help! Pill-cutting question

[fatones]

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Hey all. I had an outside question about pill-cutting, and was hoping that you pharmd's could help me out. Does cutting a pill up in sections to take a lessened dose reduce the efficacy of the drug? A friend of mine is trying to cut Proscar (I believe the active ingriedient is finastiride? not sure) so he wouldn't have to buy the more expensive Propecia. I think they both use finastiride, but the difference is that Proscar is a much larger dose than Propecia...

I myself have no clue about the drugs, so I was thinking maybe y'all did. So he wants to know if pill-cutting is a feasible idea?

Thanks guys,

fatones

 

[LVPharm]

As far as I know, Proscar comes as 5 mg tablets. Propecia only comes in 1 mg dose. It's an odd-shaped pill...it would be hard to split into 5 equal parts to approximate 1 mg dosage needed for the treatment of alopecia.

Secondly, I don't recall these tablets as having scores and may have a film coating, which splitting will destroy...and it's probably needed for either the effective absorption of the drug, or for stability reasons. Although people do indeed split this pill into 4 or 5 pieces to save money, bear in mind that this pill was never intended to be split (hence no scoring), and was probably not tested with splitting in mind.

Caveat: I'm just a pharm student 😉

 

[baggywrinkle]

The proper way to get an appropriate dose is labor intensive.

Grind 20 five mg tablets up into a fine powder. Using geometric dilution triturate with lactose or talc to a total weight
of 10 grams or so. Add a few drops of red food color and add wrist action until the powder is a uniform pink color.

If you are styling you load your capsule filler with empty gel caps
and smear the powder until it is packed into the half caps. Then close. You are done and now have 100 1mg capsules.

If you are doing it on the cheap you laboriously weigh out 100 100mg powder papers. This will take all afternoon.

That is how it is done.

 

[fatones]

Hmm, ok LVPharm. So is the film coating on Proscar needed for the effective absorbtion of finastiride? I think he'll be able to somehow cut them into five sections, but it won't matter much if the pills need the film coating to be absorbed and/or be stable. Does anyone know the answer to this?

Wow baggywrinkle, that's quite a system you've got there! So I'm assuming you're implying that crushing the film coating on the pills will have no effect on the efficacy of the drug? How long can the pills be crushed and still retain the viability of the active finastiride ingriedient?

Thanks so much for your responses guys. 🙂

fatones

 

[MNnaloxone]

I wouldn't think that the film-coat would have much effect on the absorption of the med. It is most likely there to keep it together in the stock bottle-combat friability (sp?), moisture, etc.

FWIW: A pharmacy manager told me once that using a Proscar tablet for alopecia was a sure-fire way to get in hot water during an insurance audit. The reasoning was that PBM's cover patient problems with BPH, but reject cosmetics. It would be trouble to prove (maybe a few phone calls to the doctors of the patients who aren't over 40 yo?), but never put it past those guys.

baggywrinkle: Sounds like you've done that before-any reason why? Just curious on what the circumstances were. Nice to see that someone gets to compound once in a while...

 

[baggywrinkle]

Originally posted by fatones
Hmm, ok LVPharm. So is the film coating on Proscar needed for the effective absorbtion of finastiride? I think he'll be able to somehow cut them into five sections, but it won't matter much if the pills need the film coating to be absorbed and/or be stable. Does anyone know the answer to this?

Wow baggywrinkle, that's quite a system you've got there! So I'm assuming you're implying that crushing the film coating on the pills will have no effect on the efficacy of the drug? How long can the pills be crushed and still retain the viability of the active finastiride ingriedient?

Thanks so much for your responses guys. 🙂

fatones

Removing the film coating will not affect the efficacy of the drug. In most cases the film coating is present because the drug is nasty tasting. A gel cap accomplishes the same thing. Downing a powder paper will separate the men from the boys 😀

 

[baggywrinkle]

Originally posted by MNnaloxone

baggywrinkle: Sounds like you've done that before-any reason why? Just curious on what the circumstances were. Nice to see that someone gets to compound once in a while...

Compounding. That is what pharmacy is all about. All of you will get to do a bit along the way. Some more, some less. I have not done this particular drug. It doesn't matter. This is roughly how any pharmacist would do it, allowing for differences in technique
with the same goal in mind; diluting a dry powder from 5mg to 1mg. Piece of cake.

 

[fatones]

Thanks for all the help guys! So looks like the general consensus is that pill-cutting the Proscar should have no effect on the drug, just gotta make sure that the 5mg tablet is properly sectioned or crushed. Anyone else with opinions on the Proscar topic?

fatones

 

[GravyRPH]

How about: It would save a lot of time, effort, and money if everyone would just be happy with who they were and how they looked and not fall prey to some distorted sense of self-worth based on the number of hair follicles on your head. But I suppose that's too much to ask.

😉

And I would like to echo the fact that the Proscar should not be billed to an insurance or you could get your pharmacy into some deep audit problems. Extension of a small number of misfilled claims to your entire billed prescription number can mean HUGE losses. I've seen it happen, and it ain't pretty.

 

[SwePharm]

The main reason for the coating of the tablett is to eliminate the risk of drug absorption through the skin of a pregnant woman due to the possible teratogenic effect the drug could have on a male fetus since it blocks the transformation of testosterone into dihydrotestosterone.

So unless your friend have some bizzare habit involving cut proscar pills and pregnant women nothing bad will happen.

I recommend cutting the pill in four considering the shape of the pill, if the drug is sold in 1 and 5 mg 1.25 mg probably won?t kill you. (I?m doing it myself so I think I can recommend it with a clear conscience)

 

[MNnaloxone]

Grrrrr..... totally forgot about the teratogen thing. (Slams head against wall). I guess that's what happens when you don't work in a pharmacy for a couple months.

Thanks for the apparent answer, SwePharm