# Tablet Scoring: Current Practice, Fundamentals, and Knowledge Gaps
## 4 Tablet Scoring
### Tablet Splitting: Current Practice
Several marketed products that are commercially available at doses much higher than those traditionally used are currently being partitioned. If a marketed tablet is to be used at a prescribed dose of 12.5 mg, however, that product lowest marketed dose is 25 mg, partitioning the commercially available 25 mg tablet is needed for the patient to obtain the intended 12.5 mg dose. For example, patients undergoing post-myocardial infarction (PMI) often require taking a lower dose of \(\beta\)-blocker because of the adverse reaction associated with taking a full dose of \(\beta\)-blockers as observed in clinical trials [95; 96]. This is done in order to clinically observe patient tolerability of the drug. Based on the clinical trial data, the dosage is then gradually increased to reach the appropriate dosage to be used, provided that the patient tolerability of this dose is justified [97]. Patients who are receiving therapy with a certain marketed product may require frequent dosage changes to maintain an appropriate level of effectiveness of the therapy. As such, patients may partition the tablets in order to adjust to the target dose as appropriate [98]. In certain cases, the weight accuracy after the partition is dependent on the tablet size and characteristics [99]. Smaller sized tablets, in general, introduce greater weight variation post partitioning as opposed to larger size tablets. In many instances, partition data tend to fall out of the compential limit of variation for tablets [99; 100]. Because there is a wider weight variation when smaller sized tablets are being partitioned, it is more  
Figure 2: Different geometry scored tablets. Images are obtained from [[https://consumermedsafety.org](https://consumermedsafety.org)]([https://consumermedsafety.org](https://consumermedsafety.org)). Permission obtained by [PERSON] at ISMP. favorable to partition larger sized tablets. However, that practice is not limited only to smaller size tablets, although the clinical data seem to favor larger size tablet [99; 100]. Whereas tablet partitioning offers provides the flexibility to dose adjust and/or taper as well as some financial benefits, there are several disadvantages associated with it. Some of these drawbacks are highlighted below:  
* Out of specification tablets. Controlled release tablets have been designed to release the medication in a predictable manner over time [102]. To accomplish this, a variety of methods have been employed. Some methods, such as the use of coated granules, may be suitable for tablet splitting [103]. Other dosage forms, however, would have their designed features impaired by splitting. The difficulty in assessing the suitability of each controlled dosage form and the potential effect on their function makes it not favorable to partition these tablets. * Non-robust tablets. Tablets with inadequate physical properties (e.g., low hardness, high friability) can crumble or shatter because of the brittleness property and/or low hardness values during splitting/partitioning [104]. This can compromise the desired dose and may lead to product fragmentation and wastage [104; 105; 106]. * Inadequate dose. This can present serious clinical adverse reaction, particularly in the case in which a drug of narrower therapeutic index is used [107]. Uneven split tablets may lead to administration of incorrect dose. Certain products, particularly potent compounds, are available commercially at doses of less than 1 mg. Splitting such smaller dose tablet can lead to dose inaccuracy, hence can pose serious clinical risks [108]. Controlled-release tablets should never be split. Altering these types of tablets can potentially allow immediate absorption of the full dosage, which can saturate the plasma level and lead to overdosing. This can pose a risk of serious adverse reaction [109]. Similarly, splitting opioid tablets can result in dose inaccuracies and can be harmful to patients [110; 111].