[e-drug] Splitting of fixed dose combination tablets?

["Chengetanai Mangoro" <cmangoro@unicef.org>]

E-DRUG: Splitting of fixed dose combination tablets?
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Dear e-druggers

I have come across instances where fixed dose combination ARV tablets have
been split in half, particularly for children. 

Is this rational? Is there any pharmacokinetic data that supports this practice and ensures that adequate amounts of the drug are being administered? 

What are others' experiences with this practice?

Best regards,

Chengetanai T. Mangoro
Antiretrovirals/Essential Drugs Officer
UNICEF, 6 Fairbridge Ave, Belgravia,
P.O. Box 1250, Harare, Zimbabwe
Tel: 263-4-703941/2 Fax: 263-4-731849

[FDC tablets can theoretically be split if the substances are homogenously distributed in the tablet. However, some FDCs use the "pellet" technique, in which there is a "sub"-tablet inside the tablet. This would be tricky, as all of one ingredient could end up in half of the tablets only.
 
The real question might be: is the pharmaceutical industry prepared to make FDCs suitable for children? Some paediatric FDC ARVs have been developed by generic manufacturers, but they might not (yet) be widely available. UNITAID and Clinton Foundation have taken it upon them to make these better available. WB]