Can You Cut Or Split Jardiance In Half?
In our latest question and answer, the pharmacist discusses whether or not the diabetes drug Jardiance (empagliflozin) can be cut in half.
Hello! I was prescribed a diabetes drug by my doctor called Jardiance. I am wondering if I can cut it in half to make every fill last longer?
Sep 21, 2021- The manufacturer recommends swallowing Jardiance tablets whole because they are film-coated, and splitting them would destroy the coating and potentially make them harder to swallow and taste bitter.
- While Jardiance is not a modified-release medication and splitting it may not cause serious harm, split tablets have not been studied for safety and effectiveness, so you should talk to your doctor before deciding to split them.
- There is no way to guarantee that splitting a tablet will give you an exact half-dose, since the medication may not be evenly distributed throughout the tablet.
Hello and thank you for reaching out to us!
last longer. It's a very expensive medication and most individuals will be paying a high-tier copay for the drug, and if you are in a deductible or coverage gap phase of your insurance, you're looking at paying a lot of money out of pocket.
Before getting into the answer here, I do want to emphasize that you should speak with your doctor or other health care provider about your options and therapy before making any changes
Can You Split Jardiance Tablets?
The official recommendation from the manufacturer of Jardiance, Boehringer-Ingelheim, is that the tablets should not be split, cut or divided.
Interestingly enough, the FDA-approved prescribing information does not discuss this. However, the Canadian product information does state not to divide tablets explicitly:
Swallow whole. Do NOT cut or divide tablets.
Why Is This The Recommendation?
Jardiance tablets are not extended-release and don't have any sort of modified release mechanism, and, in general, drugs that are 'immediate-release', like Jardiance, can be split.
However, Jardiance tablets are film-coated. Film-coating tablets provide several benefits, including:
- Taste masking
- Improved ease of swallowing
- Improved appearance
- Improve shelf-life
Cutting or splitting the tablets would destroy the film-coating, and thus, many of the benefits of the coating would no longer be applicable (e.g. they may be more difficult to swallow, taste bitter, etc...).
Boehringer-Ingelheim doesn't provide any specific information as to why they state Jardiance tablets should be swallowed whole, but it likely is due to the following three factors:
- The tablets are film-coated (as discussed above)
- Split tablets have not been studied for safety and efficacy
- Doses obtained from split tablets (5mg from a 10mg tablet, and 12.5mg from a 25mg tablet) have not been studied.
Okay To Split Jardiance Tablets Anyway?
While it can be quite dangerous to cut or split a drug that has a modified-release mechanism, the potential negatives of cutting a film-coated tablet such as Jardiance (which is not modified-release), don't necessarily seem all that bad.
In fact, due to the fact that Jardiance isn't modified-release, is not considered a narrow-therapeutic index drug (where small changes in dose can have a big impact) and that splitting the tablets could result in large cost savings, doing so (splitting tablets) could be something some practitioners and patients consider doing.
A potential point in favor of splitting Jardiance 25mg tablets (to obtain a 12.5mg dose) are the results reported in a clinical trial published in the New England Journal of Medicine, Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes, also known as the EMPA-REG OUTCOME trial.
The study states the following:
...in our study the two dose groups [10mg and 25mg] had similar hazard ratios for cardiovascular outcomes. Thus, in clinical practice, the choice of the empagliflozin [Jardiance] dose will probably depend primarily on the achievement of metabolic targets and the occurrence of adverse events.
Based on the information currently available, it doesn't appear as though there is a significant clinical difference between the 10mg and 25mg doses.
It seems reasonable to assume then that a 12.5mg dose (obtained from splitting a 25mg tablet) would also be similar in effectiveness to the 10mg and 25mg doses.
Final Words
Having said all of the above, it is important to state that splitting Jardiance tablets, and taking a split tablet for your daily dose, has not been studied, so it's tough to definitively say it is okay to do so. Add in the fact that the manufacturer says not to split them, complicates a potential recommendation.
Additionally, there is no clear information available that shows that the contents of a Jardiance tablet are evenly distributed within that tablet (i.e. we don't know if splitting a 25mg tablet would result in exactly 12.5mg on each side).
All in all, it is probably safe to split Jardiance tablets, but the decision to do so should be based on a conversation you have with your doctor.
References & sources
- Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes — New England Journal of Medicine
- A Comprehensive Review on Pharmaceutical Film Coating: Past, Present, and Future — PubMed
- Jardiance Monograph (Canada) — Drug and Health Product Portal
Glossary — Terms in This Answer
- Film-coated
- A tablet covered with a thin protective layer that masks taste, makes it easier to swallow, and helps the medication stay stable on the shelf.
- Immediate-release
- A medication that dissolves and is absorbed by the body quickly after you take it, rather than slowly over time.
- Modified-release
- A medication designed to release into your body slowly over several hours instead of all at once.
- Narrow-therapeutic index
- A medication where small changes in the dose can cause big differences in how well it works or how safe it is.
- Empagliflozin
- The active ingredient in Jardiance, a medication used to treat type 2 diabetes.
- Cardiovascular outcomes
- The effects a medication has on heart health and blood vessel health.
- Metabolic targets
- Specific health goals related to how your body processes blood sugar and other substances.
- Adverse events
- Unwanted side effects or harmful reactions that happen when taking a medication.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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