Split Medication in Half

Introduction

As part of a pharmaceutical treatment, splitting (cutting in half) has been an accepted practice as a way of obtaining the prescribed dose when a specific dose is not available. For example, in pediatric or geriatric patients for whom, the proper doses are often not available on the market.

Other examples include cases

where there is a need to provide proper fractioned doses within a flexible regimen,
when there is a need to reduce or increase the dosage in a dosing regimen,
when there is a need to begin therapy with the lowest possible dose in order to avoid an incidence of adverse effects,
when there is a need to adjust the therapeutic response of an individual patient,
as an aid in the administration of large tablets which patients find hard to swallow whole, and
as a way of cost saving using cheaper larger dose medications in the required proportions.

NOTE: Cost saving cases is only applicable to flat-priced tablets (costs of different dosage strengths are equal or similar)

However, are they necessary?

Is Splitting of Medications Advisable?

The concern relies on the content uniformity and stability of tablet segments.

Inaccuracy in splitting tablets resulted in dose fluctuations.
Increased degradation of drug as a result of exposure to air.
Alterations in the dissolution rate of some formulations.
Complex regimens involving split tablets may decrease patient compliance.

Generally, tablets that are scored are usually considered by the manufacturer to be suitable for division.

However, some tablets, even with a score line, may not break easily into 2 pieces of equal size.

Nonetheless, there are very few medications with scoring line yet splitting is not recommended.

Epilim Chrono 500 mg Tablet
Keppra 250 mg, 500 mg and 1 g Film Coated Tablet - Foul tasting
Pentasa PR 500 mg Tablet

NOTE: Tablet factors contributing to inaccuracy of tablet splitting include small size, irregular shape, scored on one side only. Plus, many tablets are not designed to be spilt or are difficult to divide and tablets may break into uneven parts or crumble. To illustrate, Proscar 5 mg had an oddly shape, rendering it not suitable for splitting.

Nonetheless, it is generally fine for chronic therapies (e.g. hypertension, cholesterol, diabetes mellitus) since it often does not matter when a patient takes a little more of a drug one day and a little less the next day. However, there are few medication categories where we should not split.

Drugs that should NOT be Split

Generally, oral medications that usually should not be split include

Capsules
Tablets that crumble when split

e.g. Sublingual tablet, orodispersible tablet
Exception cases: When using Glyceryl Trinitrate 0.5 mg Sublingual Tablet for the first time when experiencing symptoms of angina, you may place one or half a tablet under the tongue.

Potentially hazardous substances, e.g. chemotherapy drugs

You may check up NIOSH List of Hazardous Drugs in Healthcare Settings, 2020 for more info

Modified release medications - Exception cases include

Carbamazepine 200 mg and 400 mg CR Tablet - As per product leaflet of Tegretol CR, the CR tablets of carbamazepine (either whole or, if so prescribed, only half a tablet) should be swallowed unchewed with a little liquid.
Gliclazide 60 mg MR Tablet - As per Lexicomp recommendation, you may split the 60 mg modified-release tablets of gliclazide in half, however, the 30 mg modified release tablets must be swallowed whole. Modified release tablets should not be crushed or chewed.
Isosorbide Mononitrate 60 mg Extended Release Tablet - As per Lexicomp recommendation, do not chew or crush ER tablets; may be divided in half. Due to insoluble matrix embedding, ER tablets that are scored may be split.
Theophylline 250 mg SR Tablet - As per Lexicomp recommendation, do not chew or crush tablets; may split tablet if scored.

Medications that is enteric coated

To mask taste, to reduce stomach irritation or other reasons.

Combination medication tablet - Exception cases include:

Atenolol 100 mg and Chlortalidone 25 mg Tablet - Can be half tablet in dosing
Carbinoxamine Maleate 4 mg and Pseudoephedrine 60 mg Tablet - Can be halved for children dosing
Levodopa 200 and Benserazide 50 mg Tablet - Can be halved or quartered
Sulfadoxine 500 mg and Pryimethamine 25 mg Tablet - Can be half tablet in dosing
Zidovudine 300 mg and Lamivudine 150 mg Tablet - Can be halved for children dosing

Medications that have a narrow therapeutic index

A small fluctuation in dosage can have a big difference in effect, e.g. digoxin and warfarin.

Examples of Tablets that Should Not Be Split

Hazardous

Abiraterone 250 mg Tablet
Afatinib 20 mg, 30 mg, 40 mg and 50 mg Tablet (Giotrif)

Giotrif tablets may be dispersed in approximately 100 ml of noncarbonated water.

Apalutamide 60 mg Tablet (Erleada)
Axitinib 1 mg and 5 mg Tablet (Inlyta)
Brigatinib 30 mg, 90 mg and 180 mg Tablet (Alunbrig)
Busulfan 2 mg Tablet (Myleran)
Cabozantinib 20 mg, 40 mg and 60 mg Tablet (Cabometyx)
Capecitabine 150 mg and 500 mg Tablet (Xeloda)
Capmatinib 150 mg and 200 mg Tablet (Rahika)
Chlorambucil 2 mg Tablet (Leukeran)
Cyclophosphamide 50 mg Tablet
Erlotinib 25 mg, 100 mg and 150 mg Tablet (Tarceva)
Everolimus 0.25 mg and 0.75 mg Tablet
Gefitinib 250 mg Tablet

Alternatively, put the tablet in half a glass of plain water, stir until it dissolves (about 15 minutes), then drink it straight away; rinse glass and drink this too.

Leflunomide 10 mg and 20 mg Tablet (Arava)

Arava 20 mg is triangular in shape

Lorlatinib 25 mg and 100 mg Tablet (Lorviqua)
Melphalan 2 mg Tablet (Alkeran)
Mercaptopurine 50 mg Tablet
Methotrexate 2.5 mg Tablet
Mycophenolate Mofetil 180, 360 and 500 mg Tablet
Olaparib 100 mg and 150 mg Tablet (Lynparza)
Osimertinib 40 mg and 80 mg Tablet (Tagrisso)

Alternatively, if you cannot swallow the tablet, put the tablet in one quarter of a cup of plain water, stir until it disperses, then drink it straight away; rinse cup and drink this too.

Pazopanib 200 mg and 400 mg Tablet (Votrient)
Ponatinib 15 mg and 45 mg Tablet (Iclusig)
Ruxolitinib 5 mg, 15 mg and 20 mg Tablet (Jakavi)
Tamoxifen 20 mg Tablet (Nolvadex-D)
Tofacitinib 5 mg Tablet (Xeljanz)
Valganciclovir 450 mg Tablet (Valcyte)
Vemurafenib 250 mg Tablet (Zelboraf)

Sublingual Preparation

Asenapine 5 mg, 10 mg Sublingual Tablet (Saphris)
Buprenorphine 2 mg and Naloxone 0.5 mg Sublingual Tablet, Buprenorphine 8 mg and Naloxone 2 mg Sublingual Tablet (Suboxone)
Desmopressin 60 mcg and 120 mcg Sublingual Tablet (Minirin)
Fentanyl 100 mcg, 200 mcg and 400 mcg Sublingual Tablet (Abstral SL)

Orodispersible Tablet

Bilastine 10 mg Orodispersible Tablet (Bilaxten ODT)
Donepezil 5 mg and 10 mg Orodispersible Tablet (Aricept Evess)
Everolimus 2 mg, 3 mg and 5 mg Dispersible Tablet (Afinitor)
Lamotrigine 5 mg and 25 mg Dispersible Tablet (Lamictal Dispersible)
Mirtazapine 15 mg and 30 mg Orodispersible Tablet (Remeron)

Modified Release Preparation

Bisacodyl 5 mg Enteric Coated Tablet (Dulcolax)
Budesonide 9 mg Prolonged Release Tablet (Cortiment)
Cefaclor 375 mg MR Tablet (Distaclor)
Cetirizine 5 mg and Pseudoephedrine 120 mg Extended Release Tablet (Zyrtec-D)
Dapagliflozin 5 mg and Metformin 1000 mg MR Tablet, Dapagliflozin 10 mg and Metformin 500 mg MR Tablet, Dapagliflozin 10 mg and Metformin 1000 mg MR Tablet (Xigduo XR)
Desloratadine 2.5 mg and Pseudoephedrine 120 mg Extended Release Tablet (Aerius D-12)
Desvenlafaxine 50 mg and 100 mg Extended Release Tablet (Pristiq)
Diclofenac sodium 75 mg and 100 mg SR Tablet (Voltaren SR)
Doxazosin Mesilate 4 mg XL Tablet (Cardura XL, Kamiren XL)
Esomeprazole 20 mg and 40 mg Tablet (Nexium)
Felodipine 2.5 mg, 5 mg and 10 mg Extended Release Tablet (Plendil)
Fexofenadine 60 mg and Pseudoephedrine 120 mg Extended Release Tablet (Telfast-D)
Fluvastatin 80 mg XL Tablet (Lescol XL)
Glimepiride 2 mg and Metformin HCl 500 mg Prolonged Release Tablet (Amaryl M SR, Proglutrol G2)
Indapamide 1.5 mg SR Tablet (Natrilix)
Indapamide 1.5 mg and Amlodipine 5 mg MR Tablet, Indapamide 1.5 mg and Amlodipine 10 mg MR Tablet (Natrixam)
Loratadine 5 mg and Pseudoephedrine 120 mg Extended Release Tablet (Clarinase)
Methylphenidate 18 mg and 36 mg Extended Release Tablet (Concerta)
Mirabegron 25 mg and 50 mg Prolonged Release Tablet (Betmiga)
Naproxen 500 mg and Esomeprazole Magnesium 20 mg MR Tablet (Vimovo)
Oxycodone and Naloxone Extended Release Tablet (Targin)
Oxycodone 10 mg, 20 mg and 40 mg Controlled Release Tablet (OxyContin)
Paliperidone 3 mg, 6 mg, 9 mg and 12 mg XR Tablet (Invega)
Pantoprazole 20 mg and 40 mg Enteric Coated Tablet (Controloc)
Pentoxifylline 400 mg Controlled Release Tablet (Trental)
Posaconazole 100 mg Modified Release Tablet (Noxafil)
Potassium Chloride 600 mg Slow Release Tablet (Potrelease TR)
Pramipexole 0.375 mg and 1.5 mg Extended Release Tablet (Sifrol ER)
Quetiapine 50 mg, 200 mg, 300 mg and 400 mg Extended Release Tablet (Seroquel XR)
Rabeprazole 10 mg and 20 mg Enteric Coated Tablet (Pariet)
Ranolazine 375 mg, 500 mg and 750 mg PR Tablet (Ranexa)
Saxagliptin 2.5 mg and Metformin 1000 mg Extended Release Tablet, Saxagliptin 5 mg and Metformin 1000 mg Extended Release Tablet, Saxagliptin 5 mg and Metformin 500 mg Extended Release Tablet (Kombiglyze XR)
Sitagliptin 50 mg and Metformin HCl 500 mg Extended Release Tablet, Sitagliptin 50 mg and Metformin HCl 1000 mg Extended Release Tablet, Sitagliptin 100 mg and Metformin HCl 1000 mg Extended Release Tablet (Janumet XR)
Sodium Valproate 500 mg Enteric Coated Tablet (Epilim)
Tamsulosin 400 mcg Prolonged Release Tablet (Harnal OCAS)
Upadacitinib 15 mg MR Tablet (Rinvoq XR)
Verapamil 120 mg and 240 mg MR Tablet

Combination Preparation

Abacavir sulphate 600 mg and Lamivudine 300 mg Tablet (Kivexa)
Alendronate 70 mg and Cholecalciferol 5600 IU Tablet (Fosamax Plus)
Allopurinol 100 mg and Benzbromarone 20 mg Tablet (Lanolone)
Alogliptin 12.5 mg and Metformin 500 mg Tablet, Alogliptin 12.5 mg and Metformin 1000 mg Tablet (Nesina Met)
Amlodipine 5 mg and Atorvastatin 10 mg Tablet, Amlodipine 5 mg and Atorvastatin 20 mg Tablet, Amlodipine 5 mg and Atorvastatin 40 mg Tablet, Amlodipine 10 mg and Atorvastatin 10 mg Tablet, Amlodipine 10 mg and Atorvastatin 20 mg Tablet, Amlodipine 10 mg and Atorvastatin 40 mg Tablet (Caduet)
Amlodipine 5 mg and Losartan 50 mg Tablet, Amlodipine 5 mg and Losartan 100 mg Tablet (Cozaar XQ)
Amlodipine 5 mg and Perindopril Erbumine 4 mg Tablet, Amlodipine 5 mg and Perindopril Erbumine 8 mg Tablet, Amlodipine 10 mg and Perindopril Erbumine 4 mg Tablet, Amlodipine 10 mg and Perindopril Erbumine 8 mg Tablet (Amopril)
Amlodipine 5 mg and Valsartan 80 mg Tablet, Amlodipine 5 mg and Valsartan 160 mg Tablet, Amlodipine 5 mg and Valsartan 320 mg Tablet, Amlodipine 10 mg and Valsartan 160 mg Tablet, Amlodipine 10 mg and Valsartan 320 mg Tablet (Exforge)
Amlodipine 5 mg, Valsartan 160 mg and Hydrochlorothiazide 12.5 mg Tablet, Amlodipine 10 mg, Valsartan 160 mg and Hydrochlorothiazide 12.5 mg Tablet, Amlodipine 10 mg, Valsartan 160 mg and Hydrochlorothiazide 25 mg Tablet (Exforge HCT)
Amoxicillin 500 mg and Clavulanate 125 mg Tablet, Amoxicillin 875 mg and Clavunalate 125 mg Tablet (Augmentin)
Artemether 20 mg and Lumefantrine 120 mg Tablet (Riamet)
Artesunate 25 mg and Mefloquine 55 mg Tablet, Artesunate 100 mg and Mefloquine 220 mg Tablet
Aspirin 100 mg and Glycine Tablet (Cardiprin, Glyprin)
Atorvastatin 10 mg, Perindopril Arginine 5 mg and Amlodipine 5 mg Tablet, Atorvastatin 20 mg, Perindopril Arginine 5 mg and Amlodipine 5 mg Tablet, Atorvastatin 20 mg, Perindopril Arginine 10 mg and Amlodipine 5 mg Tablet, Atorvastatin 20 mg, Perindopril Arginine 10 mg and Amlodipine 10 mg Tablet, Atorvastatin 40 mg, Perindopril Arginine 10 mg and Amlodipine 10 mg Tablet (Triveram)
Atovaquone 250 mg and Proguanil 100 mg Tablet (Malarone)
Bisoprolol 2.5 mg and Hydrochlorothiazide 6.25 mg Tablet, Bisoprolol 5 mg and Hydrochlorothiazide 6.25 mg Tablet (Lodoz)
Bisoprolol 5 mg and Amlodipine 5 mg Tablet, Bisoprolol 5 mg and Amlodipine 10 mg Tablet (Concor AM)
Bisoprolol 5 mg and Perindopril Arginine 5 mg Tablet, Bisoprolol 5 mg and Perindopril Arginine 10 mg Tablet, Bisoprolol 10 mg and Perindopril Arginine 10 mg Tablet (Cosyrel)
Candesartan 16 mg and Hydrochlorothiazide 12.5 mg Tablet (Atacand Plus)
Chlorzoxazone 250 mg and Paracetamol 300 mg Tablet (Paras)
Clopidogrel 75 mg and Aspirin 100 mg Tablet (CoPlavix)
Cobicistat 150 mg, Elvitegravir 150 mg, Emtricitabine 200 mg and Tenofovir Alafenamide 10 mg Tablet (Genvoya)
Conjugated Estrogens 0.625 mg and Medroxyprogesterone Acetate 2.5 mg Tablet (Premelle 2.5)
Cyproterone Acetate 2 mg and Ethinylestradiol 0.035 mg Tablet (Diane 35, Estelle-35, Cybelle)
Desogestrel 150 mcg and Ethinylestradiol 20 mcg Tablet (Mercilon, Novynette)
Desogestrel 150 mcg and Ethinylestradiol 30 mcg Tablet (Marvelon, Desolon, Regulon)
Dienogest 2 mg and Ethinylestradiol 30 mcg Tablet (Dienille)
Diosmin 450 mg and Hesperidin 50 mg Tablet, Diosmin 900 mg and Hesperidin 100 mg Tablet (Daflon)
Efavirenz 600 mg, Emtricitabine 200 mg and Tenofovir Disoproxil Fumarate 300 mg Tablet (Trustiva, Viraday)
Efavirenz 600 mg, Lamivudine 300 mg and Tenofovir Disoproxil Fumarate 300 mg Tablet (Forstavir-LE)
Empagliflozin 10 mg and Linagliptin 5 mg Tablet, Empagliflozin 25 mg and Linagliptin 5 mg Tablet (Glyxambi) - Arc triangular in shape
Empagliflozin 5 mg and Metformin 500 mg Tablet, Empagliflozin 12.5 mg and Metformin 500 mg Tablet, Empagliflozin 12.5 mg and Metformin 850 mg Tablet, Empagliflozin 12.5 mg and Metformin 1000 mg Tablet (Jardiance Duo)
Emtricitabine 200 mg and Tenofovir Alafenamide 10 mg Tablet, Emtricitabine 200 mg and Tenofovir Alafenamide 25 mg Tablet (Descovy)
Emtricitabine 200 mg, Rilpivirine 25 mg and Tenofovir Alafenamide 25 mg Tablet (Odefsey)
Ergotamine Tartrate 1 mg and Caffeine 100 mg Tablet (Cafergot, Caffox)
Ertugliflozin 5 mg and Sitagliptin 100 mg Tablet, Ertugliflozin 15 mg and Sitagliptin 100 mg Tablet (Janumet)
Estradiol 1 mg and Drospirenone 2 mg Tablet (Angeliq)
Estradiol 1 mg and Estradiol 1 mg with Dydrogesterone 10 mg Tablet (Femoston 1/10)
Estradiol 2 mg and Estradiol 2 mg with Dydrogesterone 10 mg Tablet (Femoston 2/10)
Estradiol 1 mg and Norethisterone Acetate 0.5 mg Tablet (Activelle)
Estradiol 1 mg with Dydrogesterone 5 mg Tablet (Femoston Conti)
Estradiol Valerate 2 mg and Norgestrel 500 mcg with Estradiol Valerate 2 mg Tablet (Progyluton)
Ethinylestradiol 20 mcg and Drospirenone 3 mg Tablet (Yaz, Liz)
Ethinylestradiol 20 mcg and Gestodene 75 mcg Tablet (Femodette)
Ethinylestradiol 20 mcg and Levonorgestrel 100 mcg Tablet (Microgynon 20ED, Loette)
Ethinylestradiol 30 mcg and Chlormadinone Acetate 2 mg Tablet (Belara)
Ethinylestradiol 30 mcg and Drospirenone 3 mg Tablet (Yasmin, Liza, Volina)
Ethinylestradiol 30 mcg and Gestodene 75 mcg Tablet (Minulet)
Ezetimibe 10 mg and Atorvastatin 20 mg Tablet, Ezetimibe 10 mg and Atorvastatin 40 mg Tablet (Atozet)
Ezetimibe 10 mg and Simvastatin 10 mg Tablet, Ezetimibe 10 mg and Simvastatin 20 mg Tablet, Ezetimibe 10 mg and Simvastatin 40 mg Tablet (Vytorin)
Fenofibrate 145 mg and Simvastatin 20 mg Tablet, Fenofibrate 145 mg and Simvastatin 40 mg Tablet (Cholib)
Glecaprevir 100 mg and Pibrentasvir 40 mg Tablet (Maviret)
Iberet-Folic-500 Tablet
Irbesartan 150 mg and Amlodipine 5 mg Tablet, Irbesartan 150 mg and Amlodipine 10 mg Tablet, Irbesartan 300 mg and Amlodipine 5 mg Tablet, Irbesartan 300 mg and Amlodipine 10 mg Tablet (Aprovasc)
Irbesartan 150 mg and Hydrochlorothiazide 12.5 mg Tablet, Irbesartan 300 mg and Hydrochlorothiazide 12.5 mg Tablet, Irbesartan 300 mg and Hydrochlorothiazide 25 mg Tablet (Coaprovel)
Linagliptin 2.5 and Metformin 500 mg Tablet, Linagliptin 2.5 and Metformin 850 mg Tablet, Linagliptin 2.5 and Metformin 1000 mg Tablet (Trajenta Duo)
Ledipasvir 90 mg and Sofosbuvir 400 mg Tablet (Harvoni)
Levodopa 100 mg, Carbidopa 25 mg and Entacapone 200 mg Tablet, Levodopa 150 mg, Carbidopa 37.5 mg and Entacapone 200 mg Tablet, Levodopa 200 mg, Carbidopa 50 mg and Entacapone 200 mg Tablet, Levodopa 50 mg, Carbidopa 12.5 mg and Entacapone 200 mg Tablet (Stalevo)
Levonorgestrel 150 mcg and Ethinylestradiol 30 mcg Tablet (Nordette, Rigevidon, Oralcon)
Losartan 50 mg and Hydrochlorothiazide 12.5 mg Tablet, Losartan 100 mg and Hydrochlorothiazide 12.5 mg Tablet, Losartan 100 mg and Hydrochlorothiazide 25 mg Tablet (Hyzaar)
Meclozine HCl 25 mg and Pyridoxine 50 mg Tablet (Veloxin)
Metformin 500 mg and Glibenclamide 2.5 mg Tablet (Glucovance)
Olmesartan 20 mg and Amlodipine 5 mg Tablet, Olmesartan 40 mg and Amlodipine 5 mg Tablet, Olmesartan 40 mg and Amlodipine 10 mg Tablet (Azoren)
Olmesartan 20 mg and Hydrochlorothiazide 12.5 mg Tablet, Olmesartan 40 mg and Hydrochlorothiazide 12.5 mg Tablet, Olmesartan 40 mg and Hydrochlorothiazide 25 mg Tablet (Olmetec Plus)
Orphenadrine Citrate 35 mg and Paracetamol 450 mg Tablet (Norgesic)
Paracetamol 500 mg and Ibuprofen 150 mg Tablet (Maxigesic)
Perindopril Arginine 3.5 mg and Amlodipine 2.5 mg Tablet, Perindopril Arginine 7 mg and Amlodipine 5 mg Tablet (Viacoram)
Perindopril Arginine 5 mg and Amlodipine 5 mg Tablet, Perindopril Arginine 5 mg and Amlodipine 10 mg Tablet, Perindopril Arginine 10 mg and Amlodipine10 mg Tablet, Perindopril Arginine 10 mg and Amlodipine 5 mg Tablet (Coveram)
Perindopril Arginine 5 mg and Indapamide 1.25 mg Tablet, Perindopril Arginine 10 mg and Indapamide 2.5 mg Tablet (Coversyl Plus)
Perindopril Arginine 5 mg, Indapamide 1.25 mg and Amlodipine 5 mg Tablet, Perindopril Arginine 5 mg, Indapamide 1.25 mg and Amlodipine 10 mg Tablet, Perindopril Arginine 10 mg, Indapamide 2.5 mg and Amlodipine 5 mg Tablet, Perindopril Arginine 10 mg, Indapamide 2.5 mg and Amlodipine 10 mg Tablet (Triplixam)
Perindopril Erbumine 4 mg and Indapamide 1.25 mg Tablet (Coversyl Plus)
Rifampicin 150 mg and Isoniazid 75 mg Tablet (Akurit 2)
Rifampicin 150 mg, Isoniazid 75 mg, Pyrazinamide 400 mg and Ethambutol HCl 275 mg Tablet (Akurit 4)
Sacubitril 24.3 mg and Valsartan 25.7 mg Tablet, Sacubitril 48.6 mg and Valsartan 51.4 mg Tablet, Sacubitril 97.2 mg and Valsartan 102.8 mg Tablet (Entresto)
Saxagliptin 5 mg and Dapagliflozin 10 mg Tablet (Qtern)
Sitagliptin 50 mg and Metformin HCl 500 mg Tablet, Sitagliptin 50 mg and Metformin HCl 850 mg Tablet, Sitagliptin 50 mg and Metformin HCl 1000 mg Tablet (Janumet)
Sofosbuvir 400 mg and Velpatasvir 100 mg Tablet (Epclusa)
Telmisartan 40 mg and Amlodipine 5 mg Tablet, Telmisartan 40 mg and Amlodipine 10 mg Tablet, Telmisartan 80 mg and Amlodipine 5 mg Tablet, Telmisartan 80 mg and Amlodipine 10 mg Tablet (Twynsta)
Telmisartan 40 mg and Hydrochlorothiazide 12.5 mg Tablet, Telmisartan 80 mg and Hydrochlorothiazide 12.5 mg Tablet (Micardis Plus)
Tenofovir Disoproxil Fumarate 300 mg and Emtricitabine 200 mg Tablet (Tenvir EM)
Valproic Acid and Sodium Valproate (ER) 500 mg Tablet (Epilim Chrono)
Valsartan 80 mg and Hydrochlorothiazide 12.5 mg Tablet, Valsartan 160 mg and Hydrochlorothiazide 12.5 mg Tablet, Valsartan 160 mg and Hydrochlorothiazide 25 mg Tablet, Valsartan 320 mg and Hydrochlorothiazide 12.5 mg Tablet, Valsartan 320 mg and Hydrochlorothiazide 25 mg Tablet (Co-Diovan)
Vildagliptin 50 mg and Metformin 500 mg Tablet, Vildagliptin 50 mg and Metformin 850 mg Tablet, Vildagliptin 50 mg and Metformin 1000 mg Tablet (GalvusMet)

Miscellaneous

Alpelisib 50 mg, 150 mg and 200 mg Tablet (Trezilent)
Alendronate 70 mg (Fosamax)
Apremilast 10 mg, 20 mg and 30 mg Tablet (Otezla)
Cefuroxime 125 mg and 250 mg Tablet - Crushed tablet has strong, persistent, bitter taste
Chlorpromazine 100 mg Tablet - Can cause contact dermatitis
Conjugated Estrogen 0.3 mg and 0.625 mg Tablet (Premarin)- Teratogenic
Deferasirox 90 mg and 360 mg Film Coated Tablet (Exjade)
Hydroxychloroquine 200 mg Tablet (Plaquenil) - Bitter taste
Ibandronic Acid 150 mg Tablet (Bonviva) - Irritant. Chewed, crushed or sucked tablets may cause oropharyngeal irritation
Letermovir 240 mg and 480 mg Tablet (Prevymis)
Levetiracetam 250 mg, 500 mg and 1 g Tablet (Keppra) - Foul tasting
Lopinavir 200 mg and Ritonavir 50 mg Tablet (Kaletra) - Affect absorption
Raltegravir 400 mg Tablet (Isentress)
Raloxifene 60 mg Tablet (Evista) - Taste and teratogenic potential
Risedronate 35 mg Tablet (Actonel) - Irritant. Chewed, crushed or sucked tablets may cause oropharyngeal irritation
Semaglutide 3 mg, 7 mg and 14 mg Tablet (Rybelsus)
Sevelamer 800 mg Tablet (Renvela)

Few Key Reminders

Ask your pharmacist if you ever in doubt.
Do not split your pills at once, since moisture and heat may affect half-pills differently than whole pills.
It is important to divide the pill correctly into two even halves to ensure equal doses.
A pill splitter is the best way, and can be purchased at most pharmacies.
Splitting is not recommended for patients with poor eyesight, arthritis, memory problems or impaired thinking.

NOTE: If you do not have a pill splitter yet, you may try this simple trick using metal spoon for scored tablets.

Crushing Medications?

If you are finding references on crushing medications for enteral administration, you may have a look at this discussion.

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