Hello lovely people, very quick question, I’m on 62.5mcg levo. Don’t get on well with Teva 12.5mcg so been given Wockhardt 25mcg to split. However these tablets are tiny and not scored. I’ll do 75mcg and 50mcg on alternate days to use them up. Does anyone know of a 25mcg that are ok to split? I’ll be putting my story on here when I have some bloods done in couple of weeks so be asking for your guidance then too. Thanking you 🙏
25mcg Levothyroxine that can be split? - Thyroid UK
25mcg Levothyroxine that can be split?
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Auders
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I used to split 25mcg tablets from Boots. They were Accord.
I wouldve thought the protocol you are suggesting would be fine as levthyroxine is the storage from of thyroid hormone. If you can split I alwaus ensure that I take the other half of the split tablet the next day or the next dose. This balances any inaccuracy of cutting little tablets. I use a pill cutter to cut mine.
Can you not just tell your doctor that you have a problem getting hold of 62.5 tablets and suggest that he/she upgrade it to 75 as you can get that in one tablet instead of you having to try and cut one in half as if you are anything like me as most of the time when I try to cut one in half I just crush it into dust I am sure they would increase your dose.Regards Poppy Ann.
Auders wont want 75mcg tablets because the only brand that makes 75mcg is Teva which she doesn’t get on with
There’s Tirosint, or Tiche, in Italy. It comes in small steps. 12.5mcg.
Its a gel sort of pill.
Not available in U.K.
Order online?
It will be impossible to write a prescription for 62.5 microgram tablets in much of the UK - simply because the computer systems won't offer the option.
Although it is possible to add products (in most GP surgery systems, for example), or even write by hand, the prescriber would have to be pretty confident it exists before they did so. And they don't exist in the UK.
Thank you for your reply. At the moment I’m sub clinical according to the Dr. I have so many of the symptoms he agreed to do a trial of levo. Started on 25mcg, upped to 50mcg. Symptoms not really getting any better. I saw another GP who said he wasn’t happy to try increase, he rang me up and said was small wriggle room with increase hence he added 12.5mcg to the 50mcg I already had. Of course they only checked TSH. I’m going to do private bloods in 2 weeks to see what they are. I’m going to do the full range Tft, iron panel etc and post on here for advice. Only results I’ve got at hand are (06/04/22) serum TSH 5.2 mu/L [0.3 -4.2] Serum T4 17.6pmol/L [10 -22] B12 253ng/L [197-771] Folate 3.4ug/L [4.6-18.7] (I’m taking folate tablets since result) Serum ferritin 48ng/L [13-150]. On (26/05/22) TSH was 3.3mu/L [0.3-4.4]. Started levo in January this year bloods (10/12/21) TSH 4.3 [0.3-4.2] T4 17.2 [10-22] I did a Thriva test (22/10/21) TSH 7.83miu/L [4.2-1.] FT4 15.5pm l/L [12-17] FT3 5.4pm old/L [5-6.8]. TPOAb 11.5kiu/L [0-34] TgAB 12.8ku/L 0-115]. 68 year old female, have OA of most joints, take Omeprazole prescribed. Others meds are Folate, Selenium, B12, D3 and K2 and Zinc. Thank you for any advise given.
Most of us on levothyroxine only need a TSH around 1.0 or lower.
Although it is wrong to use TSH to manage dosing, at 3.3 it is too high.
Your B12 is too low for someone already supplementing.
Omeprazole can and does affect absorption of B12 and other nutrients.
I don't see why they are being so restrictive regarding your levothyroxine dose. Fine if they suggest incrementing slowly and carefully, but the implication is that they would be unwilling to go further.
Your ferritin, whilst nowhere near as bad as some members have reported, is a bit low. And, with omeprazole, you might not be absorbing iron well. Needs more consideration including an iron panel to check further. (Ferritin can and does rise when there is any inflammation in your body. If that is the case, which is likely given your high antibody results, the ferritin value says little about your iron levels.)
Thanks for the reply. I wondered if it’s because they class me as sub clinical as they are fixated on the blood results not so much the symptoms? The last Dr said “If I’d got a cure for being tired I wouldn’t be sat here!” That’s when I said “thanks for you help” and walked out! I literally had just sat in my car when he rang me and said he’d thought about it and decided there was wriggle room, hence the 12.5mcg increase. I also said I’d notice my ferritin was in the lower third of range and I was taking Active Iron 14mg, he just said your results are fine. However I did read on here not to medicate unless necessary so I finished the months dose off and I’m doing a iron panel tomorrow morning. As I’m 100kg I’m sure I could manage another small increment, but I’m going to do a full shebang test in a Fortnite or so when I’ve been on 62.5mcg for 8 weeks. Don’t they make things so hard? Again thank you for your advice. This is such a lovely and informative forum. I am learning so much. I never knew where the measurement grain came from! 🙏
Auders
I’m doing a iron panel tomorrow morning.
If this is a private test to be sent in the post, please delay it until the weather cools off. Sending blood through the post in this heat risks it spoiling.
Ok, thanks for that info. I think I just wanted it doing, but don’t want to risk any spoiling 🙏
Hi...Omeprazole is I’ve just found out contraindicated with Thyroxine. I used to take Omeprazole every day but 5 years ago changed diet (after developing kidney stones which can be associated with antacids) and now have maybe one a month if that ...but GP practice has changed my script if I should need any to something which is compatible...not that I will need a new scrip for years! (I’m 72 if that helps)
Oh wow! I was told to leave at least 6 hr between levo and Omeprazole. I tend to take it in the evening. Have you been recommended any other PPI? I have a hiatus hernia, I’m doubled up in agony if I go more than 4 days without. Thank you for the info 🙏
SlowDragonAdministrator
Get a sharp craft scalpel or a pill cutter and cut in half
62.5mcg is very small dose levothyroxine
How long have you been on just 62.5mcg
Been on 62.5mcg for 6 weeks now, will do full blood workout in 2 weeks or so and see where I can go from there. Started on 25mcg, then increased to 50mcg and after a bit of a walk out on GP I’ve been put up to 62.5mcg. Was a young chap doing GP surgery as part of his rotation. Heaven help the NHS!
I take Wockhardt and have no problem cutting them with a pill cutter. If they don’t split equally, just take the other “half” the following day. I have never had one crumble.
I agree.
The only thing that is really important is not to lose any fragments/crumbs.
Oh my goodness, they are so teeny tiny! I’d better get the Stanley knife out!
I think you should get a decent pill cutter- I wouldn’t trust myself with a Stanley knife, I value my fingers too much 😱
Yes thanks I’ve ordered a pill cutter and some scalpels. Really hope for the sake of my fingers the pill cutter works!
Me too 😂
I would suggest experimenting with a pill cutter first. Don't rush, place the pill in the right place, making sure it is pushed hard up to the edges/corners or wherever it has to be. Then you can experiment with whether slowly pushing the pill cutter to do the cut works or whether it woks best when done quickly. Only cut one pill, then collect all the crumbs so that whatever is left of the first tablet can be taken tomorrow. If you want to see the choice available look at what's for sale on Amazon.
The alternative to a pill cutter is a scalpel/hobby knife/craft knife. Some hobby or craft knives come with odd shaped blades - ignore those. You want blades that are a standard shape. Always buy a product that comes with spare blades.
Swann-Morton is a very famous name in scalpels and blades. I have seen complaints in reviews with some other makers that the blades are blunt even when new.
Why do need to split the pills? Alternating 50 and 75 is perfectly fine as a long term solution.
Taking on alternate days was an option, main drawback for me would be I’d forget if I was on 50mcg or 75mcg! Too much brain fog. After I get new blood results in 2 weeks or so I’ll see if I can get a gentle increase to 75mcg. I’m new to this but I’m sure it will be long and drawn out unfortunately. Thank you for your response.
Taking a different dose each day doesn’t suit everyone, me included.
Thanks Gingernut, I would prefer to take 62.5mcg daily if I can. I’ll see how I get on with the pill cutter. Good luck to you and thanks for the input 🙏
Thanks Auders, I was actually replying to annablanca as she was querying about the need for a pill cutter 🤨
Yes that’s what I have been doing for 3 years.
SlowDragonAdministrator
Exactly what vitamin B12 are you currently taking
B12 should be at least over 500
How much vitamin D are you taking and what brand
When was vitamin D last tested
Aiming for vitamin D at least around 80nmol
Test twice year when supplementing
Guidelines on dose Levothyroxine by weight (1.6 mcg per kilo per day )
suggests you’re going to fight for a lot of dose increases over coming months
Hi yer, I’m taking Bioactive B12 (3000mcg) D3 (4000iu and 100ug) by Superself. I’ve only been taking them about 3 months, started taking them after reading advice on here. I was going to wait until I’ve got a wide range of results before going into battle! Again many thanks for input. I am trying to loose weight but my goodness it certainly is not easy.
If hypothyroid and under medicated, it will be (virtually) impossible
Be quite a task just to stop weight going up
I’m surprised at the range of sizes with some 25mcg being larger than 100mcg. Alternating the dose as you’ve been doing with the remainder is absolutely fine and possibly more accurate than splitting a tablet where some particles may be lost.
Thanks for your advice. Apparently the 12.5mcg are mega bucks, in my mind the larger the dose the more expensive it would be but it seems it doesn’t work that way. Depending on my next bloods I’m going to push for an increase. Only Teva does 75mcg so if I was increased to that I’d ask for 50mcg and 25mcg. My goodness it’s so complicated!
The cost of the levothyroxine content is extremely low!
Wonder why the cost of T3 in this country is extortionate?! I only take 5mcg a day and feel like a burden on the NHS!
There seem to be two reasons:
The long-term monopoly supplied raised their prices dramatically (it was about £12 for 28 tablets when I first became aware of T3 prices). This has been the subject of the CMA investigation.
The NHS didn't, or couldn't, seek alternative suppliers at more reasonable cost.
No-one appeared able to pick up this issue and do anything to get a reasonable product at a reasonable price.
5 micrograms a day would be £55 for 28 days if supplied as Roma capsules. More in tablet form - £99.47 (NHS Drug Tariff price).
Remember, it is not your fault!
This was in the Lancet In 2016, the 28-day National Health Service (NHS) cost of liothyronine in the UK increased dramatically from about £4·50 to £258·19, resulting in widespread patient concern and media coverage.5 By contrast, the cost of levothyroxine has broadly remained the same. Clinicians are under increasing pressure to justify prescriptions and, for many patients, treatment has been discontinued or requires private sourcing. A parliamentary enquiry is ongoing. As these changes in costs occurred uniquely in the NHS, these trends in liothyronine prescribing likely only apply in the UK.
However it goes on to say this must be questioned and can really affect some patients adversely.
Sent from my iPad
Exploitation of loop hole
news.sky.com/story/regulato...
Yes understood there was a loophole but why it wasn’t plugged earlier ..why couldn’t the NHS have bought in T3 from countries wher it was cheaper? And a year on what has changed? My practice won’t pay for the T3 so the local hospital has to carry on paying. So many implications as couldn’t think of moving to another area which wouldn’t fund my T3. Oh well. Maybe we need a petition ...
Same here!!!
Only Teva make 12.5mcg tablets levothyroxine
100mcg, 50mcg and 25mcg are all approx £1 per 28 tablets
12.5mcg tablets are £12.50
Regardless of being sub clinical you were diagnosed, once on levothyroxine the guidelines are to dose roughly by your weight
pathlabs.rlbuht.nhs.uk/tft_...
Guiding Treatment with Thyroxine:
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
Increasing slowly upwards in 12.5mcg or (more usually) 25mcg steps upwards until TSH is always below 2
Most people when adequately treated on levothyroxine will have TSH around or under one and Ft4 at least 60-70% through range
ESSENTIAL to regularly retest vitamin levels and supplement to maintain optimal levels
Vitamin D at least around 80nmol minimum
Serum B12 at least over 500
Folate and ferritin at least half way through range
PPI are notorious for stripping vitamins out
GP should be testing iron, ferritin, Magnesium, folate and B12 at least annually
Have you had thyroid antibodies tested?
Low stomach acid can be a common hypothyroid issue
Thousands of posts on here about low stomach acid
healthunlocked.com/search/p...
But never ever assume you have low stomach acid
healthygut.com/4-common-bet...
Web links re low stomach acid and reflux and hypothyroidism
nutritionjersey.com/high-or...
stopthethyroidmadness.com/s...
thyroidpharmacist.com/artic...
How to test your stomach acid levels
healthygut.com/articles/3-t...
meraki-nutrition.co.uk/indi...
huffingtonpost.co.uk/laura-...
lispine.com/blog/10-telling...
Ppi like Omeprazole will lower vitamin levels even further
gov.uk/drug-safety-update/p...
webmd.com/heartburn-gerd/ne...
pharmacytimes.com/publicati...
PPI and increased risk T2 diabetes
gut.bmj.com/content/early/2...
Iron Deficiency and PPI
medpagetoday.com/resource-c...
futurity.org/anemia-proton-...
onlinelibrary.wiley.com/doi...
sciencedirect.com/science/a...
Oh my goodness! There is a lot to take on. I’ll leave it till the end of the month and do full thyroid bloods. I’ll also do bloods for vitamins and minerals too. Thank so much for the info 🙏
I am also in the same dose as you and take 75mcg Mon Wed and Friday and 50mcg the other 4 days. Mine are also wokhardt 25mcg. They won’t split for me, even with a pill cutter, so I don’t know how else you could take these. I can’t take 75mcg because of palps getting worse, and 50mcg isn’t enough. I hope that you find the right solution for you.
Hello Flecmac, I’ve used the pill cutter today and yes it has seemed to have worked well. It’s an ongoing learning curve I think. I’m hoping for an increase after next lot of bloods. I took 75mcg for first time this morning so I’ll take 50mcg tomorrow and then see how I go with 62.5mcg. Been reading about how bad ppi can be for you. Think I’ll have try see if there is a different way of protecting the stomach that won’t strip levo and vitamins etc. Thanks for input, good luck to you 🙏
Synthroid levothyroxine has a 25mcg tab that has a split in it you can easily cut to halve it.
Synthroid is not available in the UK.
Few UK tablets are officially splittable. Even tablets which, when supplied in other countries are officially splittable! That is the MHRA attitude.
It would appear they would rather we alternated dose - 50/75 - than split a 25 to take 62.5 every day. I'm afraid I don't understand. Even if the split is wildly uneven, it would be closer than 50/75. Leaving the only issue I can see being losing crumbs.
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