The best way to cut small pills for a wily cat?
April 21, 2017 7:27 AM   Subscribe

My cat who nearly died of a brain infection has been seizure-free long enough to step down on his 16.2-mg dose of phenobarbital. The vet wants me to give him 3/4 of a very small pill twice a day. The pill cutter the pharmacy gave me for this purpose is not working well.

The pill cutter (similar to this one) just cuts some of the pill and renders the rest dust even if I try to line the blade up with the line on the pill and I can't seem to get an accurate cut so the dosing would not be consistent. Weirdly, the prescribing neurologist does not have a good solution to this issue.

After some trial and error and a year and a half in, Eisenhower is very good about being pilled, but crushing the pill and putting it in his food is a non-starter. I worry that we would lose too much of the pill if we crushed it and tried to sweep it into a pill pocket. Putting the pill in a piece of pill pocket and putting it in his mouth works best. I have a large bottle of these pills and they are not cheap so ideally I'd like to use existing stock. If he does well enough on a 3/4 dose, I can step down next month to a 1/2 dose.

Do you have any tried-and-true suggestions for a good pill cutter for small pills? Or any out-of-the box ideas to dose accurately? I want to preserve Eisie's liver but also not have him seizing due to inaccurate dosing.
posted by *s to Health & Fitness (15 answers total)
I recommend finding pharmacy that can make you a liquid formulation, though this won't help with your current stock. Also, I get my cat's meds from Diamondback Drugs, I requested a quote, and the price was MUCH cheaper than my previous pharmacy.
posted by florencetnoa at 7:36 AM on April 21 [1 favorite]

I would ask for a prescription for liquid, which should be measurable in drops. I just checked around to see if it can (like some medications) be made in a meat-flavored paste but it looks like that's not an option here.
posted by Lyn Never at 7:37 AM on April 21

Could you get it compounded into a single pill of the proper dosage? We used to get some pet meds from a compounding pharmacy that offered delivery.

We had to quarter an eensy pill that could not be compounded, and we ended up buying this pill cutter, which is expensive, but did work better than the others.
posted by amarynth at 7:38 AM on April 21 [2 favorites]

Here's an idea that uses the sticky/doughy property of Pill Pockets:

Do the crushing as you are now, assuming you're confident you can achieve correct and consistent dosages. Instead of trying to sweep up the dust, use a small piece of the Pill Pocket "dough" to absorb/lift up the dust. Roll that into a tiny ball and put it inside larger piece of pill pocket.
posted by amtho at 7:42 AM on April 21 [1 favorite]

Ugh, I'm dealing with the same issue right now, you have all my sympathy. I think that once my cat is at a stable dosage we're going to go the compounding route.

Until then, it sounds like you've tried most of the things that can be done. Other options might be something like:

Mix the pill dust in with a small spoonful of something (baby food?), maybe chop the pill right over the dish so you're not worried about losing any. This only works if the pill doesn't taste terrible; my guy's pill dust is apparently so yucky that it ruins baby food for him, so this was a no-go for me.

If you're not trying this already: make the first cut into halves with the pill cutter, but for halving the half, do it by hand with a paring knife. It seems to be slightly less prone to pulverizing the pills. I think it works best if I place the knife blade on the cut edge of the pill instead of a smooth part, but that might be me imagining things. Make the cut swiftly and decisively: the pills can sense your fear and will crumble if you don't just take a deep breath and chop straight through the damn thing.

If the med is cheap enough, accept that you're going to lose a certain amount to Pill Dust and have the doc prescribe more pills than you need to account for it, so you can get a close-enough-to-accurate dose and just accept that you're going to lose roughly 1/4 of each pill to dusting? Sounds like this is probably not an option for you but FWIW in case it's useful for further step-downs, I'll offer it.
posted by Stacey at 7:59 AM on April 21

Wrong answer or not, I bite my kitty's pills in half with my teeth since I had a similar pill cutter experience. No more pill dust.
posted by yes I said yes I will Yes at 8:13 AM on April 21

I found an xacto knife worked better than a pill-cutter for cutting my cat's meds.
posted by msbubbaclees at 8:19 AM on April 21 [2 favorites]

0.75 of a pill, twice a day, is 1.5 pills per 24 hours. Which is 3 pills per 48 hours, or 1 pill per 16 hours.

Would your vet allow you to dose Eisenhower on a schedule like that, so you don't have to chop up tiny pills? I am not a pharmacist.
posted by dywypi at 8:50 AM on April 21 [5 favorites]

Could you get a high precision scale and give him 3/4 the weight of each pill each time?
posted by rhythm and booze at 9:27 AM on April 21

That's another option: grind the pill in a small mortar and weigh out the amount of powder you need. A 0.01g accuracy scale can be had for as little as $10 now, which should be good enough, barely.
posted by bonehead at 10:27 AM on April 21

I would tell the vet you're having a hard time cutting the pills and you need another solution that will allow you to finish the bottle. I got a technician to cut them for me. While she probably hated me, I got it to work. My feeling is I pay enough money to the vet that they shouldn't be making my life harder. I know you aren't having a problem getting Eisenhower to take the pills, but for anyone reading in the future - you can get a pet piller at any pet store or vet for under $5. Totally worth it.
posted by Bistyfrass at 11:38 AM on April 21

If you can syringe liquid into him:
Crush the pill and dissolve it in a measured amount of water, say 2 ml. Give him 3/4 of that suspension, or 1.5 ml in this example.
posted by SLC Mom at 2:10 PM on April 21

Thank you all for your great ideas! I called the neurologist's office and spoke to the vet tech and she said not to mess with the dust or to dissolve it in anything or give larger doses less frequently because the dosage needs to be steady and regularly given due to the half-life of phenobarbital. We have several compounding pharmacies and apparently it is not terribly expensive (not sure what that means in a world where check-up blood tests run $630) to get them to compound custom 12-mg capsules. Why the vet did not suggest this after telling me it would be a nightmare to keep up with the 3/4 pills is unclear.
posted by *s at 2:28 PM on April 21

When I had a small dog who required twice-daily phenobarbital, I used a cylindrical pill cutter. YMMV.
posted by ellenaim at 1:42 AM on April 22

Further update: The vet had us order the 12-mg formulation through Diamond Back Drugs. Service was not cheap ($35 for a one-month supply), but came on time in capsules with treats tucked inside the prescription bag. We are a few days in and so far so good.
posted by *s at 9:21 AM on April 30

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