Can the 25mg brensocatib (non-steroidal anti-inflammatory) tablet be cut in half?

Can Brensocatib 25mg Tablets Be Cut in Half?

No, brensocatib 25mg tablets should not be cut in half as there is no evidence supporting this practice, and doing so could potentially affect the drug's pharmacokinetic properties and therapeutic efficacy.

Rationale for Not Cutting Brensocatib Tablets

• Brensocatib is a novel dipeptidyl peptidase 1 (DPP-1) inhibitor with specific pharmacokinetic properties that could be altered if the tablet is modified 1
• The drug has a relatively long elimination half-life ranging from 22 to 28 hours, which is designed for once-daily dosing 1
• Clinical trials have specifically evaluated whole tablet doses of 10mg, 25mg, and 40mg, with no data on split dosing 1, 2

Pharmacokinetic Considerations

• Brensocatib demonstrates dose-dependent exposure with low to moderate interindividual variability 1
• The drug is designed to provide consistent plasma concentrations over 24 hours when taken as a whole tablet 2
• Cutting tablets that aren't specifically designed to be split can lead to:
  • Inconsistent dosing due to uneven distribution of the active ingredient 3
  • Potential degradation of the drug due to exposure to environmental factors 3
  • Altered absorption characteristics that may affect therapeutic outcomes 3

Available Dosing Options

• Clinical trials for bronchiectasis have evaluated brensocatib at specific doses of 10mg and 25mg once daily 4
• If a lower dose is required, the 10mg tablet formulation would be the appropriate choice rather than splitting the 25mg tablet 4
• The phase II WILLOW trial demonstrated efficacy with both 10mg and 25mg whole tablets 4

Clinical Implications

• Maintaining the integrity of the tablet ensures the intended pharmacokinetic profile is preserved 2
• Brensocatib has been shown to reduce neutrophil elastase activity and prolong time to pulmonary exacerbation at specific whole-tablet doses 4
• The drug's efficacy in bronchiectasis is dependent on maintaining appropriate plasma concentrations throughout the dosing interval 2

Recommendations for Healthcare Providers

• If dose adjustment is necessary, prescribe the appropriate tablet strength (10mg) rather than instructing patients to split the 25mg tablet 4
• For patients requiring dose modifications, consult with the prescribing physician to determine the most appropriate dosage form 3
• Monitor patients for efficacy and adverse events when initiating therapy at any dose 5

Unlike some medications that are specifically designed with score lines to facilitate splitting (such as certain antihypertensives or psychiatric medications), brensocatib tablets have not been formulated or tested for this purpose 3, 1.