Splitting pills

[Mothebear]

Apologies this is a bit long.

Daughter, I and my brother all take T3. All split our doses over the day. Our pill packs say throw away unused half.

If you have ever tried to get T3 you will realise you sell your soul to get it - gene tests, rejection by endocrinologists, challenges to your needs/symptoms etc. And this medication was exceptionally expensive, I think still is expensive but we fortunately get through NHS.

So, why throw this gold dust away?

Because, apparently ‘you might not otherwise get a balanced dose’.

Surely, if you split a pill you immediately run the risk of the medication not being evenly distributed in the pill. So if, as I need, I split three separate pills a day (yep supposedly throwing a pill and a half a day away), I could with each pill actually get a 5th/4th/3rd whatever percentage of the active ingredient. So on this basis on any one day, I could get any percentage of active ingredient from each pill, (possibly 10% three times over, or 70% from each pill!)

So if the argument is getting a ‘prescribed dose’ then surely I am guaranteed that by taking ONE pill (split for two distributed doses) even if the distribution is uneven in the two halves, but I have significantly less chance of this splitting two, let alone 3 pills.

And the other argument is the ingredient is potentially less stable…so if untouched from foil pack, into pill splitter and second half kept there in the dark til needed five hours later, is this destabilising the ingredients?

I know there are pill splitters here and T3 takers….any thoughts please.

[SlowDragon Administrator]

Yes…..it was a ploy by pharmaceutical company to get patients to use/waste more tablets

And you shouldn’t throw waste water with T3 away into sink either

Instead

Just cut with sharp scalpel or pill cutter

How much T3 are you taking in total per day and in how many split doses

Which brand?

Cost

Current costs of tablets and capsules

healthunlocked.com/thyroidu...

[Mothebear in reply to SlowDragon]

Hi SlowDragon

7.5 split over three doses, 6am, middayish and 6ish pm. So according to my prescription I should be throwing away 1 and 1/2 pills a day!!

[helvella Administrator]

Throwing away split tablets is nonsensical. Other than any lost crumbs, whatever way it splits simply shifts exactly when you get which dose - but the total will always be 100%.

If you throw half away, then you have no idea and could easily end up with anything from 60% to 140% from the two halves of two different tablets.

But they don't tell you to throw away half a split tablet.

They say to throw away half the liquid that you have dissolved/dispersed the tablet in.

I think we have insufficient evidence of what happens to come to a sensible conclusion about keeping T3 dissolved/dispersed in water.

[Mothebear in reply to helvella]

Thank you Helvella

Our prescription packs explicitly say throw away the half and the pharmacy from the hospital rang me to say that is what I should be doing! Nothing about suspension in water or anything else.

[helvella Administrator in reply to Mothebear]

I realise some have been updated. At one point, the advice was as in the Accord and Tertroxin PILs - use an oral syringe and dissolve.

But most of them say nothing about splitting. Just offer dissolving as an option for taking the tablets if there are issues swallowing.

Looks like quite a bit of inconsistency across products.

What exactly do you mean by "Prescription Packs"? Do you get the original PIL documents? (You should.) What make are you getting?

Teva

If you have been prescribed a dose

lower than 20 micrograms, you

should allow a tablet to

dissolve/disperse in 20 ml of water

for 10 minutes in a small measuring

cup.

mhraproducts4853.blob.core....

Sigmapharm

The tablets can be either swallowed whole

or dissolved in water. To dissolve the tablet:

• Put the tablet in a glass with at least

20 ml water for each tablet

• Either stir to dissolve or wait until the

tablet is fully dissolved

• Drink all the liquid

• Add a little more water to the glass and

drink that, to make sure no medicine is

left in the glass

mhraproducts4853.blob.core....

Accord (not available)

Liothyronine Sodium Tablets are taken by

mouth. They should be swallowed with a

glass of water.

• If you have been prescribed a dose

lower than 20 micrograms, you should

allow a tablet to dissolve/disperse in

20ml of water for 10 minutes, in a small

measuring cup.

• You should gently swirl the solution

occasionally to aid the dissolution/

dispersion.

You should then swirl the solution for

a few seconds prior to using a suitable

oral syringe to withdraw the amount

of liquid corresponding to the dose

prescribed (5ml for a 5 micrograms

dose; 10 ml for a 10 micrograms dose)

and squirt the liquid directly into your

mouth by gently pressing the plunger.

• Any remaining liquid should be

discarded.

mhraproducts4853.blob.core....

Strides

For patients who have difficulty in

swallowing a whole tablet, such as the elderly

and young children, a whole tablet may be

crushed and allowed to dissolve/disperse in

a minimum of 20 mL of water. The entire

volume of liquid should be consumed to

ensure ingestion of the full dose.

mhraproducts4853.blob.core....

Morningside (Iraksin and generic)

If you have any difficulty in swallowing a whole tablet,

then you may crush the tablet and add it to a glass with

minimum of 20 ml of water and swirl for 5 minutes until

completely dissolved. Please ensure that you take the

entire amount of water to ensure you take the full dose. Do

not worry if the solution appears cloudy. If you are unsure

how to take the medicine correctly, check with your doctor

or pharmacist.

mhraproducts4853.blob.core....

And

mhraproducts4853.blob.core....

Mercury Pharma Tertroxin

f you have been prescribed a dose lower than 20 micrograms, you should allow a tablet to

dissolve/disperse in 20 mL of water for 10 minutes, in a small measuring cup.

• You should gently swirl the solution occasionally to aid the dissolution/dispersion.

• You should then swirl the solution for a few seconds prior to using a suitable oral syringe to

withdraw the amount of liquid corresponding to the dose prescribed (5mL for a 5mcg dose; 10 mL

for a 10mcg dose) and squirt the liquid directly into your mouth by gently pressing the plunger.

Any remaining liquid should be discarded.

mhraproducts4853.blob.core....

[asidist in reply to helvella]

Hope you’re well helvella!

I’m confused by the discussion so far (admittedly didn’t have time to watch the video). I always thought it was as tattybogle described below—that generally the formula for a thyroid pill is well mixed enough that a half / quarter of a pill would be as likely to have the right amount as the full pill. Is that not the prevailing thinking at this point / only the case if a pill is scored?

When I cut out a quarter of my unscored t3 pill, I typically lose the rest to crumbs or uneven, useless portions. Are all of us who throw out the remainder when (somewhat accurately) splitting a pill actually potentially wildly misdosing ourselves every day?!

[helvella Administrator in reply to asidist]

I think the tablets are well-mixed enough for that not to be an issue.

The scoring of pills does not itself mean that they can be split for dosing (officially). The MHRA insist that the score lines have only two functions - identification and allowing pills to be broken in two to make them easier to swallow.

I'm not in the least convinced of this argument.

Not least, if you lose crumbs, you lose crumbs regardless why you are breaking them!

And if you do not lose crumbs, then the imperfection might be small enough not to be important.

In the simplest case of splitting a tablet in two, if you end up actually achieving a 60:40 split, then you could take one part and throw the other. But if you do that, you could end up taking the 60 part every day and being over-dosed. Or the 40 part and end up being under-dosed. But if you split each tablet and take one part today, the other part tomorrow, you end up taking 50 every day - on average and probably close enough in practical terms.

(There are a few medicines where the MHRA have undertaken extra work to ensure that splitting is acceptable. If so, the Patient Information Leaflet will say that.)

I take Vencamil 100 - and have been splitting them to get my dose of 125. But I only do that because I still have not managed to get my GP surgery to prescribe Vencamil 25 - and end up being offered Teva (mostly) or Wockhardt. And I feel better on all Vencamil.

The score line on Vencamil is accepted for splitting by the medicines agencies in Ireland and many other countries. But not in the UK. (And you don't need anything other than pressure from a thumb to split them.)

[asidist in reply to helvella]

Thank you, Helvella. I do wish there was more official clarity around this but I agree with what you say and feel better that the ever knowledgeable helvella thinks it’s fine I may also just reach out to the manufacturer for the heck of it to see what they say if I find time sometime soon

With my Tirosint caps which I also split I do as you say and keep the remaining part for the next dose without worrying too much about whether it’s 60/40 or 50/50 or what, but because the body is more immediately sensitive to T3, with that my goal is getting an accurate 1/4 for my dose which means often shaving a bit off the biggest portion after two splits and tossing the remaining crumbs and powder (or saving another 1/4 out of the mess if possible). Mayne Pharma lio is incredibly crumbly!

The scored pills that can be split by hand are the best. Such a time saver.

[tattybogle]

the accuracy of the dose taken must surely be as good as the accuracy of the cut ?

concern that the T3 might not be evenly distributed throughout the tablet just doesn't hold much water when you think about it practically ...... i'm assuming they basically have a big mixing bowl of all the ingredients, very thoroughly mixed, and then press a load of tablets from that mix ?

... if they had significant problems with 'lumps' of T3 in the mix or 'lumps' of filler, then they couldn't guarantee how much T3 was in each tablet could they ?,

they don't test each individual tablet's T3 content at the factory, they test samples from batches ... so their mixing of ingredients needs to be good enough for each batch of tablets to pass quality control by containing the required amount of T3.

i have 25mcg T3 tablets that do split quite well with a scalpel, in half along line, then each half in thirds , giving doses of approx 4mcg ...... i cut one tablet and put those bits in pill box with am / pm sections , before cutting another, so i know i've taken one specific tablet over a few consecutive doses.

yes ok, one dose may be closer to 3 and the next one closer to 5 if the splits were a bit uneven, but the total is still going to be 25 as long as i use the whole tablet.

Some brands of tablet will split better than others of course, so it's not ideal , but it's more sensible than spending a fortune and throwing some of it away.

[helvella Administrator in reply to tattybogle]

I know this is all government/company/product PR, but it is in its own way quite good.

And it very much supports your view.

No UK levothyroxine or liothyronine tablets are coated!

View from about 18:00

Surgical Needles / Pharmaceutical Manufacturing Equipment

Japan's Top Inventions

www3.nhk.or.jp/nhkworld/en/...

[Zephyrbear in reply to tattybogle]

The alternative would, of course, be to crush the tablet back into a powder and get the old mirror and razor blade out… 😉

[AKatieD]

Much easier to just nibble in half on the line (accurate enough) crunch in your mouth and then swallow with the drink. You may get slightly more/ less but will make up to the same total with the next dose.

[Babette]

The endo said that if the tablet has a line in the middle, it can be split. I've just accepted it despite the pharma co's advice, mainly because I don't want to waste my T3.

[Mothebear]

hello all

Thank you for all your varied views on pill splitting.

My prescription is issued only by the hospital pharmacy and the label of instruction as applied to any medication (name, date, dosage, timings of intake etc) states very clearly, ‘halve each pill and dispose of the unused half’.

There is no mention of how to split, storage, lines on pills, accuracy or anything else….just ‘dispose of unused half’. It is this latter instruction that I do not comply with to ensure I minimise the risk of under/over dosing at least for 2/3rd of my medication as i take both halves within a 12 hour period.

The second pill may be less accurately cut but I take it about 10 pm and I take the second half of that pill the next morning, so again getting the full dosage from the one pill within a 12 hour period.

In all your contributions no-one has indicated that this compromising the quality of the medication, so thank you, and there would seem to be a shared consensus that in taking the one pill, as two halves reduces over/under dosing and it is just wasteful to throw any half of a pill away.

[helvella Administrator in reply to Mothebear]

Leaving half tablets around can cause deterioration - from oxygen, humidity, light - but I never got the impression you were splitting 28 tablets and leaving them around somewhere! For a few hours, not in sunlight, and moderately dry, I doubt there is an issue.

[Mothebear in reply to helvella]

👍

[thyr01d]

I have been splitting for years but recently moved surgery and am now prescribed 5mcg and 10mcg sizes which saves the problem. If you would like to know the brand I will check.