Inconsistency in pill sizes

[Catseyes235]

I perhaps naively thought that pills of one type were the same size and shape. Wrong!

My latest 100mcg T4 tabs are bigger than anything I’ve ever had in 40 years with well defined line for splitting them. I’ve also had 25 mcg which have been bigger than 100 mcg. ! Weird but now I’m on new meds and finding the same applies to them - one for high blood pressure which has been first oblong, the second round and easily halved, and now a bigger flatter round which crumbles when halved and I use a pill cutter.

It can get very confusing especially as they’re all white and I have to halve T3 as well plus I have had short term memory problems ...luckily injections for AMD are maintaining my eyesight, otherwise goodness knows what a mess I’d make but I’m thinking of investing in several weekly pill boxes to keep things separate instead of one compartment of pills which I take half asleep an hour before I fully wake and have breakfast. I do have another pill box for evening meds which is kept in the kitchen and I keep my blood thinner which I have with breakfast in it . Luckily it’s pink!

Thing is there are lower doses of some meds which are not available in this country. It would make things so much easier if they were.

[Beads]

Accord 100s are tiny, Wockhardt 25s are even tinier. But Teva 100s and 25s are the same size and bigger than the others. I don’t like the Teva, if I mix the 25s and 100s by mistake they need chucking as I can’t tell the difference (there may be something written on them I can’t see without my glasses). I too take mine half asleep in the morning. When I went from taking 100 to 125 I got a simple pill box to put a week’s worth in coz I didn’t trust myself to be able to differentiate the 2 blister packs. Now I turn the alarm off, flip he lid of the next compartment, take whatever’s in there, back asleep.

[Catseyes235 in reply to Beads]

I always use a pill box but the trouble with the half asleep method is having a dry mouth where the pills fall out before getting the water sipped!! It’s amazing how many little white things you can find on a carpet, but like you I often have to throw out/give up and start again which doesn’t half wake you up and focus the mind!

[Batty1 in reply to Catseyes235]

Oh my god you should see my mothers carpet my nieces and nephews can’t let their little one on the floor … its bad.

[cazlooks]

hi you can ask for them to be split for you and boxed up in advance, so when you collect from the chemists they are all ready for you to take. Chemists hate doing the tiny ones, but it is better than you making mistakes. I don't know if you have to ask the GP or the chemist, but it's worth mentioning next time you get your tablets prescription. cx

[Catseyes235 in reply to cazlooks]

Hmm I may ask if I feel I can’t cope with splitting them. I may mention it though. My chemist was really busy last time and the main chemist away with two new young ones, who were v good and attentive, working there like they were on a work placement! Maybe next time but I can’t imagine them taking the time to take 90 or so pills out of a blister pack to split. Plus some start to disintegrate if rub together! Ah well onwards and upwards.

[silverbelle51 in reply to cazlooks]

Was trained in nursing school that scored pills can be split. I am now questioning that . My husband was prescribed a drug and his specialist then said no he could only take half a dose, so I informed his Doc and advised I would split the scored pill, but have noticed inconsistent response to drug that I have related to the pill perhaps not being evenly blended. Just our experience.

[cazlooks in reply to silverbelle51]

I was always told that I could split the pill, but only if I took all of the pill in a day, for example I split my liothyronine into quarters, but I take all of it in the same day; this allows for incomplete mixing, overall.

[Catseyes235 in reply to cazlooks]

Yes I split my T3 also ..one for morning and evening. But actually morning and next morning (bedside pills) and then evening and next evening (downstairs pills). Not going to get neurotic about it!

[helvella in reply to silverbelle51]

The origin of breaklines was, as you were told, to permit breaking tablets.

But sometimes that was to make it easier to swallow - obviously more applicable to larger tablets.

In more recent times, tablet splitting should be regarded as not acceptable for dividing doses - unless the Patient Information Leaflet says it is OK.

Taking two doses in a day, well, it's might be OK but you are unlikely to see any conformation of that.

Bulk tablet splitting is always going to be an issue because of the loss of fragments, and that you could inadvertently take a series of "small halves". At least if you split your own on an as-needed basis, you can be careful not to lose crumbs, and always to take the two parts of one tablet close together. That should avoid the worst variation.

(Some tablets, when split, are more prone to deterioration due to oxygen, humidity and light being able to reach more active ingredient.)

[Catseyes235 in reply to helvella]

I’ll stick to splitting my own. Instructions on my blood pressure pills actually now say to have half a tablet daily. Mybig worry is if I ever had to go into hospital and they tested my TSH. Maybe I should get a tattoo saying TSH always very low!

[Hylda2]

My chemist has been bought out so I seem to get whatever drug manufacturer is the cheapest that week. Atorvastatin has gone from oval to round, Bumetanide now minute, Flecainide has grown. Thank goodness I have MP on my prescription for Levo after Teva snuck in xx

[Catseyes235 in reply to Hylda2]

OMG so far my Atorvastatin has been oval! I think I will invest in more boxes but what annoys me is one starts on Monday and the other starts on Sunday! Yes they I daresay have to find the cheapest but I’m just thankful to have the NHS and the drugs I need. There is a nationwide shortage of one of the drugs used for macular degeneration injections. Luckily the one I have is still available otherwise I’d be going blind!

[Beads in reply to Catseyes235]

Our dog (he’s ancient and takes one anti inflammatory, 2 painkillers and joint aid tablets each day) has a little carousel with 7 pill pots in, each with 4 compartments. We take that day’s out and he gets his pills at the right time. You can ‘start’ the week on any day, Fred’s gets refilled on Saturday morning. There are different versions of them (most in rainbow colours). Would one of these help?

[Catseyes235 in reply to Beads]

I only need one (weeks supply). upstairs for bleary eyed early consumption at least an hour before eating, and one in the kitchen as have one blood thinner (luckily pink ..so far) with breakfast then ones left in compartment later at 10. It’s making sure I’ve filled with correct dosage especially when changing to a new manufacturer’s pill of a different size which has to be halved!

[helvella]

For thyroid hormones, the size of tablets is entirely arbitrary. 100 micrograms, for example, is of the order of size of individual crystals of sugar. All UK products are round.

In countries which produce a wide range of dosages, they are usually all the same physical size. But mostly, they are dyed so that they can be recognised by colour.

Some thyroid hormone products seem to be made with one formulation used for two (or more) dosages. If that is the case, the 100 would be twice the size (at least, by weight) as a 50.

But if they also produce a 25, half the mixture used for a 50 might be too small to be satisfactory!

[Catseyes235 in reply to helvella]

So why would the 25 mcg be bigger than the 100mcg. as I stated in an earlier post when I was just taking thyroxine? Seems that size is irrelevant just as long as the active ingredient is correct, the rest is filler ! (Like many TV progs today). I’ve also had 25mcg which looked a quarter of the 100!

[helvella in reply to Catseyes235]

Sorry - what I said needed some more information to make sense.

I suspect that, going back many years, several companies only supplied 50 and 100 tablets. For that, they could use the same physical mixture - just make 100 tablets twice the weight/volume as 50 tablets.

In 1980, and since, several companies introduced 25 microgram tablets. But doing so with the same recipe would have resulted in tablets that were smaller than they wanted. So they devised another recipe with more excipients. They had some freedom to choose a size and decided on one that was noticeably different to their existing 100 and 50 tablets.

(Back towards and before the turn of the century, several brands supplied Goldshield/Mercury Pharma 25 microgram tablets in their own packaging. So I think the size was to suit them, or the previous companies that supplied the same products - MedEv and, before that, Glaxo. 25 tablets became more common from 1st December 1980 when the formulations of ALL UK levothyroxine tablets changed.)

[Catseyes235 in reply to helvella]

I’ve read that in the US T4 comes in 5mcg size too! . I was surprised that my blood pressure meds didn’t come in half dose as I know they are available. Trouble is that many meds are tested on males so are too strong for smaller people and women.

[helvella in reply to Catseyes235]

There is no standard 5 microgram levothyroxine product in the USA (or anywhere else, so far as I know). The usual smallest dosage is 12.5 or 13.

It is not impossible that someone got a 5 microgram product from a compounding pharmacy.

Liothyronine (T3), though, does come in 5 microgram dosages both in the USA and in the UK.

Which blood pressure medicine do you take?

[silverbelle51 in reply to Catseyes235]

I can't speak your specific pills, but when I took Levo. I finally did some research and found essentially 3 companies make all the world's pills, no matter what the label . Most made in China and some in India for all the drug companies. Size may not be related to dosage, but who they are being made for I am thinking.

[Catseyes235 in reply to silverbelle51]

China and India make many many drugs at a much lower price than the US or Germany etc who do the research and hold patents. This is the first time in 40 years I’ve had a 100mcg with a definite split for halving!

[helvella in reply to Catseyes235]

Officially, a scoreline or breakline does NOT mean that a tablet can be split.

If the Patient Information Leaflet says that it can split, then that is OK.

[helvella in reply to Catseyes235]

Levothyroxine and liothyronine have never been patented in the UK (nor, I believe, the USA).

[RedApple in reply to Catseyes235]

Catseyes235 'This is the first time in 40 years I’ve had a 100mcg with a definite split for halving!'

More information please. What medicine are you referring to, levothyroxine? Manufacturers name? Dispensed by a UK pharmacy?

[Catseyes235 in reply to RedApple]

it’s Aristo which I don’t think I’ve had before. U.K. pharmacy.

[helvella in reply to silverbelle51]

This is simply not the case.

For levothyroxine:

Accord, Glenmark, Mercury Pharma (Advanz) and Wockhardt are all manufactured in the UK.

Teva is manufactured in Croatia.

Aristo is manufactured in Germany.

For liothyronine:

Accord, Mercury Pharma (Advanz) and Morningside are manufactured in the UK.

Roma (and Colonis, if they are now being marketed) are manufactured in Greece.

SigmaPharm are manufactured in the USA or the UK.

Teva are manufactured in Hungary.

That covers most thyroid hormone tablets supplied in the UK.

Note: there is currently uncertainty about Mercury Pharma/Advanz products into the future.

[Batty1]

Crazy isn’t it. Have you seen the new pill dispenser that dispenses your meds automatically? My mom has AMD and has a horrible time with meds I've been thinking about this dispenser for her she still would need someone to fill it.

[helvella in reply to Batty1]

Have you got a link?

[Batty1 in reply to helvella]

No I only just saw it advertised on TV and haven’t caught the commercial again. Maybe Amazon would have it but I can’t recall the name of it .

[Catseyes235 in reply to Batty1]

Surely you’d have to put the right pills in the dispenser? Luckily my AMD doesn’t affect my sight but my late brother was registered blind so until the chemist started putting his pills into weekly dispensers he was very much at the mercy of his own judgement or home helps etc. And heaven help him if he dropped something.

[Batty1 in reply to Catseyes235]

Yes it is very difficult for my mom sometimes I wonder if she take too much of certain meds because of this.

[Catseyes235]

I know my brother did. Could her chemist not set up a monthly pill box? Or four weekly ones? My problem was after a mini stroke having short term memory problems so I just could not remember if I’d taken something and refilled the pill box or taken from the packet first. I seem to be a bit better now. Must be a worry for you!