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.

Question

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?

Asked by Steven On Sep 21, 2021

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Sep 21, 2021
Last updated Mar 03, 2022

Key points

  • The manufacturer of Jardiance states that the tablets should be swallowed whole, and should not be cut, split, crushed or divided.
  • Jardiance tablets are film-coated, and splitting them will destroy this coating. Split tablets have also not be studied for safety and efficacy.
  • Even with the manufacturer's recommendation, splitting Jaridiance tablets may be a potential solution for some individuals to help reduce costs, but doing so should only be done after discussing with your doctor.

Hello and thank you for reaching out to us!

I can certainly understand the thought behind wanting to split tablets of Jardiance to make your prescriptions 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 deductable 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 Jardiacne 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

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 11 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication related questions!

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