14 replies to this topic

[LivingWellWithCML]

Hi everyone,

I am considering splitting 400mg Gleevec tablets, so I can start taking 200mg 2x/day to help ease some ongoing side effects.  I've been taking a single 400mg pill with breakfast for one year and have had (so far) good response (CCyR < 6 months).  Have others made this change and maintained good response?  It's safe to split the 400mg tablets?

I've seen threads on this around the board, but just wanted to get some reassurance before I take the plunge.

Thanks so much all!

[jjg]

Hi Dan,

I saw a CML specialist recently and we discussed dose splitting but for 800. He was definitely in favour of dose splitting, at least for the 800. He said for gleevec it doesn't matter when you get it all into you as long as you manage to get all the dose done every day; which is kinda a general statement you'd think would apply also to 400.

The other thing in favour of dose splitting is that the half life of both glivec and tasigma is long..about 18 hours so you will still get pretty high concentration levels even when splitting. The half life for sprycel is much shorter, from memory about 5 hours. Going back to glivec I did sometimes split taking it at breakfast and lunch - generally if I felt particularly dodgy at breakfast. Certainly for nausea side effects I was finding that even splitting by 4-5 hours made a big difference and if you were worried about concentration levels that could be a compromise to try first.

Hope your running is going well.

[LivingWellWithCML]

Thanks all.  I split a G 400mg pill this morning and am trying the 200mg morning / 200mg lunch thing for a couple of days to start; that seems like a reasonable compromise.  I have my one-year draw on Apr 11th, so I am hoping for continued good response ... even with the split.

@Billie and @jjg - Thanks for your encouragement.  Wow, the first year really did go quickly, didn't it?  And that's right, I ran a road race on the morning that I was diagnosed (got the call about 3 hours after the race to report to the ER ... still in my running shoes!).  It was quite a surreal experience, as I know it is for everyone.  Although I wasn't feeling 100% at the time, I was running on a regular basis with a 100,000+ WBC and had no idea.  Something really bad would've happened eventually, so it's good that I was super persistent about my slower running and going to the doctor multiple times complaining about it.  Whew.  I just ran that same race a couple of weeks ago on the weekend of my "cancerversary" and was the 9th overall finisher.  What a difference a year of TKI treatment can make.  I hope my fitness level is an indicator of response ... I will find out this month.

Thanks all!

[Trey]

I have written a number of times about how I have split my 400mg dosage since shortly after diagnosis.  At first I split the 400mg tablet in two, but prefer to use the 100mg tabs and take two at a time.  The split dosage worked well for me, and I know that several others here do it.

[PhilB]

Depends what you mean by safe.  If the knife slips you could lose a finger.

[LivingWellWithCML]

I was trying to remember when you started doing that - thanks Trey.  When you split, approximately what time of day did you take each 200mg?  And now that you're on 200mg daily, when do you take each 100mg?

Just curious what works for you...

[0vercast]

I'm new to this, but I wouldn't assume that you can split the dosage just because you can split the pill in half.  That just give a person more dosage options, such as when you temporarily need to take 600mg.

FWIW, I was recently advised not to split my 400mg dose.

[Susan61]

Hi Dan:  Anytime a pill is scored, its so you can cut it in half to split your dose.  I am on the 400mg. tablets, and I take the whole pill every morning with Breakfast.  I have no reason to split my dose, but if you think you would feel better than try half in the morning and half with your dinner or however you want to do it.  Glad your doing so well.

[Susan61]

HI Phil:  Thats not funny.  That would be me.  My husband teases me constantly if he sees me with scissors or a knife, after almost cutting my finger off with that stupid Mandolin Slicer on Thanksgiving.  My finger is still not right, and very sensitve.  I do the most idiotic  things, and my family calls me LUCY because of the situations I get into.

You always make me laugh.  Hope all is well with you.

[LivingWellWithCML]

Thanks.  I tried it today and I was ultra-careful with the pill splitter ... all fingers intact today.  I took half dose at breakfast like usual, and the other half dose at lunch.   Mentally, I think I'm more comfortable (for now, anyway) continuing the full 400mg dose with breakfast, then I've gotten it out of the way for the whole day, but we'll see.  That said, it did seem to make the GI issues less pronounced in the middle of the day.  But it's funny .... I'll go several weeks and have ZERO issues, then I'll go through a stretch where it's a bit more challenging.  For all I know, it might be completely unrelated to Gleevec and more associated to work stress and travel.  Who knows.

Regardless, life is definitely different when you're living on a TKI ...

[Trey]

When taking 400mg I split it 200mg AM and 200mg PM.  Now on 200mg daily I do not split it.

[0vercast]

It's funny you mention the slower running.  I just realized the same thing in the last week.  I'm able to see now how badly my unchecked CML was weakening me during my workouts.  Since I began hitting the weights again recently, a few weeks after diagnosis with a 250K WBC, I'm breezing through the routines I was doing prior to my diagnosis, with far less soreness the next day than I was experiencing before.

[LivingWellWithCML]

Yup, that's exactly what happened to me ... it was, and still is, amazing.  When I started Gleevec in mid-April a year ago, I started tracking my running times in detail to see how my running performance would respond.  There is a 4.8 mile hilly route from my house that I run regularly and it improved drastically through the summer .. for anyone who's curious, here are some of the times that I recorded throughout the spring/summer last year (I was running the route about 4 times/week).  I was tracking it like I track my CBCs!

The speed-up below directly correlated to response on the TKI.  Each month I saw a pretty big improvement in running, and the resulting blood draw would show increasing RBC/Hemoglobin and decreasing FISH/PCR.  Running is a great treatment monitor for me when I'm in between the 3-month draws.  I have to think that if my fitness level is good, then something must be going right:

Running Time (minutes.seconds)

4/18: 41.00 (was on Gleevec for ~ 5 days and I was very winded, RBC/Hemoglobin levels well below normal)

4/23: 38.13

5/4: 38.00

5/9: 37.41

6/19: 36.24

7/14: 34.59

8/30: 33.24

I still track it, and I've now settled in and can run this hilly route at a pretty good clip for me ... I'm around 32.50 or so, although I've been nursing a foot injury for a bit [probably caused by the faster pace].  Despite that, it is a mind-boggling 8 minutes faster as compared to a year ago when I started Gleevec.  I have lost a decent amount of weight during this period through some diet changes and from the faster running feeding on itself, so that's also a contributing factor.

I also started a weight training routine in early June and that has shown some remarkable improvement with the TKI response.  I truly believe that rigorous fitness masks the Gleevec fatigue as well, so I'm trying to keep this up as hard as I can, as long as I can.

It could all fall apart now, but it definitely feels good today...

[threedprof]

So you mentioned the half life of Gleevec is 18 hours when you split the pill. How did you determine that? Main reason I ask is because I'm splitting my doses and taking 200mg a day now but decided to save time by splitting the contents of the bottle, ahead of time. Am I in trouble?