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Splitting Pills Into 1/4s, Am I Asking For A Mess Of Hurt?


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#1 nettles

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Posted 13 June 2008 - 08:49 AM

All I was given were 14 25mg pills and then a bunch of 100mg and told to follow the regular schedule. Requests to go slower and aim for a lower steady dose were met with the, typical for my county clinic doc, ridicule and murmuring about how I might as well take placebos. I have a skin disorder already and a history of reacting quickly to meds, I'm taking this slower.

I've been thinking of how to get an even dose from those oddly shaped 100mg pills. How likely is there to be an even distribution of active chemical throughout the pill? Say I'm able to quarter them fairly uniformly, could there still be 40mg in one hunk and just 10mg in another? Would the potential fluctuation be a worse choice than just going to 50mg next Friday?

My plan:
Wk1. 1/2 a 25mg tab daily = 12.5mg

Wk2. 1 25mg tab daily = 25mg (just started today)

Wk3. 1/4 a 100mg tab + 1/2 a 25mg = 37.5 (Ideally I'd like to coast around 33-38mg for a few weeks, I'm already feeling the med, I think I'm liking it. but unless I had access to a good scale I doubt I could portion out that dose without the 25mg pills to split.)

Wk 4 1/2 a 100mg tab = 50mg (which is where I'm staying unless the benefits change. Sadly I will be telling the doc that I've gotten to 100mg and agree to fill the 200mg script because, "otherwise I see no point in bothering with trying the lamictal" to quote my oh so respectful p-doc.)

or wk3 I could just take 1/4 of a 100mg tab to stay at 25 mg longer...

I don't think this is a med I can dissolve and portion out that way??

Am I being super silly about this?

Would love to hear ideas.

(Crazy cough is gone, thanks for the help with that.)

(Phelps')

Edited by nettles, 07 July 2008 - 05:55 AM.

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#2 Rayjean

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Posted 13 June 2008 - 08:18 PM

Well, when I started Lamictal I was paranoid about getting a rash, etc. as I had been thru the ringer with Tegretol and had bad memories. My doctor told me to follow the normal schedule that is in the starter packet they give you....well, I knocked it back and went for 2 weeks at each dose cut in 1/2 doses from what was in the pack. I cut the 25 mg in 1/2 and used that dose for 2 weeks & then on from there. It took me forever to titrate up, got up to 200 mg and was too hyper so went down to 150 mg. I personally was glad I did it that way as it worked for me & I was in a situation where I really wanted (and needed) Lamictal to work.
I believe my doctor gave me a prescription along the way for 50 mg. tabs and that made the dosages easier.
My doctor didn't think it was necessary to titrate up so slowly & I don't think he knew how slowly I did it, and yes, I remember cutting some pills in quarters, I was able to do it with those cheap plastic pill cutters and it worked for me. But, I did trash some pills as they crumbled.
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#3 Jerod Poore

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Posted 14 June 2008 - 10:45 AM

I've been thinking of how to get an even dose from those oddly shaped 100mg pills. How likely is there to be an even distribution of active chemical throughout the pill? Say I'm able to quarter them fairly uniformly, could there still be 40mg in one hunk and just 10mg in another? Would the potential fluctuation be a worse choice than just going to 50mg next Friday?


Quartering any Lamictal tablet would take incredible skill. Lamictal tablets above 25mg tend to split unevenly when cut along the scoring line as it is. Cutting across it will give you a bunch of crumbs.

And please use italics to indicate emphasis. Underscores are used to indicate links. It's very confusing. Where is the page showing evidence of even vs. uneven distribution of active ingredients?

While anecdotal evidence has indicated uneven distribution of active ingredients in some generics, there has been no such complaint from a brand name drug.

You're better off going to 50mg due to the fluctuation that would come from not being able to cut the damn things consistently.
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#4 litgirl

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Posted 14 June 2008 - 11:22 AM

I too used a pill cutter to cut them into fourths, and certainly it wasn't exact but I did fine with it. I had to titrate at 12.5 mg at a time to keep from getting side effects (especially dizziness.) It wasn't precise (or ideal I suppose) but for me it didn't cause any issues/problems.
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#5 berry

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Posted 15 June 2008 - 05:45 AM

since the lamictal tablets (at least the two generics that ive had) arent square, how could you be sure its even?

ive tried splitting them in half and wasnt too successful, so im not sure how 1/4 would be good, even with a pill cutter. (unless of course, you have square or circle pills).

any reason why you cant just get more of the lower dose pills? i have a collection of 25mg, 50mg, 100mg and now i take 200mg tablets. much less time wasted too if you dont have to keep cutting them.

another idea - could you dissolve them in water and then distribute the water evenly? (that might be a bit weird)
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#6 Jerod Poore

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Posted 15 June 2008 - 06:59 AM

another idea - could you dissolve them in water and then distribute the water evenly? (that might be a bit weird)


I doubt they would completely dissolve in anything that wouldn't mess with the lamotrigine itself.
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#7 nettles

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Posted 15 June 2008 - 03:18 PM

another idea - could you dissolve them in water and then distribute the water evenly? (that might be a bit weird)


I doubt they would completely dissolve in anything that wouldn't mess with the lamotrigine itself.


I did find one abstract about compounding a liquid version from commercial pills.


The stability of lamotrigine 1 mg/mL in two extemporaneously prepared oral suspensions at 4 and 25 [degree sign]C was studied.

Lamotrigine tablets were ground to powder, and the powder was combined with a 1:1 mixture of Ora-Sweet and Ora-Plus or a 1:1 mixture of Ora-Sweet SF and Ora-Plus (Paddock Laboratories) to produce two 1-mg/mL suspensions. One 100-mg lamotrigine tablet was used to prepare one 100-mL batch of each suspension. The suspensions were stored in amber polyethylene terephthalate prescription bottles at 4 or 25 [degree sign]C. Samples were collected on days 0, 7, 14, 28, 42, 56, 70, and 91 for analysis of lamotrigine content by high-performance liquid chromatography; pH was measured, and the samples were visually observed against a black and white background.

The mean concentration of lamotrigine was >99% of the initial concentration in all samples throughout the 91-day study period; there was no change in apparent pH, odor, or physical appearance.

Lamotrigine 1 mg/mL in two extemporaneously compounded oral suspensions was stable for 91 days in polyethylene terephthalate prescription bottles at 4 and 25 [degree sign]C.

Am J Health-Syst Pharm. 1999; 56:240-2


http://pt.wkhealth.com/pt/re/ajhp/abstract...#33;8091!-1

If someone has an account, I'd love to see the full text.



Ora-plus is 97% water with some bulking agents, and thickeners. (Sorry about the previous underlining frustration.) Fairly pricey if one can only suspend 4.75 100mg tablets in each bottle. At 33mg daily I would need two bottles a month = $50. And true, there is no mention of how evenly dispersed the LTG is, but if the samples are consistently giving 101-99% (bottom of pg 3) wouldn't that mean that the distribution was pretty darn even.

Homemade seems easy enough to do. Purified water, benefiber (which is guar gum), agar, citric acid. Final ph of solution in study was 4.5



Maybe I'll just go buy a mirror and box of razor blades.

Berry - My p-doc wouldn't prescribe more 25 mg tabs. He isn't a slow and low guy. I've stopped arguing with him about my "placebo" doses. Sleeping pills I just nibble. I cut ibuprofen in half. I crushed the Zoloft and made very crude piles. But I'm just not as willing to brave the variations of dose with this type of drug.



Lots of compounding love for those who collect links.
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#8 berry

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Posted 16 June 2008 - 02:25 AM

well that sucks. you'd think pdocs would be more inclined to go slow!

i was under the impression that you could dissolve lamictal - when they say dispersable, what does that mean if its not good to put it in water or anything else thats easy to get?

of course i just swallow it, so it doesnt matter to me.

another random, probably unlikely idea - you know those really sensitive scales you can get? for measuring minute amounts of stuff? you could crush them up and measure them on that :mad: that might be a bit far out though.
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#9 lostanddelirious

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Posted 16 June 2008 - 07:14 AM

When I started lamictal I was so excited about the way it made me feel that I titrated up a little too fast. But it didn't hurt.
Now I am at 250mg 2x a day. I use 100mg pills. So I take 2 and then split the 3rd one in half by biting it righton the line. It can be a bit uneven but I never figured that it would make that much of a difference.
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#10 bookowl

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Posted 16 June 2008 - 10:18 AM

I've never tried fourths, but I've had good luck splitting the 200s into halves since I got a new pill splitter (sharper, maybe?) and turned the pill with the wider end into the "V" of the splitter. I also tilt the splitter a bit downward when I squeeze it. I'm thinking all this maybe helps it slide instead of shatter as it splits? I've played with one detail at a time, and it really does seem to make a difference. I'm getting neat halves instead of odd pieces now.

For me, it's a cost issue to do it this way instead of getting a supply of 200s and 100s. Because of the way my insurance works, this would double my cost. I'm charged on a "per prescription" basis.
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#11 Bipolar Bear

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Posted 20 June 2008 - 09:53 AM

Not to sound snarky- but how about finding a doc that doesn't treat you like crap? If he doesn't respect your requests and concerns on something that *doesn't make any more work for him*, why would you continue to see him or let him treat you that way? If he's ridiculing you- talk to someone about it. There has to be *someone* above him. You don't deserve that as a patient. Personally- I think that standing up for yourself has to be easier than trying to compound a med on your own.

On the other hand, I would jump from the 25 to 50 mgs. You can reliably split the 100's to 50 mgs, and it's not that big of a jump. Stay at 50 for a while if you want.

Worse case scenario with that jump- you get a rash- which if you read Jerod's info on lamictal and sjs, isn't going to kill you overnight. Get seen immediately, and step back down. Then you can go back and tell this jackass that you were right.
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#12 nettles

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Posted 20 June 2008 - 03:25 PM

Not to sound snarky- but how about finding a doc that doesn't treat you like crap? If he doesn't respect your requests and concerns on something that *doesn't make any more work for him*, why would you continue to see him or let him treat you that way? If he's ridiculing you- talk to someone about it. There has to be *someone* above him. You don't deserve that as a patient. Personally- I think that standing up for yourself has to be easier than trying to compound a med on your own.

On the other hand, I would jump from the 25 to 50 mgs. You can reliably split the 100's to 50 mgs, and it's not that big of a jump. Stay at 50 for a while if you want.

Worse case scenario with that jump- you get a rash- which if you read Jerod's info on lamictal and sjs, isn't going to kill you overnight. Get seen immediately, and step back down. Then you can go back and tell this jackass that you were right.


Snarky snark snark. :mad:

I've had worse. One I've walked out after she told me I was just mentally masturbating with her. This one makes eye contact, isn't creepy, and takes longer than 5 minutes. His name was mentioned a few times by other who've needed to use the county system. Suppose they've seen the other options as well. At the moment I have a drug lord/gatekeeper. I would love to have someone I felt comfortable deferring judgment to - isn't the reality at the moment. I'll stand up someother time.


I'm going to stay at 25 for a few weeks. Cutting the pills with a chef's knife isn't very hard at all. The rocking motion helps as does placing a towel over the knife to catch the little suckers. Going to play with putting a drop of water on the pill to see how much it softens.
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#13 nettles

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Posted 28 June 2008 - 08:34 AM

Turns out I can't cut them well every time. It worked well the first two times! :mad:

So now I'm crushing them, dumping them on graph paper, making as uniform line of squares as I can and then making little piles. Just taking the powder seems to hurt my throat (or there were some allergens in the air the day I tried that.)

Anyway, I've been cutting a large raisin open, pouring in the powder and pressing it closed. I can swallow a raisin. I'm going to try rice paper as well. Seaweed bundles don't stay closed.

I'm still trying to split them, but the ones that don't behave I can "raisin".
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#14 berry

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Posted 06 July 2008 - 05:25 AM

thats a really cool idea :mad:
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#15 notfred

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Posted 06 July 2008 - 05:46 AM

another idea - could you dissolve them in water and then distribute the water evenly? (that might be a bit weird)


I doubt they would completely dissolve in anything that wouldn't mess with the lamotrigine itself.



Leave them in 10 ml water overnight, remove shell. Set aside to dry. (or use pill cutter to slice up the pill and shell before putting into solution) It you want to take it, use pill cutter to slice it up into small pieces add back to solution.

Now you have a 10% solution; 1 ml = 1/10 of the total pill. If you use 20 ml water you have a 5% solution, 1 ml = 1/20th of the total pill.


People, this is not hard. I had to do it for months for my cat; some petmeds only come in pills.

In the states Walgreens compounds pills into solution.

Normal saline, distilled water, bottled water are good for solutions. Syringes are available (w/o needle) in the infants section of a drug store, as are measuring cups. Everything is in metric/ml's.

Refrigerate what you do not use; don't make up too much at one time.

nf
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#16 berry

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Posted 07 July 2008 - 12:44 AM

do they have a shell? mine don't!


nettles - how long till you can increase to the whole pill?
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#17 Serpens

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Posted 07 July 2008 - 01:22 AM

do they have a shell? mine don't!


nettles - how long till you can increase to the whole pill?


Lamotrigine's solubility in water is .17mg/ml. Means it's going to be a bit of a bitch to get it to dissolve completely.
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#18 nettles

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Posted 07 July 2008 - 06:09 AM

NF, Serpens - Yeah, not very soluble. But will stay in suspension with a suitable agent, see the previous post with links to ora-plus.

Berry - I had gotten up to 50 mg. But due to some lymph node swelling I'm taking it back down to 25mg for awhile. I have 100mg pills.

Would be nice if Lamictal had a shell, would hold it together so I could chop at it better!

So far, making my stuffed fruit is working fine. Quite a curious little appetizer tray.
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Past meds: Prozac, Effexor, sertraline, trazodone, hydroxyzine, diphenhydramine, bc pill, vitex, kava, other herbal stuffs.

Current: Wellbutrin XL 300mg, Lamictal 100mg, zolpidem ~3.3mg, fish oil 2000mg, multi vitamin, lorazepam .5mg prn


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