This study link.springer.com/article/1... finds that taking levothyroxine with a sip of water reduces the amount of levothyroxine needed.
I believe the recommendation to take levothyroxine with a full glass of water is to avoid the tablet becoming stuck in the oesophagus. I don't know of any studies that were carried out prior to this recommendation.
We know that an acid environment in the stomach is needed for good levothyroxine absorption and that an empty stomach is recommended. When empty the stomach is contracted with a small volume. It seems logical that if you introduce a full glass of water it will substantially reduce the acidity of the stomach. This study seems to confirm this hypothesis.
The study has a number of pitfalls. The sujects were on a lowish dose of levothyroxine, averaging 69.1 mcg. Also, it was not placebo controlled, improvements over time may just happen. They could have done a simple crossover trial.
So it does seem that the recommendation to take a full glass of water is silly, we need a better trial to be sure. I take mine with orange juice but I've never had an absorption problem.
Most people are getting on just fine, at least in terms of absorbing their levothyroxine. In which case don't worry, be happy. If you are one of the minority who have absorption problems it might be worthwhile trying a sip of water and see how it goes.
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jimh111
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Yes, it seems the recommendation to take with a full glass of water comes from cases of the tablet sticking in the throat. It appears that this is a particular problem in the USA as brands such as Levoxyl expand rapidly when wetted. I suspect the clear instructions with these brands get copied into the general advice.
When Levoxyl was reformulated (I think in the first few years of this century), there were reports of gagging.
Choking and Gagging on LEVOXYL Tablets
There have been reports of choking, gagging, tablet stuck in throat, and dysphagia with LEVOXYL tablets, predominately when LEVOXYL tablets were not taken with water
Funnily enough I read a couple of studies recently that showed combining Vitamin C with levothyroxine increased the absorption by a reasonable amount.
They suggested putting an effervescent vitamin C tablet 500mg into the water, rather than having it plain. I suppose this would support your statement by making the water midly acidic.
I guess the clue's in the name, ascorbic acid. David Halsall who heads the blood testing lab at Addenbrooke's suggests taking it with fruit juice. For most people it doesn't matter as they don't have a problem.
At the time I was thinking along the same lines as you. I looked at a variety of brands, and I couldn't find a single one that didn't contain varying amounts of dodgy sweeteners, so that put me off that idea.
Maybe get a soda syphon (or soda stream) and put pure (or suitably flavoured) ascorbic acid into it?
(This is, of course, said for humour. I do not know if that approach is safe re metallic components in soda syphons! And it might go flat extremely quickly ending up being pretty pointless.)
I'd also note that while the discussions focus on vitamin C (ascorbic acid), the main acid by weight would be citric acid. Probably also perfectly OK but accuracy is a good idea when we can manage it.
Roma Liothyronine capsules Patient Information Leaflet says:
Liothyronine sodium Capsules are taken by mouth. They should be swallowed with a glass of water.
If you have difficulty swallowing a whole capsule, empty the contents of a capsule into a minimum of 20 ml of water. Stir and drink the whole liquid to ensure you take the full dose. It is possible to do this with Liothyronine because this substance is soluble in water.
Liothyronine is much more soluble in water than levothyroxine. (As is well-known.) Which suggests that acidity is not important.
The water advice is pretty much the same - but we do not know the justification/rationale.
One of the reasons I have tended to be comfortable with the idea of taking water (levothyroxine, liothyronine and most other medicines) is that dispersion avoids the possibility of the entire dose being concentrated in a tiny area of the stomach. But maybe my imagination is allowing this to become a factor which has no reality?
My T3 is in tablet form.....I tend to take it (4×25mcg) with only 2 or 3 good gulps of water.
I did experiment with roughly chewing the tablets but read that was not advised. I don't think it made any difference....so it's down the hatch, as above, and off to bed!!
I've never done the "full glass of water" thing. It makes no sense to me. All you need is to get the pill into the stomach. So a quick drink out of the bottle by the bed is all I've ever done.
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