Does opening up a pill alter it's efficacy?
October 19, 2021 3:17 PM   Subscribe

I take lithium carbonate for bi-polar disorder and want to only take half of the pill. The pill is not a hard pill but a capsule (so the contents are powder). I only want to be taking half of the pill and so want to remove half of the contents and then reseal it and swallow that. My question is: will this effect the efficacy of the medication much or at all? To put it a bit crudely, "it's just powder in a container, right?"

My reason for wanting to do this: my psychiatrist insisted on upping my lithium after I mentioned that I was feeling a little down lately. I am feeling a little down but it's not because of a chemical imbalance it's because a lot of things are happening in my life and the world right now that are causing me to feel this way. I am going to find a new psychiatrist but until then want to take the amount of medication that I actually do need.
posted by defmute to Science & Nature (12 answers total)

This post was deleted for the following reason: Hey there - sorry for the delayed delete. On balance this is something to get advice from a verified actual medical professional, and not from random strangers. -- LobsterMitten

With some medications this would be dangerous. If it’s meant to be slow release and you don’t reseal the capsule properly and it all gets into your system at once, that’s not good.

You know your psych better than us, but are you certain they wouldn’t adjust it back down if you insisted?
posted by showbiz_liz at 3:18 PM on October 19, 2021 [2 favorites]

Response by poster: showbiz_liz, I see. I tried insisting quite strongly during our visit and it seemed quite clear that she was not going to budge.
posted by defmute at 3:21 PM on October 19, 2021 [1 favorite]

Best answer: I think this is a question for a pharmacist, rather than AskMe. You might find they'll give you advice on the practical element of this without you having to justify your reasoning the way you would to your psych.
posted by penguin pie at 3:22 PM on October 19, 2021 [21 favorites]

this is not a good idea. to second showbiz_liz, depending on the formulation of your medication, it can be dangerous. it will affect the levels of the medication in your bloodstream, and lithium is meant to stay at a consistent level in your bloodstream. i am not a doctor or pharmacist, but take both ir and xr medications and have done so for about a decade.
posted by europeandaughter at 3:24 PM on October 19, 2021 [1 favorite]

Penguin Pie has it on the nose: talk to your pharmacist, they are happy to give consultations and this kind of thing is their specialty.
posted by assenav at 3:27 PM on October 19, 2021 [1 favorite]

I would not do this or recommend anyone else do this unless they got an explicit OK from the dispensing pharmacist.
posted by basalganglia at 3:28 PM on October 19, 2021 [7 favorites]

I absolutely would not do this, it does not work like this for capsules. You will not get a consistent dose of medication even if you weight it out. Just the other day I was with a group of psychologists who discussed a client doing this (IIRC it was a bipolar med too, possibly even lithium) and there was a good round of universal horror and "no wonder they're having such a bad time."

I'm really sorry about your psychiatrist, I hope you find a new one who listens to you, but you could seriously mess yourself up if you do this. You're welcome to talk the pharmacist as well of course, but I strongly suspect the answer will be "definitely not."
posted by brook horse at 3:35 PM on October 19, 2021 [1 favorite]

Response by poster: Thank you so much for all the replies, everyone. I just got off the phone with the pharmacist letting him know that it is not an XR medication and that he said that it doesn't make a difference if I remove some of the capsule contents and then reseal it and take it.
posted by defmute at 3:35 PM on October 19, 2021 [5 favorites]

Did you literally tell your psychiatrist that you planned to alter your dosage anyhow? Have you tried telling your health insurance this to try to get in with a different psychiatrist faster? Do you have other trusted people in your life who think that this is a good plan and would also feel comfortable telling you if they thought it wasn’t working out? This could go okay or it might not, stay safe.

Also: no one will know exactly what dosage you’ve been taking if this doesn’t work out so we’ll.
posted by momus_window at 3:46 PM on October 19, 2021 [2 favorites]

Response by poster: momus_window, I didn't tell my psychiatrist that I'm doing that. I just asked the pharmacist.
posted by defmute at 4:02 PM on October 19, 2021

In the abstract I'd have two concerns if you're trying something like that.

One is that you are messing with the stability of the drug by exposing the solid directly to air. This will be a non-issue with lithium carbonate, especially if you take the second half of the dose immediately.

The other that the capsule is meant to control release in some way, and this could be a big deal. There's not enough information for us to tell--some capsules are meant to dissolve immediate but others don't. The pharmacologist can know this, so assuming yours actually thought before they answered it seems like this is also not an issue.

Definitely getting a prescriber you can discuss this stuff with openly is the correct long term solution, but I think it'll do what you want (give you half a dose.)

If you want to do this, the best way to do it would be to blend the contents of the capsule into a known quantity of water (say 500mL) and then drink half (or whatever) (250mL). I’m not a pharmaceutical chemist but from poking around it seems like lithium carbonate has some amount of solubility in water.

That would potentially have a much bigger impact on the pharmacokinetics than taking the powder.
posted by mark k at 6:51 PM on October 19, 2021 [3 favorites]

The correct AskMe answer is "you need to talk to a psychiatrist." The right AskMe answer is probably that if your pharmacist says in essence that you can self-titrate the dosage then you should do what works for you in the circumstances you're in. If you're bipolar then you're acutely aware of the place that your meds are putting you (or conversely, the place where absence of meds puts you) and you should feel granted permission to nudge yourself into a good place.
posted by holgate at 12:23 AM on October 20, 2021

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