Elsevier

Clinical Therapeutics

Volume 37, Issue 10, 1 October 2015, Pages 2332-2338
Clinical Therapeutics

Tablet Splitting of Psychotropic Drugs for Patients With Dementia: A Pharmacoepidemiologic Study in a Brazilian Sample

https://doi.org/10.1016/j.clinthera.2015.08.015Get rights and content

Abstract

Purpose

The objective of this study was to assess the frequency of tablet splitting of psychotropic drugs in a population of older adults with a diagnosis of dementia.

Methods

This retrospective, cross-sectional study examined a sample of geriatric outpatients seen at a public center specializing in the care of elderly patients, a referral center for management of dementias in general, especially Alzheimer dementia to identify the frequency of tablet splitting of psychotropic drugs and the factors that may be involved in this practice. Comparison of the presence or absence of tablet splitting in relation to several parameters was assessed by means of P values; between-group differences with an α < 5% (P < 0.05) were deemed significant.

Findings

The presence of dementia was significantly associated with prescriptions implying to split tablets, which was found in 88 patients with dementia (34.9%) versus 90 patients without dementia (23.7%) (P = 0.002). Among the 88 patients with dementia who split tablets, 64 (72.7%) split tablets of psychotropic drugs.

Implications

These results indicate the importance of identifying the practice of tablet splitting, particularly when it involves psychotropic drugs, because it entails several factors that can reduce the efficacy of the drug therapy.

Introduction

As of 2010, the global prevalence of dementia was estimated at approximately 35.6 million people, which corresponds to 5% to 7% of the world population.1 This figure is expected to double every 20 years, reaching 65.7 million in 2030 and 115.4 million by 2050.1

The treatment of dementia requires a multidimensional approach, and the 4 pillars of care for this condition must be taken into account: managing the disease, managing symptoms, supporting the patient, and supporting the caregivers.2 Pharmacologic and nonpharmacologic therapies are available to treat dementia, and the best strategy is to combine both.2 Acetylcholinesterase inhibitors and N-methyl-d-aspartate antagonists are the mainstay of pharmacotherapy for the cognitive symptoms of dementia.2 For its neuropsychiatric manifestations, both pharmacologic and nonpharmacologic approaches can be considered, and psychotropic drugs, such as antidepressants and antipsychotics, are often used.2 However, these drugs are not always commercially available in the doses prescribed for treatment of neuropsychiatric symptoms. One option that can be used to achieve these target doses is tablet splitting.

Tablet splitting, using hands or any device, is a common practice in some countries (Canada, United States, Germany), where it is even used in the health system, at pharmacies, or at other health care facilities, whether to achieve an intermediate dose among marketed strengths3; to provide appropriate fractional doses in a gradually increasing or decreasing dosage regimen (eg, in a weaning regimen)4; to begin therapy at the lowest possible dose, so as to decrease the incidence of adverse effects or to assess an individual patient’s response to the drug4; or for economic reasons, to reduce the costs of pharmacotherapy.5, 6 Tablet splitting could be a valid alternative for treatment of patients with dementia, who incur high costs due to use of multiple medications.7 Thus, the objective of the study was to assess the frequency of splitting of psychotropic drug tablets in a population of older adults diagnosed as having dementia.

Section snippets

Study Design and Sample Selection

This retrospective, cross-sectional study was conducted on a convenience sample of geriatric outpatients treated at a public center, available for free for all citizens, specializing in the care of elderly patients, classified according to Brazilian law as individuals aged ≥60 years.8 The center provides referral for dementia in general, especially Alzheimer dementia. Dementia patients receive special attention from a multiprofessional team.

All outpatients seen at the study clinic from January

Results

A total of 632 patients were treated at the study clinic during the period of interest. Of these, 252 (40%) had dementia, most of whom (n = 136 [54%]) had Alzheimer disease. Women accounted for two-thirds of the sample (n = 168 [66.7%]). Approximately half of participants (n = 122 [48.4%]) were aged >80 years, and most had up to 4 years of formal education (n = 92 [36.5%]) (Table I).

Presence of dementia was significantly associated with the use of split tablets, which occurred in 88 patients

Discussion

This study, performed on a sample of patients followed up at a center specializing in the care of older adults, revealed that one-third of all patients with dementia (n = 88 [35.1%]) had prescriptions for fractioned doses, suggesting split-tablet. Most of these prescription were psychotropic drug tablets (n = 64 [72.7%]). Clinical management of drug doses, particularly for psychotropic agents, is important to minimize adverse drug reactions and ensure the desired effect is achieved.11 A

Conflicts Of Interest

The authors have indicated that they have no conflicts of interest regarding the content of this article.

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