Can Zoloft (Sertraline) Tablets Be Cut in Half?
Yes, Zoloft tablets can generally be cut in half, though this practice comes with important caveats regarding dose uniformity and patient capability.
Key Considerations for Splitting Sertraline
Evidence on Sertraline Splitting
Sertraline passed dose uniformity testing when split in a controlled study, with half-tablets meeting United States Pharmacopeia (USP) specifications for both weight and drug content uniformity 1.
In this study evaluating 16 commonly split medications, sertraline 50 mg tablets demonstrated acceptable weight and content uniformity after splitting, unlike several other medications (bromazepam, carvedilol, bisoprolol, losartan, digoxin, and meloxicam) that failed uniformity tests 1.
When Tablet Splitting Is Appropriate
Sertraline is a reasonable candidate for splitting because:
It has a relatively wide therapeutic index and long half-life, making minor dose variations less clinically significant 1.
Sertraline is associated with discontinuation syndrome, making dose flexibility through splitting potentially useful for gradual dose adjustments 2.
Guidelines recommend dose titration in small increments at 1-2 week intervals for shorter half-life SSRIs like sertraline, which splitting can facilitate 2.
Important Warnings and Limitations
Patient capability must be assessed:
The majority of elderly patients may not be capable of breaking tablets properly 3.
When tablets are split by hand (without tools), uniformity results are significantly worse than when using a razor blade or tablet splitter 4.
A tablet splitting device should be recommended and proper technique demonstrated to patients who will be splitting tablets 3.
Only split immediate-release, scored tablets:
Never split extended-release or enteric-coated formulations, as this destroys the controlled-release mechanism and can cause overdose 3, 5.
Sertraline is available in immediate-release formulations that are appropriate for splitting 2.
Clinical Implementation
Before prescribing split tablets:
Assess the patient's physical ability and willingness to split tablets accurately 3.
Provide proper instruction on splitting technique 3.
Consider prescribing a tablet splitter device if the patient will be splitting tablets regularly 6.
Verify that scored tablets are being used when available 5.
Alternative approaches when splitting is problematic:
Consider liquid formulations if available 5.
Use lower-strength whole tablets when possible 5.
For patients with physical limitations preventing accurate splitting, avoid this practice entirely 6.
Cost and Safety Balance
Tablet splitting can provide significant cost savings and dose flexibility 3, 1, 6.
For sertraline specifically, the practice appears safe when proper technique and appropriate patient selection are employed 1.
Computerized decision support can reduce inappropriate splitting by 50% when implemented in healthcare systems 5.