PT - JOURNAL ARTICLE AU - Aanchal K Saran AU - Natalie A Holden AU - Scott R Garrison TI - To split or not to split? systematically reviewing the evidence surrounding pill-splitting AID - 10.3399/BJGPO.2022.0001 DP - 2022 Feb 18 TA - BJGP Open PG - BJGPO.2022.0001 4099 - http://bjgpopen.org/content/early/2022/02/18/BJGPO.2022.0001.short 4100 - http://bjgpopen.org/content/early/2022/02/18/BJGPO.2022.0001.full AB - Background Tablet splitting can provide dose flexibility, and cost savings. However, pharmaceutical representatives typically discourage the practice.Aim To identify and summarise all published concerns related to tablet splitting and to present the experimental evidence that investigates those concerns.Design & setting Systematic review and qualitative synthesis of pill-splitting concerns and evidence.Method Medline and EMBASE were searched, over all years of publication, for articles in English discussing the splitting of tablets/pills. Eligible articles included original research, narrative reviews, systematic reviews, and expert opinion.Results After removing duplicates, 1,837 potentially relevant articles underwent dual review and 1,612 articles were excluded based on title and abstract. After examination of 225 full texts, 138 articles were included (one systematic, 4 narrative reviews, 101 original research articles, and 32 opinion articles). The described concerns included difficulty breaking tablets, loss of mass, weight variability, chemical instability, overly rapid dosing if sustained-release medications are split, noncompliance, and patient confusion resulting in medication errors. We found no substantive evidence to support concerns regarding loss of mass, weight variability, chemical instability, or noncompliance. Evidence does support 1) some older adults struggling to split tablets without pill splitters, and 2) the inappropriateness of splitting sustained-release preparations given the potential for alteration of the rate of drug release for some products.Conclusion With the exception of slow release tablets, which should not be split, and excepting those elders who may struggle to split tablets based on physical limitations, there is little evidence to support pill-splitting concerns.