Tablet fillers

[dodge1979]

Why do table fillers cause us so many problems?

[SeasideSusie Remembering]

They do for some people, they don't for others.

Same as saying why do certain topical creams make some people come out in a rash but they don't affect others.

I've never had any adverse reaction to tablet fillers, I would appear to tolerate everything, maybe I've got a cast iron stomach. Someone else may be very sensitive.

It's a very individual thing.

[helvella Administrator]

Starting with a repeat of something I have posted before:

The ingredients of medicines are often divided into active ingredients and excipients. Put simply, excipients are all the ingredients other than the active ingredient!

I love the word excipients.

We very often see use of the word filler. A filler is an excipient with a specific function - it adds bulk. Calling them all fillers is somewhat misleading. Other functions of excipients include:

Antiadherents

Binders

Coatings

Colours

Disintegrants

Flavors

Glidants

Lubricants

Preservatives

Sorbents

Sweeteners

Vehicles

Some excipients have multiple functions.

The word filler often seems to imply that the substance is being used instead of the active ingredient - to reduce the amount. But we'd better remember that some of these excipients are absolutely essential.

The article linked below might be of interest:

drugtopics.modernmedicine.c...

It is very easy to assume that a problem is due to excipients. Seems likely that at least sometimes it is! But there are other possibilities such as impurities in the active ingredient. Or the precise level of hydration, or particle size. Or how much pressure is applied when forming the tablets. Or some combination of these and other factors.

There also seems to be inadequate testing of reformulated medicines. An example is the change from lactose to mannitol in "French" levothyroxine. Only a small number of healthy volunteers were used to check that the change was acceptable. In my view, grossly inadequate.

[MaisieGray in reply to helvella]

I was going to write along the same lines, so you've saved me the effort lol.

I am one of those who isn't troubled by excipients; but agree with you that there can be other factors at play. A few years ago I was prescribed co-codamol after foot surgery, and had the proverbial 'funny turn'when I was home and had started taking them, although it was actually quite scary in its severity. So I stopped taking them and they've languished in the bathroom cabinet until recently, when I took two in advance of a longish walk with a friend, in anticipation of my 'normal' back and leg pain. I experienced no adverse reaction at all, and wonder whether it was a combination of the med and the anaesthesia that caused my reaction, rather than either the active or inactive ingredients of the co-codamol itself.

[Fruitandnutcase]

I take Zestril for high blood pressure. Many years ago I was given a generic lisinopril and I didn’t feel good - it’s so long ago that I can’t remember my symptoms but I spent hours studying and making little charts of the ingredients in both and came to the conclusion that it could only have been a filler that was in one and not the other - I discussed it with my then GP who put me back on to the Astra Zeneca Zestril which I have taken ever since.

I wouldn’t say my body is particularly delicate but whatever was in that at that time didn’t work for me.

[dodge1979]

What are the symptoms?

[silverfox7]

I think the symptoms can be varied depending on the individual but the usual advise if checking on thyroid meds is to take an antihistamine one hour before your thyroid meds and the symptoms don't seem to appear then it's something in the medication causing a problem as the antihistamine will have done its job. Usually it means a change but sometimes more than one as the fillers aren't confined to one so the first change could still have the rogue one included but when you are happy then best to get your doctor to name it on your prescription and also check your pharmacy puts it in your notes as well.

[Lovecake]

I take Imigran for migraines (as and when needed).

When the NHS decided that everyone should have the generic, (cheaper) I was given the alternative.

The first one I took to stop a migraine did not do it’s job - and subsequently was sick every time I moved even a tiny bit for 7 hours!

I tried it once more and had the same result.

The Gp I saw said it couldn’t be the tablet or the fillers and prescribed me anti sickness tablets - they stopped me being sick for 2 hrs then I threw up anyway!

The pharmacist said I could be allergic to the fillers in the generic.

Needless to say, I don’t have the generic now. If they ever stopped Imigran, I’d be better off with the migraine than take those others.

I think we all react differently and you might just have to get through a few different things to find something that suits.

Sorry if it’s been too much info in this post 🙊

[McPammy]

If you have problems with fillers. You could request to change to liquid Levothyroxine these are no fillers. Also brilliant for dosing. You can go up or down in smaller mcg’s

As it’s liquid measured in a syringe.

You then squirt it in your mouth.

[helvella Administrator in reply to McPammy]

There is a considerably GREATER amount of excipients in a liquid levothyroxine than the equivalent dose in tablets.

It might be that the precise excipients used, being different, are better tolerated by some. However, there are people who are less tolerant of liquid forms.

[McPammy in reply to helvella]

I was advised by my Professor Endocrinologist in Oxford that there was considerably less in liquid Levothyroxine.

Not sure why he would say that and transfer me to the more NHS expensive option.

[helvella Administrator in reply to McPammy]

I don't doubt someone, professor or otherwise, has said that to you.

There are nine excipients in one particular oral levothyroxine solution against four in the same company's levothyroxine tablets.

The basic dose of the oral levothyroxine solution is 5 millilitres. One teaspoonful. You could get several 25 microgram tablets in the scoop of a teaspoon - more if powdered and gently tamped down.

On that basis, I claim that the oral solution has more excipients both by number of different substances and by quantity in an equivalent dose.

The only way I can see of turning that round is to do something like claim the Purified Water doesn't count.

Levothyroxine 50micrograms/5ml Oral Solution (Wockhardt UK Ltd)

6.1 List of excipients

Citric acid monohydrate

Sodium methyl parahydroxybenzoate

Sodium propyl parahydroxybenzoate

Propylene glycol

Maltitol, Liquid

Sodium Hydroxide

Hydrochloric Acid

Sodium Hydroxide

Purified Water

medicines.org.uk/emc/produc...

Levothyroxine 25 micrograms Tablets (Wockhardt UK Ltd)

6.1 List of excipients

Lactose

Sucrose fine powder

Maize starch

Magnesium stearate

medicines.org.uk/emc/produc...

[McPammy in reply to helvella]

I have a consultation tomorrow with him. I will ask him again. I understand what you are saying. I just don’t know why I was taken off tablets and switched to liquid format then. I do still prefer the liquid after being in tablet form for 11 years. Not so much the excipients but the way in which dosing can be controlled much better. I can up or down by 5mcg which I find much better than 12.5 mcg lowest in tablet form.

[helvella Administrator in reply to McPammy]

Be very interested to hear.

I am very willing to believe that some people prefer liquid to tablet - for any number of reasons.

I just don't get the "no fillers". Unless the assumption is that all fillers are solid? And avoiding the proper word, excipient.

[BadHare in reply to McPammy]

I've learned to trust us users rather than endocrinologists!

[elwins]

I find fillers do not always work for me, having trouble with gluten, take paracetamol and can only take one brand due to the fillers. Suffer with colitis. In Australia easy to buy over the counter without maize starch in. But over here not so easy.

[Hidden]

I thought April 1st was 29 days ago.

It is one of the daftest posts I have seen.

I'm so ill because my T3 has been stopped, to do what you suggest would finish me off.

[Hidden]

Hi, I posted a link to a research paper recently. It looks at the problems with reformulating levothyroxine in France. It gives some interesting info of the effect of mannitol on absorbtion of levo. Might be relevant to your question. Here it is again

link.springer.com/article/1...

Michael

[helvella Administrator in reply to Hidden]

And this paper makes use of mannitol for assessing intestinal permeability. Which makes me wonder if the mannitol has a direct effect on the levothyroxine absorption - and which depends on individual intestinal permeability.

ncbi.nlm.nih.gov/pmc/articl...

[Hidden in reply to helvella]

That one's a bit too hard for me 😗