Wednesday, October 22, 2014
Friday, August 08, 2008 Linda, Community Member, asks

Q: Can you split an imitrex tablet to take?

I have noticed that it says not to split or crush an imitrex tablet.  What is the reason for this and

what would happen if I split the tablet and only take half of it at a time?

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Answers (15)
Teri Robert, Health Guide
8/12/08 2:13am

The tablets have a special formulation that may be less effective if split. You might want to check this with your doctor before you do it.

 

Teri

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MedStudent, Community Member
4/ 7/11 12:39pm

What "special formulation" might this be?

 

They're not xr and they don't have an enteric coating.  So they hit your stomach, dissolve in your stomach, and are absorbed in the stomach (somewhat) and then in the small intestine (mostly). 

 

I'm not trying to be rude or combative, but saying not to split them because they have a "special formulation" is only slightly less vague and unhelpful than the instruction's statment, "Do not split."  Can you be more specific about this formulation that is threatened by splitting?

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Teri Robert, Health Guide
4/ 7/11 1:12pm

I'm not a pharmacologist, so no, I can't be more specific because I don't fully understand it myself.

 

What I am confident of is that those instructions have to be approved by the FDA, and the FDA wouldn't approve them if the only reason the manufacturer didn't want them split so they could sell more tablets. They have to have a good reason, or they wouldn't be allowed to make the statement.

 

Teri

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AuntieN, Community Member
6/ 4/12 10:54am

Agreed.  I have been taking Imitrex for many years AND splitting them.  Before they went generic and my co-pay was $110 per nine tablets, it was cheaper to purchase a 50 mg box and split them into 25 mg tabs, which I did with the approval of my doctor.  Imitrex is a medication that you want to be fast acting.  The last thing you need, when your head is imploding, is extended release.  I now have 100 mg tabs and, when the pain has just started or I need to be functional at work, I split that tab into thirds or quarters.  It works just fine that way and I've suffered no ill effects. 

 

In this sue-happy world, that warning to not split the tabs could be a legal protection.  Kind of like the warning that says, "Do not use this electric fan in the bath tub."  And they make less money when people split their tabs instead of purchasing two different mg strengths.  Just my opinion.

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evelyn, Community Member
1/ 4/13 1:54am

I agree, I have been splitting the 100 mg Imatrex for yrs. Now i split the generic. I just keep them in a dark place. I have a small pill carrier for my purse that i keep the cut up pieces in. I only split one at a time. I have had no ill effects either. Evelyn 

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1prncis, Community Member
8/ 9/08 8:33pm

I believe imitrex tablets have a time release but I don't know the affect it will do to your body if you take half.  Imitrex may not work if you split it.

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MJ, Community Member
8/ 9/08 8:48pm

I can't say that I have ever split an Imitrex, as I usually need at least 100 mg to knock out a migraine.  For me, it takes about 30 minutes after taking a tablet for it to kick in.  I do not think the tablets are coated,  so I do not see why you couldn't split them.  You might also try the statdose injection.  The shot is self-administered and feels like a hefty bee-sting, but the migraine relief is more immediate.  I keep both as options and judge which to take when based on how fast the onset of the migraine is.  I have been battling the migraines for over 20 years...good luck getting rid of yours.

 

 

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Nebula, Community Member
9/15/08 5:54pm

No idea Linda. But I am also perscribed to relpax (40mg). If I am experiencing a very bad migraine I take the imitrex. If it's just one of those migraines that stays at a low grade level but isn't going away on its own, I take the relpax because it is not as strong as imitrex (for me anyway). You cannot mix these medications!! But I alternate them so I don't get rebounds. I understand wanting to cut the imitrex...it's really powerful and affective but if your headache isn't that bad you don't want to waste them.

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Teri Robert, Health Guide
9/15/08 6:00pm

Nebula,

 

Alternating triptans will NOT avoid rebound. Avoiding rebound takes not using the same CLASS of medications more than two or three days a week.

 

Teri

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rbcool, Community Member
1/13/09 4:20pm

I have been spliting Imitrex for years. My neurologist told me I could split them and I have not noticed any problems. I just tried the new generic and it doesn't work as well for me so I now wonder if spliting them is the problem. I would like an answer on this too.

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Granny V, Community Member
7/30/09 3:40pm

I take the new generic form for Imitrex.  I also split them when I don't feel like I need 100 mg.  It takes about an hour for it to work but other than that I have not had any problem.

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DBW, Community Member
3/ 4/13 9:32pm

I have split both the brand and generic versions with the same good results over the years. I see no difference in the effeciveness of the generic vs the Imitrex. I  split mine into thirds or in half. My doctor did not mind me splitting them when I mentioned it to him so, hopefully, it's okay.

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Teri Robert, Health Guide
1/13/09 5:58pm

rbcool,

 

Please see my answer above. The Imitrex prescribing information says, "Do not split tablets." The can't say that just so you won't. They can only say it if splitting the tablets makes the medication less effective.

 

Teri

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Anne-Pharmacist, Community Member
10/ 1/12 11:47pm

Hi Teri,

The FDA is not the author of the package insert.  Any tablet that is not scored is more difficult to "tablet-split" and come away with roughly equal doses of medication on both sides of the split.  The company writes the package insert.  The company decided not to include a score line on the tablet. 

If a patient decides to cut a tablet and ends up with 60 mg in one piece, and 40 mg in the other piece, the company is safe.

Anne-Pharmacist

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Mollimom, Community Member
1/ 9/13 5:15pm

I would like to chime in here. (lol)

I've had Migraines for many, many years and I too, not only take Immitrex (Sumatriptan that is the generic form of Immitrex) but I split my 100mg tablet as much as I can.  I was getting 50mg tablets and after my Dr's approval, he switched me to the 100mg tablets and now, I split the 100 tabs and this split tab provides me with the relief I need and if I happen to have a monster, nightmare of a headache, then I (luckily) have the 100mg tablet and I can take the whole thing. 

But in the end, having the 100mg tabs works best for me because it gives me potentially 18 doses per refill (by splitting 9 pills) instead of 9.  Another bonus is they are oblong and not triangular like the actual Immitrex brand, so they are much easier to splt. and they are not time released.  I couldn't imagine such a medication being time released.  That is just one med you need all of right away! :)

 

 

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bootmommaone, Community Member
1/16/09 3:27am

i split my imitrex 100mg all the time into halfs cuz sometimes a 100mg is too much & i feel like im wasting it.  my md prescribe 100mg cuz it was cheaper on my insurance.  if it is a migraine that i catch when it 1st starts ill split the half into half again.  i asked my nurse & she told me whatever works.

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Kerriann, Community Member
8/27/09 9:31am

I agree with this. I split my tablets because the 100mg rendered me unable to move. I am a very slim person, and when a drug has side effects I am pretty much 95% of the time going to be effected by them. When i take 100mg it takes about 15 minutes before I start to feel really fuzzy and sick to my stomache. If I don't lay down and stay completely still I get so nauseous I have to fight to not throw up. I decided to cut my pill once to see what happened and it worked just as well and without the extreme nausea. I can function enough to go to work when with the 100mg I would have had to call in (and i get my migraines once a month so my employer was not liking that). I will be asking for a smaller dose the next time I go to my doc though.

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Ellen, Community Member
12/13/10 11:38am

I asked my pharmacist about this. She agreed that the manufacturer has to have a reason to say it. The reason she found for Imitrex: "may cause unpleasant taste." (Unpleasant? Have these folks ever had a migraine?) So I've been splitting them ever since with no ill effects on my taste buds or anything else. You may want to ask your own pharmacist.

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Teri Robert, Health Guide
12/13/10 1:59pm

Ellen,


-:¦:-•:*'""*:•.-:¦:-•*Welcome to MyMigraineConnection!*•-:¦:-•:*'""*:•.-:¦:-

 

I fully understand why people want to split these tabletd. My insurance company will pay for only a small number of tablets per month, and they're expensive. On the other hand, I want the medications I take to work as well as possible and to take them as safely as possible.

 

I don't know where your pharmaicst saw the statement about not splitting the tablets because of taste. I looked at the FDA approved prescribing information from a few years ago AND at the most recent version. Neither gave the reason for not splitting them. The current prescribing information says, "For adults, the usual dose is a single tablet swallowed whole with water or other liquids. Do not split tablets." You can read it yourself, HERE on the FDA site.

 

Pharma companies have to have reasons for such statements. I don't think the FDA would consider the taste to be adequate reason.

 

As for asking a pharmacist before spltting this or any tablet -- Pharmacists are indeed valuable health care professionals, but I'd be more comfortable with asking the doctor who prescribed the medication. It just seems to me that since they wrote the prescription, any questions about how to take it should be addressed by them..

 

Welcome again,

Teri

 

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AuntieN, Community Member
1/ 4/13 3:12am

You would think that doctors should be the "go to" person for the medications they prescribe.  But, it has been my experience over many years of taking a multitude of prescribed medications from a handful of doctors that the "go to" person is actually your pharmacist.  Their sole purpose is to know about all the medications they sell to you - warnings, side effects, when and how to take them and whether or not you should take them in conjunction with other meds or health conditions, etc.  Doctors know about medications only as much as they choose to learn, or as much as the drug rep filled them in on when he dropped off a supply of samples.   My gastroenterologist handed me a pack of Zegerid samples one time and said, "Give these a try and let me know what you think of them.  The drug rep left them and I haven't had a chance to read up on them."  When I was first prescribed Imitrex by my PCP, he pulled out a book to see what he should give me and then wrote out the script for a quantity of 60 tabs.  This was long before they went generic.  My pharmacist asked if I wanted to make a trip to see my loan officer before he filled it.  More than a few times I've had a pharmacist make a call to a prescribing doctor to report possible problems with my taking the new med he just prescribed. So, for me at least, my "go to" person is my pharmacist.

 

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Teri Robert, Health Guide
1/ 4/13 12:14pm

So much of this truly depends on the individual doctors and pharmacists. On our forum, one of the members told us about her pharmacist flat-out refusing to fill her prescription for one of the triptans because she's also taking an antidepressant. The pharmacist didn't contact the doctor or talk with the patient, just refused to fill it. Said it was contraindicated. Well, it's not contraindicated. There are warnings about triptans and antidepressants and reporting certain symptoms to our doctors if we experience them, but that's far different from a contraindication, which means that they shouldn't be taken together at all.

 

My doctor goes over the info on all meds he prescribes for me. If we're considering two medications that do the same thing, he often looks them up to see what the costs are before we decide which one to go with.

 

Teri

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adriane, Community Member
3/ 5/11 9:59pm

The way I understood it from my neurologist is that you can split them, but if they are not used very soon the other half will begin to crumble and this is the reason for the warning.  The deterioration of the medication.

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jaskoller, Community Member
4/ 7/11 3:01pm

After reading all these replies I have to respond.  This is absolutely an issue of keeping an open mind on our treatments of migriane pain.  Nothing works for everyone, if it did we wouldn't need this forum any longer.  I don't take imitrex any longer after Relpax was released but both my neuroligist and my doctor said the 100mg tab could be split in half.  Yes, I agree there are reasons the FDA has listed certain things, however, talk to your physician.  If we didn't try new things, and find things that work for us, we would all be stuck in our dark rooms suffering.  Keep an open mind and keep sharing things that work!

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tviderman, Community Member
7/18/11 3:01pm

I called one of the drug companies that make this medication as a pharmacy intern. The response I was given was "May cause hemorrhage of the throat and tongue numbness". However, hemorrhage of the nose and throat is also listed as a side effect of the drug. This may mean that spliting the tablet simply increases the chance of this happening due to a lack of coating on the broken part of the tablet. It is true that this drug is not extended release but I would suggest avoiding the split if possible. I don't believe the drug company would 'lie' to me but they may stretch the truth; IE, it may increase risk of bleeding by 0.5%.

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tviderman, Community Member
7/18/11 3:38pm

I followed up with GlaxoSmithKline and their repsonse was that it was mostly an issue with stablity as someone before cited; ie, moisture may come in and degrade the stability of the split tablet. I was on the phone for a while and asked about any adverse effects to which I got the response "To the best of my knowledge, there exists only stability issues concerning the splitting of imitrex tablets." I'm unsure why the information provided by the generic brand was so different from the brand name so be careful but it seems safe. Keep in mind that over time the second split tablet WILL become less stable, although to which degree it has yet to be documented.

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Sandra, Community Member
4/13/12 4:22pm

I have no problems splitting my 100 mg tablets into 1/4ths.  I get better results (less fogginess and nausea) than I have had with a whole tab.  I agree . . . they may break down and become less effective if you don't get around to the last 1/4 tab for a couple months, but that never happens with me which is why I'm splitting them in the first place.

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Audrey, Community Member
3/10/13 6:40pm

I have been told by my pharmacist to wrap the second half in foil to keep it from losing its effectiveness. Hope this helps.

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By Linda, Community Member— Last Modified: 05/20/14, First Published: 08/08/08