Should You Take Your Thyroid Medication Twice a Day?

Effect of hand and tablet splitter on levothyroxine dose uniformity was evaluated by performing chemical analysis such as assay, content uniformity, and friability. Assay was used to evaluate stability of whole and split tablets which showed no significant differences for their stability profiles. Content uniformity was found to be a measure for dose uniformity of split tablets. Among five marketed levothyroxine sodium tablets, it was found that split tablets either by hand or splitter showed higher rate of failures as compared to whole tablets. Tablet splitter produced more fragmentation; hence, more tablets failed content uniformity and friability if splitted with the splitter. However, it cannot be generalized as it depends on the type of splitter and dexterity of individuals.

RESULTS AND DISCUSSION

In case of levothyroxine, except L-1, all the other marketed products were oblong-shaped. Round tablets being smallest in size (5mm diameter) were found to be most challenging in terms of hand-splitting. All these tablets were scored; therefore, differences due to score line might not be a factor although depth of score line is known to affect the splittability of a tablet (29). Doctors often advise against splitting thyroid medication primarily due to the risk of inconsistent dosing. The variability in the distribution of active ingredients within a tablet means that splitting it can result in significant discrepancies in the amount of medication received in each dose.

Methods:

To identify and summarise all published concerns related to tablet splitting and to present the experimental evidence that investigates those concerns. Precise diagnosis and individual patient needs dictate the type and dosage of thyroid medication prescribed. The severity and frequency of these side effects are often dose-related, meaning that higher doses increase the likelihood of experiencing them. Careful monitoring and dose adjustments are essential to minimize side effects while achieving optimal therapeutic benefit. I don’t seem to have had a blood test for vitamins since January and in Jan after my last blood test my GP lowered my dose of B12 from daily to once a week and my ferrous sulphate from alternate days to once a week.

• From a theoretical point of view, filler and binder excipients with only a limited elastic recovery after compaction are more suitable for breaking tablets (35).
• Other two factors affecting assay and content uniformity were glidant and disintegrant although they were not statistically significant.
• Therefore, stability studies were carried out for split tablets which were stored at 25°C/60% RH and were compared with the stability of whole tablets also stored under the long-term stability condition.
• Dissolution on whole and split tablets was performed, and the results were in line with content uniformity, i.e., for split portions, some of the tablets failed to meet the USP specification as compared to whole tablets (Table II).
• No studies were found examining bioavailability after enteric coated tablets were split.

The size, shape and hardness of each kind of drug have influence on uniformity of tablet pieces and stability of blood levels of that medicine (18, 21-23). There is only one study in the literature which evaluated the uniformity of Levothyroxine halves as well as their stability in the laboratory.(20) The study showed similar stability between half and whole Levothyroxine tablets. However as the chemical imaging analysis revealed heterogeneous distribution of content, the potential likelihood of under or over dosage using tablet halves remained a clinical concern. The current study verified the same clinical effect of using each of these two methods in a large group of DTC patients.

Tablet splitting can provide dose flexibility and cost savings; however, pharmaceutical representatives typically discourage the practice. Talk to your physician or your pharmacist for specific advice on which pills can be safely split. Unfortunately I never know which day the nurse is coming, they don’t tell me, they just turn up, usually within a 2 week period, I have asked if they could let me know when they are coming but they never do. Has there been long enough since my last blood test and dosage change to have another blood test now? I think having another blood test might be best so I can see what my levels are now.

• In spite of all the above advantages of tablet splitting, critics have identified a number of potential concerns related to this practice.
• This is striking because the tablets may be cut and shipped sometimes from mail order pharmacies.
• Splitting a tablet can expose more of its surface area to the digestive system, potentially increasing the rate of dissolution and absorption.
• Understanding the intricate interplay between thyroid medication and other medications or supplements is paramount for optimizing treatment efficacy.
• Surprisingly, a Dutch study found that hand breaking tablets was more accurate than using a pill splitter (International Journal of Pharmaceutics, May 15, 2014).

A study comparing the effects of taking one and a half 100 µg levothyroxine tablets versus a combination of one 100 µg and one 50 µg tablet in patients with differentiated thyroid cancer (DTC) found no significant differences in treatment outcomes. The study measured changes in TSH and T3 levels, as well as patient weight, and concluded that both methods were equally effective. This suggests that tablet splitting can be a viable alternative when specific dosages are not available in single tablet form. Concerns related to tablet splitting include difficulty breaking tablets, loss of mass, weight/dose variability, chemical instability, disruption of sustained-release mechanisms, and confusion/non-compliance.

Splitting Thyroid Medication: Can You Cut Thyroad Meds In Half

We will explore various aspects of thyroid medication, including different types, dosages, potential side effects, and alternative treatment approaches. The goal is to empower individuals with the knowledge necessary to make informed decisions about their thyroid health management. Studies have shown that the variation in dosage can be significant enough to cause clinically relevant differences in thyroid hormone levels. Therefore, it is difficult to guarantee precise dosing when splitting tablets, particularly unscored ones.

• To ensure consistency of used drug in patients, all tablets used in these patients were produced by the same company (Iran-hormone Company) that is the most common generic form in Iran.
• Spectralon-99% was used as a reflectance standard which is nominally 99% reflectant over the 350–2500 nm range.
• They just turn up anytime between 9am and 2pm and don’t let you know which day they are coming.
• Among five marketed levothyroxine sodium tablets, it was found that split tablets either by hand or splitter showed higher rate of failures as compared to whole tablets.
• Interestingly, while the clinical outcomes of tablet splitting were comparable to whole tablet administration, patients in the thyroid cancer study expressed a preference for taking two separate tablets over splitting one.
• The variability in the distribution of active ingredients within a tablet means that splitting it can result in significant discrepancies in the amount of medication received in each dose.

Formulation and processing factors were varied in a 12-run Plackett–Burman screening design as outlined in methods section. Assay and content uniformity results were analyzed by statistical software synthroid pap JMP (Version 7.0) which revealed that binder was found to be one of the main factors affecting splitting (Fig. 5). Other two factors affecting assay and content uniformity were glidant and disintegrant although they were not statistically significant. A prediction profiler was plotted to understand effects of each of the factors on the CU of split tablets of in-house tablets, and the results are presented in Fig. Method of mixing and compression pressure or hardness of the tablets had minimal effects on CU of split tablets.

Eligible articles included original research, narrative reviews, systematic reviews, and expert opinion. Systematic review and qualitative synthesis of tablet-splitting concerns and evidence. Preprocessing and data transformation were carried out on ISys® chemical imaging software (Version 5.0, Malvern). All the reflectance spectra were converted to absorbance spectra, and the background was masked by applying sample statistics showing two distinct regions for tablet and background. The masked data for pure components were truncated to 50 × 50 pixels where each pixel represents 40 × 40 μm. For the transformation, normalization (mean center and scale to unit variance by spectrum) was applied.

My last dose of Levothyroxine is never 24 hours before the test as I don’t know what day it will be done. I take Levothyroxine in the evening approx 10pm or so and then the nurse will be out between 9am and 2pm, often around 11-12pm. My GP has recently been reducing my Levothyroxine dose because when I changed from taking it in the morning to taking it in the evening it completely changed my results. I have listed below my last 3 blood test results and the amount of Levothyroxine I was on above each result. Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he’s your knowledgeable and go-to source for all your pharmacy and medication-related questions!