How to Split Pills Safely to Reduce Medication Costs

Many people in New Zealand and around the world are cutting pills in half to save money on prescriptions. It sounds simple: buy a 40mg tablet instead of two 20mg ones, split it, and get the same dose for less. And for some, it works-saving hundreds a year. But this isn’t just a money trick. If done wrong, it can land you in the hospital.

Why Pill Splitting Saves Money

Pharmaceutical companies don’t price pills by the milligram. A 40mg tablet often costs almost the same as a 20mg one. That means splitting a 40mg pill gives you two doses for the price of one. For example, a 40mg atorvastatin tablet might cost $4.27, while two 20mg tablets cost $3.48 each-totaling $6.96. Splitting saves you nearly 40%. The same math works for lisinopril, metoprolol, and some antidepressants. In 2022, nearly 15% of Medicare beneficiaries in the U.S. split pills to cut costs. That’s millions of people doing it. But here’s the catch: not every pill can be split-and not every person should.

Which Pills Are Safe to Split?

The FDA says: only split pills that are explicitly approved for splitting. That means checking the package insert. If it doesn’t say you can split it, don’t assume. A score line down the middle? That’s not a green light. It’s just a manufacturing mark. Many extended-release pills, like metformin ER or Adderall XR, have special coatings or time-release mechanisms. Splitting them can dump the full dose into your system at once. That’s dangerous. Same with enteric-coated pills like omeprazole-splitting destroys the coating that protects your stomach. And for drugs with a narrow therapeutic index-like warfarin, digoxin, or levothyroxine-even a 5% dose error can cause a stroke, heart rhythm problems, or thyroid crisis. One woman on Reddit split her Synthroid tablet and ended up in the ER with a TSH level that was off the charts.

The Right Tool for the Job

Never use a knife, scissors, or your teeth. A cheap pill splitter-usually $3 to $10 at any pharmacy-is the only safe tool. These have a V-shaped holder and a retractable blade that cuts cleanly. A 2007 study in the Journal of the American Pharmacists Association found that using a pill splitter kept dose variation under 15%. Knife-splitting? That jumped to 72% variation. That’s not a small mistake-it’s a medical risk. And don’t split multiple pills at once. Split one right before you take it. Once you cut a pill, exposure to air, moisture, or heat can make the medicine unstable. Banner Health says split tablets lose potency within 24 to 48 hours. If you split a week’s supply, you’re not saving money-you’re risking your health.

Who Should Never Split Pills?

Some medications are just too risky. Here’s the list you need to avoid splitting:

• Extended-release or time-release tablets (ER, XR, SR, LA)
• Enteric-coated pills (look for "enteric" or "delayed-release" on the label)
• Capsules or gelcaps (you can’t split these)
• Drugs with a narrow therapeutic index: warfarin, digoxin, levothyroxine, tacrolimus, lithium
• Chewable or sublingual tablets
• Any pill that crumbles, cracks, or doesn’t split cleanly

If you’re on any of these, talk to your doctor about alternatives. Patient assistance programs, pharmacy discount cards, or generic switches can cut costs without the danger.

How to Split a Pill Correctly

If your doctor and pharmacist say it’s safe, follow these steps:

1. Ask your pharmacist or doctor: "Is this pill approved for splitting?" Get it in writing if possible.
2. Check the package insert. Look for the words "can be split" or "scored for splitting." If it’s not there, don’t do it.
3. Buy a pill splitter from your pharmacy. Don’t use a cheap one from a dollar store-get one with a sharp blade and secure grip.
4. Wash your hands and clean the splitter with a dry cloth after each use. Moisture builds up and can contaminate the medicine.
5. Place the pill in the holder. Close it slowly and press the blade down in one smooth motion. Don’t wiggle it.
6. Take the half immediately. Don’t store it. If it’s uneven or crumbly, throw it out. Don’t try to eat the smaller piece.
7. Keep the other half in a dry, cool place only if you’re taking it within 24 hours. Use a small airtight container.

Most people need 3 to 5 tries to get it right. Don’t get frustrated. Practice with a non-medicinal pill first-like a vitamin or sugar pill.

Real Cost Savings-And When It Doesn’t Work

The math works best when the higher-dose pill is significantly cheaper per milligram. For example:

Cost Comparison: Splitting vs. Buying Lower Doses

Medication	Higher Dose (Cost)	Lower Dose (Cost)	Savings if Split
Atorvastatin 40mg	$4.27	$3.48 (20mg)	38%
Lisinopril 20mg	$4.00	$4.50 (two 10mg)	11%
Sertraline 100mg	$0.12	$0.08 (50mg)	No savings
Simvastatin 40mg	$3.10	$2.95 (20mg)	15%

Notice sertraline? The 100mg tablet costs less than two 50mg ones. Splitting gives you zero savings. And for some drugs, like tacrolimus, the FDA tracked 37 adverse events from splitting between 2018 and 2022. That’s not worth a few dollars.

What Experts Really Say

Dr. Michael Miller from the Cleveland Clinic says: "A score line might indicate a pill can be split, but it doesn’t mean that you should." The Institute for Safe Medication Practices found that in a study of 94 people splitting hydrochlorothiazide tablets, 41% of halves were off by more than 10%. That’s not a typo. One person got 22mg instead of 25mg. Another got 31mg. That’s a 24% error. And that’s with trained volunteers using proper tools. Imagine what happens when someone uses a knife or splits a pill they’re not supposed to.

The American Society of Health-System Pharmacists says pill splitting should be a last resort. First, ask your doctor about patient assistance programs. Many drugmakers offer free or low-cost meds for low-income patients. Pharmacy discount cards like GoodRx can cut prices by 30-50%. And some insurers will switch you to a cheaper generic or alternative drug. Don’t jump to splitting unless all other options are gone.

What to Do If You’ve Already Split a Pill Wrong

If you’ve split a pill you shouldn’t have-like a time-release blood pressure med or a thyroid pill-stop immediately. Don’t take another dose. Call your pharmacist or doctor. If you feel dizzy, nauseous, your heart races, or you’re unusually tired, go to urgent care. Dose errors can build up over days. You might not feel it right away. Keep the pill container and the splitter. Show them to your provider. They’ll know what to look for in your bloodwork.

What’s Changing in 2026?

More drugmakers are now offering multiple strengths in one package. In 2023, 32% of new drugs came in several doses-up from 19% in 2015. That’s good news. But until prices change, people will keep splitting pills. The FDA is pushing manufacturers to clearly label which pills can be split. And pharmacies in New Zealand and the U.S. are starting "Split Safely" programs-where pharmacists show patients how to do it right. But until then, the responsibility is on you. Know your pills. Know your risks. And never guess.