Liothyronine change!

[PrincessAnnie]

I’ve just received a letter from my GP practice saying I’m being moved from the liothyronine tablets to the capsules😤the problem I have with that is I’m currently taking 15mcg of the tablet form,I half a 10mcg tablet,does the capsules come in a 5mcg form?

[SlowDragon Administrator]

What tablets are you currently prescribed- 20mcg? Current cost to NHS £59 per 28 tablets

Capsules can’t be cut

You need to tell them you will need 3 x 5mcg capsules per day

3 x £55 per 28 capsules = £165 per 28 days

Or possibly

1 x 10mcg capsule and 1 x 5mcg capsule = £120 per 28 days

(So much more expensive)

The move to capsules is to reduce cost!

Which CCG area are you in

Post discussing this from few weeks ago

healthunlocked.com/thyroidu...

[PrincessAnnie in reply to SlowDragon]

I’m currently prescribed 10mcg Morningside,I’m in Ayrshire in Scotland,I’m due to test my bloods again a week on Monday and I was thinking of lowering my levo and upping my lio to the 20mcg in two doses a day anyway,it just annoys me that the letter states they’re confident I won’t notice any difference,absolutely clueless!

[SlowDragon Administrator in reply to PrincessAnnie]

You need to talk to the practice manager and pharmacist

You can’t split capsules

This is coming up as an issue for many people

If you need 2 capsules per day that’s more expensive than existing tablet cut in half or 1/4

[PrincessAnnie in reply to SlowDragon]

I’m assuming I’ll be prescribed 10mcg capsules as I’m currently prescribed 20mcg a day with 10 in the morning and 10 at night🤷‍♀️They don’t know I only take 15mcg.

[SlowDragon Administrator in reply to PrincessAnnie]

Are you currently prescribed 2 x 10mcg tablets

Or 1 x 20mcg tablet that you cut in half?

[PrincessAnnie in reply to SlowDragon]

I’m prescribed the tablet form in 10mcg as I’m supposed to take 10 in the morning and 10 at night

[SlowDragon Administrator in reply to PrincessAnnie]

Ouch 10mcg tablets are expensive £152 per 28 tablets - £304 per 28 days

You could offer to have 20mcg tablets and cut in half …only £59 per 28 days

[PrincessAnnie in reply to SlowDragon]

Oh that’s good to know👍I’ll wait and see what my blood results show and I’ll be checking the ingredients on the capsules,I have a lot of allergies and if my memory serves me correctly I’m not very good with capsules,I don’t know if it’s what the shells are made from😤thanks for your help SlowDragon👍Actually I might just call the practice pharmacy and ask about the capsules relaying my concerns.

[helvella Administrator Thyroid UK in reply to PrincessAnnie]

It doesn't matter what the shells are made of!

The Patient Information Leaflets are clear that you can disperse the contents of the shells, the powder, in water.

It would only be if you are so extremely sensitive even being in contact with the shells would cause a problem. They are made of gelatin and, depending on dose, an iron oxide and titanium dioxide.

[PrincessAnnie in reply to helvella]

I’m not too sure if it’s the gelatine that’s bothers me🤔can’t you half the powder then?

[helvella Administrator Thyroid UK in reply to PrincessAnnie]

If you have a way of weighing it accurately.

But you have to be very careful not to blow or sneeze. And it might take a few goes to check that you can divide the contents, weigh each portion, and see that they are all very close to each other. Then store any remaining powder somewhere for the next dose. A lot of room for error.

Therefore, not so much "can't" as "fairly difficult to do reliably and safely".

[PrincessAnnie in reply to helvella]

Thanks for your help👍

[SlowDragon Administrator in reply to helvella]

Even more like cutting “a line” (of coke)

😂😂😂

[helvella Administrator Thyroid UK in reply to SlowDragon]

I have no idea how even or consistent things like that are!

Neither the "white powder" nor the division into lines.

[PrincessAnnie in reply to SlowDragon]

Could you imagine🤦‍♀️Forced to act like a drug addict to have medicine that your body needs to function and survive🤦‍♀️That’s made me chuckle🤣Do you think having one Brazil nut a day would impact on our medicine at all,I know it helps with the conversion but I’m just wondering if it could make you feel hypo?

[SlowDragon Administrator in reply to PrincessAnnie]

Does your packet of Brazil nuts say “grown on selenium rich soil “

If not you might be better off supplementing selenium

[PrincessAnnie in reply to SlowDragon]

Thanks I’ll check that out👍

[knitwitty in reply to SlowDragon]

Could I just jump in here please. Why is there such a price difference between 20 mcg tablets and 5 or 10 mcg tablets ? Are they so much more expensive to produce , I would have thought that having less of the important ingredient ( liothyronine ) would make them cheaper !

[helvella Administrator Thyroid UK in reply to knitwitty]

The reason is that for 10 microgram tablets, there is only one product. Morningside.

I think that is why Roma have added a little increment for their 10 microgram capsules.

The cost of the Active Pharmaceutical Ingredient (API) is close to ignorable. Roma 5 and 20 are both £55 for 28 - despite one (obviously) have four times the API content!

[knitwitty in reply to helvella]

Yet another example of price fixing then, why am I not surprised.

[Ajva]

I do actually split tirosint gel capsules with a sharp knife. To be honest the split is not always accurate so with t3 especially it would be more difficult as you need the same dose each day

[caledoniancat]

I can't really help you, but I did read in an earlier post over the past 2-3 weeks that a member of the forum buys empty capsules and splits his/her full capsules and puts half into an empty capsule for later use. Sorry, I don't know who it was and I don't know where they get empty capsules from.

[helvella Administrator Thyroid UK in reply to caledoniancat]

Empty capsules are available by the thousand from numerous sources - a quick search will find many.

I suspect that, in this case, the refilling process will be unnecessary and would add to the opportunity to lose/spill powder as well as increasing the possibility of reacting to the material they are made from.

My Vade Mecum document has a chart of standard capsule sizes which could be of use to anyone considering buying capsules.

helvella - Vade Mecum for Thyroid

The term vade mecum means:

1. A referential book such as a handbook or manual.

2. A useful object, constantly carried on one’s person.

Please don't get put off by the number of pages!

Nor by the fact it is targeted at people interested in thyroid issues. Much of its contents could be of use to many involved in health issues. Things like abbreviations, lists, general reference information.

In particular, it is not intended that you sit and read the document. Just that you download it and know you can look things up.

If there is anything you'd like me to add, let me know.

Not everything is in this one document - my major medicines document is still separate!

From Dropbox:

dropbox.com/s/vp5ct1cwc03bl...

From Google Drive:

drive.google.com/file/d/1P9...

[Bellaowl]

I reject all capsules 1: because they are usually filled with sugar and 2: they cannot be easily divided. Ask your pharmacist if there is any substantial difference in cost.

The last time I was given a capsule Med I found out the cost was no different. It was an introductory offer by the company. So I wrote to GP and said this.

They changed the script back to tablets.

[RedApple Administrator in reply to Bellaowl]

Bellaowl, 'I reject all capsules 1: because they are usually filled with sugar '

I don't know why you have this notion, but it is not true of the T3 capsules being discussed here.

[Bellaowl in reply to RedApple]

I was talking about capsules in general. I’v never been offered T3 as capsules in the almost 40yrs I’v had them. But have been offered a variety of strengths of T3 with chats with my pharmacist Re ease of getting them and costs.

[helvella Administrator Thyroid UK in reply to Bellaowl]

Roma levothyroxine capsules cost £55 for 28 - 5 or 20 microgram. And £65 for 28 - 10 microgram.

5 microgram tablets have drug tariff prices of £99.47 for 28.

10 microgram tablets have drug tariff prices of £152.44 for 28.

20 microgram tablets have drug tariff prices of £63.08 for 28.

So far, we have had generally positive reports about Roma capsules with the exception of one member who is allergic to the gelatin. Even then, the contents can be dispersed in water. They are distributed by Alliance.

[Bellaowl]

Adding on: I gave up using 10s and 5s bc they came in the America/ Canada- this was a few yrs ago and were enormously costly. So I asked for 20s which are a lot cheaper and cut them. My GP was happy, my pharm was happy and medically I’m happy.

[PrincessAnnie in reply to Bellaowl]

I might just call and ask them that too👍I’ll just tell them I take the 20 in the morning as that works best for me.

[helvella Administrator Thyroid UK in reply to PrincessAnnie]

In which case, they might wish to switch you to 20 microgram capsules. Which could be a problem.

[PrincessAnnie in reply to helvella]

Never thought of that🤦‍♀️I’ll see how I go with the capsules,as I said I’m due to test my bloods next Monday so I’ll decide then.

[Buttercupsareyellow]

I had a medication changed (not thyroid related) a few years back unannounced by GP practice. Similar to you I received a letter. When I phoned up to ask I was directed to someone in the practice (not a doctor) whose job it was to go through everyone’s medication and come up with a cheaper alternative. I stated I refused to have the change as the initial recommendation had come from a consultant at the hospital. I said I would only change the medication if I had an outpatient appointment with the consultant to seek expert advice on the medication (which would obviously cost the practice money as they effectively get hit for hospital referrals). I was immediately restarted on my old medication and it was never brought up again……