Starting Liothyronine 5mcg / 20mcg tablets - Advice please

[JMN2017]

Hi

Hypothyroid - +17 yrs

On Levothyroxine but need T4 levels high (out of range)

2023 - On NDT (privately) with good effect

2024 June - Starting Levothyroxine 100 mcg with Liothynine 5 mcg, twice a day thru NHS (but dispensed 20 mcg tablets) - have Mercury Pharma brand - scored tablets

So, just collected Liothyronine 20 mcg tabs today, so to start this tomorrow, but learn that I need to 'disolve' in 20mls water and take 5mls (dose 5 mcg)

I've read, on here that, in spite of directions, the tablets don't actually disolve but 'suspend' and therefore not really an accurate dose. However, pharmacy told me the tablets can't be cut. Is that because of inaccuracy, perhaps?

I do have a tablet cutter. Would that be suitable to cut the tablet into two, then two again, so I have 1/4 tablet (= 5mcg) or would that not be accuratte enough?

Would a 'suspension' be best? If so, then how is it disposed of, please?

Also, I have been issued with 52 tablets which are supposed to last until appt in 6 week, after blood test at 6 weeks of starting this regime, which suggests I can cut the tablet! I'm confused, needless to say.

I hope some of you are able to answer my query, please? Many thank and I appreciate any help/suggestions 😜

[Buddy195 Administrator]

Can you share results for TSH, FT3 and FT4.

Were you advised to keep Levo at 100mcg or reduce this slightly prior to adding Liothyronine? If FT4 is over range, and FT3 within range, I would reduce Levothyroxine for a few days prior to trialling combination therapy.

Personally, I would quarter the 20mcg Lio tablets and initially take 5mcg daily (one quarter tablet) with your (reduced) Levo dose until well tolerated, then look to increase to 10mcg, if required to alleviate adverse symptoms. I certainly wouldn't add 20mcg in one go., but build up gradually as needed. We recommend retesting thyroid levels 6-8 weeks after being on a consistent dose.

[JMN2017 in reply to Buddy195]

Hi Buddy

Thanks for responding. I haven't got latest results to hand and, to be honest, it's not relevant to my question. Also, it would relate to being on NDT, not T3.

Yes, I have been advised re dosage. Needless to say, as soon as I start the T3 with Levo 100 mcg, I won't be taking the NDT. I fully appreciate it's one or the other and not both LOL

I will be on this dose until seeing the Endo Consultant, after blood test at the requested 6 weeks. My dosage of T3 will then be adjusted, as according to the results of this blood test. I will be guided by the Consultant, of course, and not be tampering with dose myself.

I have, this afternoon, split a tablet into 4, so 4 x 5mcg, and will take just 1/4 tablet twice daily, until directed otherwise.

Thanks for the confirmation, assuming you cut your T3 tabs? 👍

[Brightness14]

If your tablets are scored they can be cut. I started with cutting mine into 8 pieces now 4 pieces. I use a craft knife which works better than a pill cutter. Start small and increase gradually is my mantra for T3. Some are not scored but can still be cut into quarters.

[JMN2017 in reply to Brightness14]

Thanks veyr much for your reply

Wow, I can't imagine cutting the tablets into 8!!! 4 was bad enough. I could have done with a magnifying glass LOL

I used similiar to a Stanley knife and short, sharp tap on the knife. This time, very little debris from the tablet so, hopefully, that will be the case each time

I suspect the endo assumes I just cut the tablets as I've been given 52 tablets. If I was to 'disolve' them in water, take out 5mls, and discard the rest, as directed by the pharmacy, I wouldn't have enough to last the 6 weeks before seeing Endo again. It will be interesting to see how she reacts when I 'drop' this into conversation.

I do think cutting has to be more accurate than trying to disolve as, apparently, it 'suspends' and not disolves. Who knows how many particles would be injested, eh? Not that cutting is totally accurate either, though

Thanks for your help

[Brightness14]

I agree I did read about a guy who apparently dissolved his in water and sipped it throughout the day. He only used T3. I did try it but it doesn't dissolve at all just suspends.

Your right about cutting into eights, luckily I didn't have to do it for long.

[JMN2017 in reply to Brightness14]

Interesting that guy took sips during the day. Potentially a good idea, if it works

I'm relieved you didn't need to gut 1/8ths for long. I would have thought you'd be picking at the crumbs left behind. One could try Pestle and Mortar, I suppose but would still suspend, I'm sure. Not going to even try that!!! LOL

[Brightness14]

I did try pestle and mortar then into water the same result it just doesn't dissolve.

It sounded like a good idea but like all good ideas, sometimes they just don't work out.

[helvella Administrator in reply to Brightness14]

You can't tell if the liothyronine has dissolved by looking. The excipients might well not dissolve, nor disperse, adequately.

The amount is so incredibly tiny - like putting a teaspoonful of granulated sugar in cold water. Might look as if nothing has happened. But taste the water and it will be sweet. The amount of liothyronine is approximately similar to one single small crystal of sugar.

Of course, you might have done that and swallowed some - and felt it had no effect. I'm just pointing out the difficulty.

[JMN2017 in reply to helvella]

Thanks Helvella

I've decided I'm not going to even try to 'disolve' in water. If I do that, I wouldn't have enough to last me to the next appt. No, I feel it's best to cut the tablet into 1/4s and hope I'm close enough to having a reasonably stable dose during each day.

I believe there are 5mcg tabs but very expensive so I'll just see how it goes with the 1/4s and will be interested to hear what the endo has to say next month

Hope you're well (enough 'ish) Take care

Julie

[helvella Administrator in reply to JMN2017]

Yes - the price for the tiny dose is crazy! Obviously no relationship between the actual ingredients and the final price!

Current NHS Drug Tariff Liothyronine Prices

Link to a blog post of Monthly NHS Drug Tariff prices for Liothyronine products from January 2023 onwards.

Also includes link to information for Northern Ireland and Scotland. (Wales' data is based on England.)

helvella.blogspot.com/p/cur...

Last updated 30th May 2024

[JMN2017 in reply to helvella]

Thanks for this, Helvella. I managed to miss seeing this post, for whatever reason. Thanks for pointing me to it again. I'll take a look later as I'm just off out now.

Thanks again, J

[Brightness14 in reply to helvella]

Yes I understand and no I didn't actually try it. Thank you.

[JMN2017]

Thanks Helvella

Unfortunately, I didn't really understand the article and couldn't see any prices in the link. However, no worries.

Hope you're keeping OK

Take care, Julie

[sparkly]

I've been cutting my t3 in quarters for over 10 years with same pill cutter and never had an issue. OK, the occasional one might not divide equally but it isn't an issue.Pill cutter must be a lot less messing than trying to dissolve and then divide water in to 4. What happens to the other half of water that isn't needed that day? I'm surprised you've been told to do that.

I'd Just forget about that faff and use your pill cutter😊

[Seashine10]

I'm prescribed 5 mcg capsules. Apparently they are cheaper. Could your pharmacy get those for you?

[JMN2017 in reply to Seashine10]

Good morning Seashine

Now, that's very interesting and I'll have to investigate to see if available in my area. They should be, if you get them, of course, I'm all for trying to reduce costs to NHS where feasible (and work reliably!)

I would feel happier taking a capsule than cutting the tiny pills into 4 and, I'm sure, the dose would be more reliable.

Would you be able to let me know (by PM, if necessary) which manufacturer/brand they are etc so I have the information, should I need to give to Pharmacy? That would be great.

At the moment, the Endo has to prescribe the Liothyronine (T3) but, once on stable dose, the GP will be able to prescibe it, being managed by Endo.

Thanks again for informing me of this J

[helvella Administrator in reply to JMN2017]

The prices to the NHS are in the link I posted earlier.

Some people have tried removing the powder from the capsules and swirling with a little water. (Details are in the Patient Information Leaflet for Roma capsules.) This avoids any possible issues from the ingredients used to make the capsules themselves.

[JMN2017 in reply to helvella]

Thanks again. Just replied in afore mentioned post re prices.

Certainly, with capsules, one can take only the contents, but isn't there a reason, re where capsules disolve in GI tract, for having in a capsule? Having said that, the tablets aren't coated so presumably it's not an issue.

If Endo is OK about me cutting tablets, she'll not likely prescibe capsules, as cutting into 4 will surely be a cheaper option, even if it's not ideal ...

Thanks again, J

[helvella Administrator in reply to JMN2017]

I think the only reason for the capsules is to deliver the powder to you in an accurate dosage! That is, a physical container. I suspect a little envelope would be just as effective.

If there were reasons, it seems odd they would put this as an option in the PIL.

[Seashine10]

Mine are Roma Pharmaceuticals. I can see the cost benefit of having 20 mcg tablets that are cut but for dose reliability and ease of use, I'm glad I'm prescribed the capsules.