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To split or not to split?

Vol. 6, No. 4 / April 2007

In “Pros and cons of pill splitting” (Pearls, Current Psychiatry, December 2006), Drs. Rakesh Jain and Shailesh Jain listed Eskalith CR in the “Do not split” category.

Although it is a controlled-release preparation, the tablet is scored, which implies that it can be split. In fact, over the years my patients have split it without problems. Am I missing something?

James W. Jefferson, MD
Distinguished senior scientist
Madison Institute of Medicine
Clinical professor of psychiatry
University of Wisconsin Medical School
Madison, WI

Drs. Jain and Jain Respond

Dr. Jefferson is correct that Eskalith CR is scored and we too have asked patients to split the pill for many years with no apparent difficulties.

However, the latest Eskalith CR package insert states, “When patients require closer titration than that available with doses of Eskalith CR in increments of 450 mg, immediate-release capsules should be used.” This statement implies that splitting this pill is not recommended.

Additionally, GlaxoSmithKline—the manufacturer of Eskalith CR—informed us that the pill is scored to facilitate dissolution studies on split pills, but these studies were never conducted. Therefore, the company cannot recommend pill splitting for Eskalith CR.

Although splitting Eskalith CR pills is common, based on the information above we were conservative in our recommendation and put this medication in the “Do not split” column.

Rakesh Jain, MD, MPH
Director of psychopharmacology research
R/D Clinical Research, Inc.
Lake Jackson, TX

Shailesh Jain, MD, MPH
Assistant professor of psychiatry
University of Texas Medical School
at San Antonio

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