To split or not to split?

[Espeegee]

I have decided to start self medicating again and used the company I first used to buy some thyroxine. They have changed brands and now only supply Eltroxin in 100 mcg tablets. Tbh I didn't even think about that so ordered some thinking I could just split them as I felt 50 was a better starting point. Well, the tabs do not have a line on them so I bought a pill splitter, not brilliant or maybe I need more practice. Just by chance I read the leaflet insert in the Levo and it says "Tablets that are not marked with a line are not meant to be split". For the life of me I can't think of a reason why not so I thought I'd come to the oracle 😉, is there a good reason? I have 300 or so of these pills which I'd rather not have to bin. I'm guessing that instead of splitting them I could just take one every other day, would that work?

[Buddy195 Administrator]

I have tablets without a line and use a pill cutter to split them. Obviously this isn’t as exact as pills with a line, but as I use the full pill within 48 hours, I reckon it evens out any cutting anomaly.

[Espeegee in reply to Buddy195]

But why do the makers say they aren't designed to be split?

[Buddy195 Administrator in reply to Espeegee]

Perhaps they want GPs to prescribe their lower dose options (which cost more money)….

[Espeegee in reply to Buddy195]

Ah maybe.

[helvella Administrator Thyroid UK]

All tablets, including those with lines on them, are not intended to be split UNLESS the Patient Information Leaflet says otherwise.

The reasons include:

Coatings which are needed for the medicine to be protected when taken;

Imperfect distribution of active ingredient in the tablets;

Imperfect breaking (uneven);

Loss of some of the tablet (e.g. crumbs being dropped or flying off);

Effects of environment (humidity, oxygen, light, etc.) on potency.

Whether these factors apply depends on you, the medicine, etc. And one thing to avoid it splitting ahead of time. Best split and use one part today, the other part tomorrow. That minimises the impact of imperfect splitting. And is FAR more even than alternate day dosing.

I am somewhat perplexed because the Patient Information Leaflet for Mercury Pharma Eltroxin says nothing about splits and lines.

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Or are these not Mercury Pharma product?

Note: Aristo levothyroxine/Vencamil is supplied in tablets with a clear line across. In many countries the PIL expressly states that they can be split and provides details as to the technique. But the MHRA has not allowed that in the UK PIL.

[Espeegee in reply to helvella]

Made by Aspen, I guess the text is perhaps more of a general warning? I have been splitting on the day and leaving the other "half" within the box for the next day. I make sure to get all the crumbs too.

2 photos in one frame

[helvella Administrator Thyroid UK in reply to Espeegee]

I think the text is a default - say this unless they have something else to say!

For levothyroxine tablets, I don't think there is an issue - other than day by day accuracy and loss of crumbs - in splitting. But if the regulators were to try splitting and see 40 one day, 60 the next, they would not allow it. Even though that is far better than 100 one day and zero the next!

Aspen Eltroxin is a different formulation to Advanz/Mercury Pharma Eltroxin. I think many here would assume Advanz/Mercury Pharma from the name Eltroxin as it is the one we get here in the UK.

[Espeegee in reply to helvella]

Thanks! Mine came from 👔 land 😉 They used to supply Merck Euthyroid in different sizes and with a line but they seem to be gone now.

[RedApple Administrator in reply to Espeegee]

If it's the supplier I'm familiar with, they stopped Merck Euthyroid when Merck changed their ingredients to include mannitol. Too many people don't get on with mannitol, so the supplier dropped that brand.

With regard to splitting, I have 50mcg levo tablets that I split, enabling me to take 25mcg each day. As Buddy195 says, as long as you take half one day and half the next, it's not an issue with levo.

[helvella Administrator Thyroid UK in reply to Espeegee]

The old "due to lack of data"!

If they don't have the data, go out and get it. They really should never be allowed to make ANY comment without data. After all, it just could be that crushing tablets would be better than not crushing them - possibly for everyone.

It is appalling to use ignorance to impose an unproven approach.