Some pharmacists have reported that patients have changed the way they take medications because of the downturn in the economy, according to a recent survey by the American Pharmacists Association. This includes skipping doses and splitting tablets in an effort to save money.

Regarding the practice of splitting tablets, the Food and Drug Administration (FDA), the American Medical Association, and other medical organizations advise against it unless it's specified in the drug's labeling.

Tablet splitting often involves buying higher strength tablets and then breaking the tablets in half or quarter doses as a way to lower drug costs. For instance, a 30 mg tablet may cost the same amount as the 15 mg tablet. So a patient may try to save money by buying the 30 mg tablets and splitting them all in half. This might seem like a smart money-saving strategy, but the practice can be risky.

Mansoor Khan, Ph.D., director of the Division of Product Quality Research in FDA's Office of Pharmaceutical Science, tells that splitting "could affect the quality of the drugs." He points out that some medications have a special coding and that splitting the tablet could affect the distribution of the medication it contains.

There are other reasons why splitting tablets is risky:

• You might get confused about the correct dose. There have been cases when people have purchased higher strength tablets intending to split them, but then they forgot to split them. Instead, they took the whole tablet. This led to accidentally taking too much medicine.

• Some tablets are hard to split. Some tablets are too small to split, may have an unusual shape that makes them hard to split, or may crumble more easily when split. Also, some people may not be able to split tablets correctly. These factors make it difficult to accurately split a tablet.

• Not all pills are safe to split. Patients may mistakenly think that any pill can be split. But some pills, such as capsules and time-released drugs, should always be taken whole. For example, some tablets are coated with a substance that helps to release the medicine slowly. Splitting these tablets destroys the coating, which means you might absorb the medicine too fast or not at all.

If you still want to split a tablet, the FDA has approved drugs where that is part of the manufacturer's drug application. "If the tablet is approved for splitting," says Khan, "the information will be provided in the drug's professional prescribing information."

He adds that FDA does not encourage the practice of tablet splitting unless it's specified in the drug's professional prescribing information. "If a patient is considering splitting a tablet, FDA recommends that the patient get advice directly from his or her doctor or pharmacist to determine whether it is appropriate or not for a particular drug," Khan concluded.