulations that would make splitting them dangerous. Cutting such a tablet would make its absorption unpredictable.

This is not the case with Lipitor, however. Researchers at Veterans Affairs and Kaiser Permanente in California determined that splitting atorvastatin (Lipitor), lovastatin (Mevacor) and simvastatin (Zocor) was an effective way to lower costs without compromising cholesterol control. The study was published in the Journal of Managed Care Pharmacy (November/December 2002).

In any case, you should get clear instructions from your doctor.

Hope this helps,

Jon
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In fact, one can get a pill splitting unit from a pharmacy. And as Jon states there are pills that shouldn't be split.
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This IS interesting. so there are pros and cons, dos and donts...i see.....so far, Pfizer PR dept who i contacted directly, wrote back one, saying they would look into it, but they have not replied to me since and that was 8 days ago.....what are they afraid of.....? weird. just tell me the answer from their POV and why or why not, right?

If I don't get an answer, I plan to call up a reporter at the NYTimes or TIME magazine, and ask fro them to do a story on this. It's funny and humorous on one level, HAMLET, to cut or not to cut the tablet in half, that is the question, and on the other hand, it might be a good medical story about pills and docs and pharmarcies and full page adverts and money and profits and the bottom line. Know any good medical reporters? I am thinking of contacting Sharon  at newsweek magazine.....sharon.***@**** and Jeff  at TIme, Jeffrey_**@****
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i call the way Pfizer is treating me, the son of a doctor no less, PILLWALLING....as in stonewalling...har!
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I don't understand why you are so unhappy with Pfizer. If you don't like the way you're being treated with Lipitor, ask to be changed to a different statin that can be given at lower doses. I know many individuals that have experienced a heart attack that are just on Simvastatin, the cheapest and most flexible statin on the market.

This is starting to sound like an anti-Pfizer/Big Drug Company thread. I am unable to find this article on any issue of the New York Times, only on blogs claiming that the Times is covering the story ststing "they are now on it".  In addition, you are copying these posts, including mine, to these blogs. I am not an expert and never claimed to be so don't use me for a reference, not cool.

You have options, don't like Pfizer, take something else, there are many statins out there ut you should keep your agenda off forums like this.

Jon
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Jon, good note and thanks and I apologize. will take your name off those things.....

no, i am not against Pfizer, I LOVE Pfizer they are saving my life....and i love lipitor,,,,i am just curious about the DONT BREAK TABS rule, is it medically sound or just a recommendation and what is the reason for the recommendation? But this is more in sense of humor than serious. just curioous that;s all. I am not anti pharm, i am pro life!@

Danny
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You asked, that's fine. However when you take our responses and post them on personal blogs, that's not right. Also, when you quote an article by the New York times knowing that it doesn't exist, it kind of ruins your credibility.

In any case you most certainly accuse Pfizer of pill-walling, that sounds like an unhappy patient. Your doctor has prescribe a medication at a dose he feels is beneficial and you want to take steps to save money by splitting pills. I don't think money would be my concern.

Jon
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I appreciate your point of view Jon and I was confused by posts when I returned to have a look here, BUT

MONEY IS A HUGE CONCERN.  Perhaps not for Lipitor because it's generic now.  But if more people were concerned about saving in more places in years past.......well, you know where that is going.  Health care is hardly even about health care anymore.  It's big business gone bad.  John Q. pinches pennies while statin makers, et al haul in the big bucks or a naturally occuring substance.  

It's all about money for the Pharm companies.  Why do you think they are pushing combination products so hard?  And pushing for every man, woman and child to take statin drugs not matter their health history or risks?  Statin are a huge money maker for them and they don't want one penny of it taken away by someone trying to save a few bucks.

It is sad indeed if this is about money at the cost of truth.  I applaud danbloom and encourage him to investigate fully.  Just turn down the volume on the hyperbole a little.
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Last I checked, this is a free market system. The big pharma companies have a right to a profit. Without their money, where will the new breakthrough drugs come from? Where did the money come from to develop the drugs saving lives today?

If people are against statins and prefer natural substitutes, they should use them. People who want to take statins who's safety and effectiveness have been proven by numerous trials administered by the NIH have the right to take them. No one forces me to take a med, I make an educated decision. Options are available for everyone, I just think it's wrong to fault drug companies for making a profit. If saving money is a concern, there are other options.

Just my opinion................


Jon
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I never said any business shouldn't make a profit and there is certainly nothing to worry about in that department.  I just think you may be falling for Pharma's line without asking enough questions.  Many people do choose other options.  Some people don't have the information they would need to do that.  Others are incapable of investigating on their own.  They need an advocate.  It's called consumer protection.  Just my opinion.

No one may be forcing you.  Some doctors will refuse to treat if patient's don't embrace a full regimine.  (Oh, yes they do.)

You miss my point.  Cost should be a consideration in all we do. (edited to remove what I doubt you want to hear anyway)

You feel you are informed. We disagree.  I'm OK with that.
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Yes, I am informed. I do volunteer work in a major Cardiac Care Center and am exposed to Cardiologists and drug company reps. Why do we need an advocate, do we not have some responsibility has a patient? De we need an advocate when we decide to buy a car or furniture?

Again, the data is available for anyone to find. To say doctors will refuse to treat is just conjecture and a reckless statement. There are always some bad examples, but to think a doctor would put his career at risk by refusing to treat someone unwilling to accept his treatment option makes no sense.

I respect your opinion, I just don't think we'll see eye to eye on this one, but that's OK, it's what makes a forum interesting.
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I think what has upset a lot of people is the new findings in some patients who suffer from memory loss and other problems associated with statins. Perhaps if someone has normal cholesterol, they shouldn't be put on statins at all, but it does seem they are automatically given to almost all heart patients as a precaution. If there have been issues with people that have normal or low cholesterol and take statins, then perhaps the big drug companies need to at least do more research on this, rather than claim these are unrelated issues. I believe this is their duty and they can then produce their findings. There's no doubt that statins help people with high cholesterol, I have no side effects. I can imagine people with naturally low cholesterol before taking statins may suffer side effects though.
What angers me is that it shouldn't be us arguing over these issues, the drug companies should be finding out. I haven't seen any research by large drug companies on memory loss or other issues with statins, just claims. So perhaps everyone is right, when differing information comes from different sources, human nature says to develop doubt and ask questions.
I think Jon is correct with the money, drug companies invest huge sums in developing the next phase in medication. If they didn't, we wouldn't have statins. It takes years to come up with a new drug and lots of investment. I wonder how much the insurance companies pay out for heart problems related to high cholesterol each year, and how much the National Insurance in the UK has to pay. A box of statins a month must cost much much less than angioplasty or bypass surgery, so it makes sense in many ways.
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Drug companies invested NOTHING to develop statins - they occur naturally.  If there hadn't been a patent somehow granted there would have been precious little interest in Rx statins.  The companies DO invest millions to manufacture and promote statins.  

I DO NOT think they (statins or drug companies) are universally bad.  I applaud the real R&D that drug companies do.  It's just not as pure as it sounds.

My statement about refusal to treat is not reckless.  It is fact based on direct experience and observation.  It is also true however that many doctors will continue to consult with patients even when their advise is blatantly ignored.

Yes, data is available about everything and anything as long as you have enough curiosity, time and mistrust to couple with your intellectual, physical, and financial where-with-all to investigate.  Look around you.  Not everyone is fortunate enough to have all those things in one package.  Some people do need advocates for all types of things because there are too many people waiting take advantage of them and too many people who don't even know they exist.  Some people simply don't know what they don't know.  Not all of us can volunteer with experts or stay in a Holiday Inn Express every night.

I apologize danbloom for my contributions toward making a mushroom cloud out of this.  It isn't even about statins is it?  Your question is about the ethics of a company's public warning if that warning is based on economic gain rather than safety, right?  Any answers yet?
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"Not all of us can volunteer with experts or stay in a Holiday Inn Express every night"

Everyone can, it's a matter of getting off the Internet and getting into the real world, many just don't want to. It's too easy to read stories on the Internet about cover ups and alleged wrong doing and take them as facts.

If not for drug companies, there would be no real money invested in R&D, that's where the next breakthrough will come from.
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"Drug companies invested NOTHING to develop statins - they occur naturally"

It would be impossible to do it for nothing. Also the statin I take is synthetic, (atorvastatin).
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I just think this is much to do about nothing. If your doctor said split the pills, then follow his advice, it's his career on the line so I'm sure he knows what he's doing. It just sounds like you want to force Pfizer to give you an explanation. Pill splitting is common under a physician's care, why does it matter so much in you get an answer from Pfizer?

Here is a detailed explanation and you'll see it's all about the quality of the split and Lipitor is not the only drug with issues;

"Not all tablets split equally well. In a 2002 study, Paxil, Zestril and Zoloft split cleanly with 0% rejects. Glucophage was described as a hard tablet, requiring significant force, causing tablet halves to fly. Glyburide exhibited very poor splitting with many splitting into multiple pieces. Hydrodiuril and Oretic crumbled. Lipitor did not split cleanly, and the coating peeled. The diamond shaped Viagra tablets made location of the midline difficult. The worst result reported was Oretic 25 mg in which 60% of tablets failed to split to within 15% of target weight."

If the pill doesn't split correctly you will get ineffective dosage, it is probably just that simple.

Jon
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My carido doc friend in OHIO tells me:

''Dear Danny
I am now really relieved that I didn't give my patient the wrong instructions. I did occasionally instruct my patients to split lipid-lowering pills. You see, when I lower the dosage, I just don't see why we should waste the pills with higher strength, like, "Here is a new prescription for pills of half of the dose. Throw away those higher dose pills." I just don't see how should we waist expensive pills like that. Let's see what Pfizer tells you."
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jon, good question

''why does it matter so much in you get an answer from Pfizer? ''

because. i am a stickler for accuracy in advertising. that was my college major. but yes, hardly an important issue. my doc is right, i know this. cutting lippy in half is okay. i just suffer from a kind of impulsive/reflex/perfectionist disorder, IRPD, and just wanna know from the horse's mouth. Kind of like a PR exercise. I am also a PR man. I feel America has let its standards down about PR professionals and reporters. Where does truth lie? Or does truth lie?

But you are right, Jon.Not important issue. and ThANKS for all the feedback here. you are great and I thank u, sir? IF THE NEW YORK TIMES calls me and wants to do a story on this, pro and con, would you be willing to give a quote and give your name to reporter? I would love to have all sides coverred here. I have no agenda. Just set the record straight.
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I've cut and pasted the update post from danbloom here since people wouldn't know to look for it under a separate topic.
------------------------------------------------------------------------------------------
It is okay to break Lipitor pills in half Pfizer now tells me...
by danbloom, 1 hour ago
Follow up on an earlier question: Finally, the PF people at Pfizer told me that while the firm recommends that the Lipitor pills NOT be broken in half or cut in half, they do say that it is perfectly okay to do this under doctor's prescription or recommendation, and that there is no negative downside at all to cutting Lippy in half. However, they do recommend not breaking them if no need to. So there. Case solved. Happy camper I am.
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Yes, all's well that ends well. I kept gently asking and finally the PR people at Pfizer dished. Thanks, twopack for the note above. Case really closed now.
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lipitor according to cvs pharmacist, can be broken in half. Not scored but not sustained release so yes, can break in half. Its a money thing.
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I take 40mg Lipitor. I was getting it thru a source that gave me 80mg to split.  This was a BIG pill, and when split often felt pretty rough going down.  I can imagine that some (wimps) would feel threatened by this. (Or, indeed MIGHT actually get in trouble with it.)

I now get 40mg tab, and they are easier to swallow.  But I vote for: $They get more for 90 40mg than for 45 80mg$.
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