Cutting Levothyroxine

[JackiePooh]

I know we are not suppose to, but has anyone ever cut their Levothyroxine? I feel my dosage is too high and as long as my numbers are within range, my doctor won’t change it.

[Lalatoot]

Yes folks cut it all the time. Pill splitter or scalpel.

[Buddy195 Administrator]

Can you share your recent thyroid test results with us, so members can better advise?Also, have you tested key vitamins (ferritin. Folate, Vitamin B12 and Vitamin D)?

How much Levo do you take?

What symptoms are you experiencing that are making you feel over-medicated?

I’m currently reducing my Levothyroxine, as my T4 is slightly over range & I’ve experienced palpitations & increased anxiety. I’m reducing very slowly, as I cannot tolerate significant changes in medication (eg reducing by 12.5mcg alternate days).

[SlowDragon Administrator]

Always test before changing dose

Symptoms can be misleading

Being UNDER medicated can give symptoms that could be confused as over medicated

Essential to test vitamin D, folate, ferritin and B12 too

We need GOOD Vitamin Levels on levothyroxine

ALWAYS test thyroid levels early morning, ideally before 9am and last dose levothyroxine 24 hours before test

How much levothyroxine are you currently taking

What vitamin supplements

[SeasideSusie Remembering]

JackiePooh

I know we are not suppose to, but has anyone ever cut their Levothyroxine?

Who says that? Years ago my doctor told me to cut 50mcg tablets in half because it was cheaper than giving me 25mcg tablets when I needed 175mcg Levo so she prescribed 100s and 50s.

I currently take 112.5mcg tablets so I take 100mcg daily and cut a 50mcg in half and take alternate days to give me the 12.5mcg. No problems at all.

[RedApple Administrator in reply to SeasideSusie]

SeasideSusie One of the UK levo manufacturers, can't recall who (and they've probably changed their name ten times by now anyway!), used to say not to cut because the active ingredient isn't necessarily distributed evenly across the tablets, so you won't get accurate doses with cut tablets.

Like you, I was told by my GP to cut 50mcg tablets in half so that he didn't have to prescribe 25mcg tabs which cost more.

Who to believe? Well both are probably couched around money rather than patient health, so take your pick! 😆

[helvella Administrator Thyroid UK in reply to RedApple]

The issues of splitting were reported by the European Medicines Agency back in 2013 with specific references to the situation in the USA.

europeanpharmaceuticalrevie...

(That was issued while the UK was a member of the EU and the EMA.)

[RedApple Administrator in reply to helvella]

I vaguely remember that. But I had a feeling it was a manufacturer who specifically advised against spitting levo tabs.

[helvella Administrator Thyroid UK in reply to RedApple]

I think some of the PILs say that a breakline does not mean that you can break them!

[SeasideSusie Remembering in reply to RedApple]

Possibly Actavis/Accord and whatever it was before (can't remember). That's the one I've used for donkeys years. I tend to think that as it's a storage hormone then what it might be missing in one half of the tablet will be in the other half the next time I take it so I don't tend to worry too much.

Come to think of it, I think that GP said the reason for just prescribing the 100s and 50s and not adding the 25s was because it would be easier to take two tablets rather than three, but I'm sure cost did come into it.

[helvella Administrator Thyroid UK in reply to SeasideSusie]

I fully agree that split tablets should be acceptable for levothyroxine. Just do not split in bulk, and don't lose any crumbs.

Some 25 microgram tablets only came into existence in 1980!

The monograph for levothyroxine was changed to specify anhydrous levothyroxine (rather than a hydrated form).

To make it easier for prescribers to adjust doses, some companies were encouraged to introduce 25 microgram tablets.

Cox/Alpharma/Actavis/Accord did not wish to do so then - nor ever since!

The difference between using the pentahydrate and the anhydrous forms for that tablet is just 2.8 micrograms of water (in a 25-microgram tablet).

Up to and including British Pharmacopoeia (BP) 1973 this was not the case. However, it was clearly required from British Pharmacopoeia (BP) 1980 forwards. Companies were required to reformulate their levothyroxine products which resulted in an increase in potency of around 11%. The pharmaceutical industry had to hold back new BP 1980 tablets until that BP came into force on 1st December 1980. Thereafter, BP 1973 stock could not be dispensed. New product conforming to BP 1980 was labelled “revised strength”. And a 25 microgram tablet was introduced by Thomas Kerfoot to help with the transition.

[RedApple Administrator in reply to SeasideSusie]

If it works for you, then no problem. I also split 50s. Some people seem to be very sensitive to small dose changes though, especially when titrating dose following diagnosis.

[JackiePooh in reply to SeasideSusie]

Thank you! I feel so much better about cutting mine.

[helvella Administrator Thyroid UK]

Pfizer's Levoxyl, when reformulated quite a number of years ago, was expressly designed to be breakable by hand.

More recently, I have seen several European makes have express instructions on how to break tablets. (This only applies to a few makes in a few countries.) I have added these to my medicines document and will continue to add any more I find. The techniques vary by make.

helvella - Thyroid Hormone Medicines

I have created, and try to maintain, a document containing details of all thyroid hormone medicines in the UK and, in less detail, many others around the world.

From Dropbox:

dropbox.com/s/shcwdwpedzr93...

From Google Drive:

drive.google.com/file/d/12N...