Cutting up Jakafi pills?

[sbs_patient]

I was wondering if anyone knows whether these pills can be cut when adjusting dosage. I've been told to reduce my initial 10 mg twice a day by taking the pills twice a day MWF and once a day on other days. This is a reduction of approximately 30%, going from 140 mg/week to 100. This is fine, but it might be easier just to cut the pills in half to make it possible to adjust dosage more flexibly. The manufacturer apparently advises against this, but I wonder if there are other perspectives on this question.

[DJK12]

I certainly wouldn't do it without checking with the dispensing pharmacist especially as the manufacturer advises against it. Many drugs degenerate if halved and this would affect your dosage, which certainly in ruxolitinib's case can lead to problems. When I was on HU I was often on different dosages each day, as I think many people on this forum are. It was a pest but doable.

[sbs_patient in reply to DJK12]

Thanks for your comment. The pharmacist has advised against splitting pills, saying that the manufacturer says not to do it. However, at least one member of this group has been pill-splitting Ruxolitinib for years. I would like to get an authoritative reading that explains why or why not to split. That being said, I was also on different HU dosages for some time.

[DJK12 in reply to sbs_patient]

Possibly then your best solution would be to contact the manufacturer direct I did it many years ago about a query about Anagrelide which I moved onto after HU - can't remember why now though it was something the pharmacist couldn't help with. I remember they were very helpful and quite happy to speak to me. If they have a scientific reason that would reassure you that you've been given the correct advice and also confirm it's not a financial reason.

I appreciate you are in the US but my rux leaflet in the UK shows a Spanish manufacturer Novartis Pharmaceuticals and their UK website has a queries email address. I ssume your leaflet will also show a US distributer or it may be manufactured in the US. Generally pills which can be safely halved have a line in the middle though this isn't full proof.

[sbs_patient in reply to DJK12]

Incyte (the original developer/manufacturer of Ruxolitinib) was initially a US firm. Given the cost structure for US pharmaceuticals, I would imagine that the corporate party line is going to be "you can't cut pills". The US list price of this medication is $18K for 30 pills. (The actual patient payout is much less but still quite high. ) In the end, the practice of paying for (say) 20 mg pills and cutting them in half would lead to a serious revenue decline; thus I can't imagine a US corporate representative ever saying that it's OK to cut.

[DJK12 in reply to sbs_patient]

Oh well it was only a suggestion as I'd had a positive result from contacting Anagrelide's manufacturer. I got a well informed person who was happy to engage and certainly gave me an ethical answer - it was ages ago but I think now it was about interactions. Certainly your doctor is right to taper slowly. I had my dose reduced too fast and ended up in hospital. I hope you find a solution you are comfortable with.

[bruddery]

hi there I was advised by my pharmacist not todo this. My dose had been reduced and my pharmacist ordered a 5mg dose along with a 10mg so that I did not have to halve them. Bruddery

[sbs_patient in reply to bruddery]

Thanks for your comment. Using multiple prescriptions (e.g., 10 mg, 5 mg) might work in the EU or UK, but would be cost-prohibitive here in the US. The choice is therefore to split pills (as at least one member of this group has apparently been doing for years) or to devise more complicated dosing regimens. I'd really like to see an authoritative statement on why these pills should or should not be split.

[ainslie]

that sounds a rather strange regime ie MWF usual dose and single dose on other days, I have never heard of anything like that. To the best of my knowledge Rux should be taken every 12 hours ie twice a day. I have been on Rux 5 years and have been splitting pills from day one to date , ie splitting 5mg into half,quarters and eighths and it definitely works. Most docs or pharmacists get a bit excited about it but I have checked with a few experts inc Dr. V at MDA and the experts are fine with it. It perhaps a money thing also as 5mg tabs are not much cheaper than the bigger ones hence more profit for Pharmacie if you also need 5mg tabs. . When you split a 5mg tab it doesn’t always get exact 2.5+2.5 but even if it’s 3+2 it doesn’t matter if you take the other half for your second dose that day. I would say most docs would suggest for 100mg a week ie 14.28mg a day just take 2x7.5mg ie a 5mg plus half a 5 ie 2.5mg or take a 10mg tab in morning and 5mg at night , thats quite common if they say no splitting. Personally I prefer even dose Am/pm so I split them as many others do. If you want a second or more views ask over on the List at MPN.net.

[sbs_patient in reply to ainslie]

Thanks so much for your thoughts on this question. Did you decide to split the pills on your own, before speaking with doctors and pharmacists? I would think that the only issue with splitting the pills is that the halves might not be precisely equal, or that some powder would be lost in the process. Pills that contain multiple ingredients or that are formulated for time-release would be another matter. Here in the US, using multiple prescriptions (e.g. 10 mg and 5 mg) would be cost-prohibitive, so the choice is to split pills or to come up with a more complex dosing schedule, as has been recommended to me. I would really like to find something that looks like an authoritative statement on why one should or should not split these pills.

[ainslie in reply to sbs_patient]

I can’t really add much to what I said in previous post, I checked with Dr V before doing it and I don’t know if you know him but at the time he was and maybe still is the most experienced expert on Rux. As mentioned uninformed dos and pharmacists throw toys out of the pram at the mention, I can only say I have done it daily for 5 years and know many long termers doing it. You may lose a fraction of power maybe a few percent, a good pill cutter or sharp knife works , all I can say is it works.

[sbs_patient in reply to ainslie]

Thanks again for your helpful comments. I will also pursue this question with some doctors with specific expertise in MPN.

[PhysAssist in reply to ainslie]

FYI- in the US- all dosages cost the exact same price per pill, [which is ridiculous, I know] which explains why they are really opposed to any form of pill splitting.

That said, I personally would not hesitate to split the pills- unless there was some specific mention of an extended release formulation, which given the every 12 hour dosing would be unlikely indeed.

Plus, experience [yours] is the best teacher.

Best,

PA

[sbs_patient in reply to PhysAssist]

Thanks so much for your comments. Yes, the recommendations from the manufacturer and from practitioners and pharmacists here in the US are suspiciously resonant with the company's need to keep sales up at US prices. It's not surprising that most if not all people who post that they've been splitting pills for years come from outside the US.

I've been thinking along the same lines as you. So far, my 10 mg pills have come in lots of 60, enough for 30 days at my original dosage of 20 mg/day. This was equivalent to 140 mg/week, which has now been reduced to 100 mg/week, very manageable with 10 mag pills. If my dosage goes down to 70 mg/week, I am intending to split pills, rather than ordering 5 mg pills. Of course, if the dosage goes much lower than that, I may have to split 5 mg pills

[Gracey22]

I was told by my Dr to not cut the pills. I was on 10 milligrams and then reduced to 5 milligrams. The Dr changed my prescription to 5.

[sbs_patient in reply to Gracey22]

That's what I would expect. My doctor seems to want to taper the medication more slowly and see what happens.

[Buggerbear]

Every other day I take 15 mg twice a day and opposite days I take 20 mg twice a day. I always get the pill in 5 mg doses and have never been told to cut pills in half. It seems like a lot of pills to take, but I follow my Dr, orders

[sbs_patient in reply to Buggerbear]

By my calculations, you would need to take 210 of the 5 mg pills over a 30-day period; I am currently taking 60. Under my Medicare Advantage plan, the cost of the pills I'm taking comes to something like $12K/year. I can't imagine what more than tripling the number of pills would do to the cost.

[3cance]

When splitting unscored pills you cannot be sure that the pill splits equally or that it doesn’t crumple even a little bit. I like knowing that I am getting the correctly prescribed dose each time I take my medication.

[sbs_patient in reply to 3cance]

That's certainly true. However, it is interesting that all the comments against splitting come from the US and those in favor come from other parts of the world. I can see that the manufacturer would have a strong opinion against splitting, especially in high-cost countries.

[Buggerbear in reply to 3cance]

I should have given more detail...I don't spilt pills. I get 5 mg pills and can take 3 or4, whichever is needed. My labs leveled out a little, so my Dr. currently has me taking 15 mg in the am and 15 at night. I agree about splitting pills, not a good idea.

[Normangirl]

I do not cut Jakafi pills. Am on very low dose, 5mg daily with 2 5mg MWF, prescribed by MPN specialist. Have never ask about splitting as do not find current schedule difficult, use pill organizer that I fill weekly . This has worked for me. Good luck.

[sbs_patient in reply to Normangirl]

Thanks for your input. That dosage (5mg daily with 2 5mg MWF) corresponds to 50 mg/week, half of my current weekly dosage of 100 mg. I wouldn't be surprised if my dosage is reduced further after this week's blood count. However, if I were to go over to 5 mg pills, I would certainly cut my remaining 10 mg pills in half before ordering the lower dose. Furthermore, obtaining a dosage of 5 mg by cutting 10 mg pills in half would be very tempting as a cost-effective strategy here in the US, since the price of the 5 mg pills is not much less than the price for 10 mg pills.

[DVDMD]

I was advised by my oncologist, a leading expert at DFCI in Boston, that it was OK to split my 10 mg pill, I have been doing it for months. The split is not exact, but it is good enough. I am tapering slowly from 10 mg twice a day to 10 in am and 5 in pm, initially taking 1/2 tablet 3x a week and now daily, to control cGVHD. It is working fine. My RX. remains 10 mg twice a day. If I get to 5 mg twice a day with my taper, I will get the lower strength prescribed. I am an MD, 5 years since BMT.

[sbs_patient]

Thanks for this input. This is the first report of physician-approved pill-splitting I've received from this side of the Atlantic; there have been quite a few from Europe. I was diagnosed with PV back in 2015, and have been on Jakafi since August 2022. My initial dose was 10 mg twice a day, but I became anemic, so this was gradually reduced to 10 mg once a day. This has worked fine for me for a year now. I'm wondering if I should shift to 5 mg twice a day; however, since the current dosing is working, I'm a bit reluctant to change.