80 replies to this topic

[invalidusername]

That sort of stress is the last thing you need during a withdrawal. They of all people should know that ticking off someone going through a withdrawal is like like flicking a lion in his love spuds with a wet towel. All hell will ensue.

[fishinghat]

Actually Kathy I see things a little different than IUN. From my perspective it appears that the FDA allowed the generic companies to use a cheaper less effective way to produce their products. I think it was all about money. I hate to say this but it appears that Eli Lilley makes the best "Cymbalta" on the market. Maybe I should say 'less worse' instead of best.

[fishinghat]

More info to follow...

 

Cymbalta Brands (Type of enteric coating)

Eli Lilley - Hypromelloses, HYPROMELLOSE ACETATE SUCCINATE
Aphena - Hypromelloses, HYPROMELLOSE ACETATE SUCCINATE
Carilion Materials Management - Hypromelloses, HYPROMELLOSE ACETATE SUCCINATE
H.J. Harkins Company, Inc.- Hypromelloses, HYPROMELLOSE ACETATE SUCCINATE
Lake Erie Medical DBA Quality Care Products LLC - Hypromelloses, HYPROMELLOSE ACETATE SUCCINATE
PD-Rx Pharmaceuticals, Inc. - Hypromelloses, HYPROMELLOSE ACETATE SUCCINATE
Physicians Total Care, Inc. - Hypromelloses, HYPROMELLOSE ACETATE SUCCINATE
Rebel Distributors Corp. - Hypromelloses, HYPROMELLOSE ACETATE SUCCINATE
STAT Rx USA LLC - Hypromelloses, HYPROMELLOSE ACETATE SUCCINATE

Duloxetine Brands (Type of enteric coating)
Aurobindo Pharma Limited - CROSPOVIDONE, HYDROXYPROPYL CELLULOSE (TYPE H), HYPROMELLOSE 2910, HYPROMELLOSE PHTHALATE (24% PHTHALATE)
Prasco Laboratories - CROSPOVIDONE, HYDROXYPROPYL CELLULOSE (TYPE H), HYPROMELLOSE 2910, HYPROMELLOSE PHTHALATE (24% PHTHALATE)
Rising Health, LLC - CROSPOVIDONE, HYDROXYPROPYL CELLULOSE (TYPE H), HYPROMELLOSE 2910, HYPROMELLOSE PHTHALATE (24% PHTHALATE)
Actavis Pharma, Inc. - HYDROXYPROPYL CELLULOSE, UNSPECIFIED), HYPROMELLOSE PHTHALATE (31% PHTHALATE), HYPROMELLOSE 2910
Teva Pharmaceuticals USA, Inc. - HYDROXYPROPYL CELLULOSE, UNSPECIFIED), HYPROMELLOSE PHTHALATE (31% PHTHALATE), HYPROMELLOSE 2910
Ajanta Pharma Limited - HYPROMELLOSES, METHACRYLIC ACID - ETHYL ACRYLATE COPOLYMER (1:1) TYPE A
Ascend Laboratories, LLC - HYDROXYPROPYL CELLULOSE (1600000 WAMW), CROSPOVIDONE, HYPROMELLOSE PHTHALATE (24% PHTHALATE, 55 CST), HYPROMELLOSES
BluePoint Laboratories - HYPROMELLOSE PHTHALATE (31% PHTHALATE, 40 CST), HYPROMELLOSE, UNSPECIFIED
Cadila Healthcare Limited - HYPROMELLOSE PHTHALATE (31% PHTHALATE, 40 CST), HYPROMELLOSE, UNSPECIFIED
Camber Pharmaceuticals, Inc. - CROSPOVIDONE, HYPROMELLOSES, POVIDONE, METHYLCELLULOSE (4000 MPA.S)
Cipla USA Inc. - HYPROMELLOSE 2910 (6 MPA.S), HYPROMELLOSE PHTHALATE (31% PHTHALATE, 40 CST,
Heritage Pharmaceuticals Inc.- HYPROMELLOSE 2910 (6 MPA.S), HYPROMELLOSE PHTHALATE (31% PHTHALATE, 40 CST),
Inventia Healthcare Private Limited - HYPROMELLOSE 2910 (6 MPA.S), HYPROMELLOSE PHTHALATE (31% PHTHALATE, 40 CST),
Lupin Pharmaceuticals, Inc. - CROSCARMELLOSE SODIUM, HYPROMELLOSE 2910 (6 MPA.S), HYPROMELLOSE PHTHALATE (31% PHTHALATE, 40 CST),
Solco Healthcare US, LLC - HYPROMELLOSE 2910 (5 MPA.S), HYPROMELLOSE ACETATE SUCCINATE 06081224 (3 MM2/S, POLYVINYL ALCOHOL,
Sun Pharmaceutical Industries, Inc. - HYPROMELLOSES, METHACRYLIC ACID - ETHYL ACRYLATE COPOLYMER (1:1) TYPE A,
Zydus Pharmaceuticals (USA) Inc. - HYPROMELLOSE, HYPROMELLOSE PHTHALATE (31% PHTHALATE, 40 CST

 

[invalidusername]

You are a true legend Hat. Sincerely... well done.

[fishinghat]

So, OK, you say to yourself who cares which one it is made of. It really does matter. Most of these compounds are designed to be a solid at room temperature and melt at around 94.6 F. However, this does not always happen. Many people, for example my wife and I, have a body temperature of around 93.6. These materials at that temperature dissolve. While the contents may be released and used by the body the capsule itself soften but do not totally dissolve leaving a gummy sticky plastic residue behind that can attach to other capsules as well as fiber, starches, etc and eventually block the digestive tract. This occurrence is called Pharmacobezoars. Many of these blockages must be surgically removed. I actually had a mild case of this once but luckily the doctors were able to get my digestive system to pass the material with large doses of laxatives. A very patient unfriendly experience for sure. In the last 20 years Pharmacobezoars have increased 10 to 15 fold (depending on what research you read). And as you can read in the info below it is not just enteric coatings but these materials are also used in tablets, otc medication, eye drops, etc.


Pharmacobezoars
 

Pharmacobezoars (or medication bezoars) are mostly tablets or semiliquid masses of drugs which block or partly block the GI tract.

http://www.thefreeli......-a0136387734
http://www.ncbi.nlm..../pubmed/8590522
Aluminum hydroxide gel, enteric-coated aspirin, sucralfate, guar gum, cholestyramine, enteral feeding formulas, psyllium preparations, nifedipine XL, and meprobamate.
Physillium, guar gum and enteric coated aspirin contribute heavily.

http://www.ncbi.nlm....les/PMC3151403/
Caused by venlafaxine (Effexor)

http://informahealth...650.2013.856442
Quetiapine

https://www.ncbi.nlm...pubmed/25083252
Curse of the ghost pills: the role of oral controlled-release formulations in the passage of empty intact shells in faeces. Two case reports and a literature review relevant to psychiatry.

https://www.ncbi.nlm...pubmed/19405260
Dissolution of pharmacobezoar using carbonated beverage.

https://www.ncbi.nlm...pubmed/21370943
Pharmacobezoars described and demystified.

http://onlinelibrary....12679/abstract
Forensic related pharmacobezoars.

http://curriculum.to...ugs In Overdose
Time release coatings causing pharmacobezoars.

http://curriculum.to...ugs In Overdose
Can be caused by any time release slow release medicine.

http://www.ncbi.nlm....0,f1000m,isrctn
Pharmacobezoars consist of medication bezoars, such as cholestyramine, kayexalate resin, carafate and antacids, which adhere when in bulk.

http://www.sciencedi...214750014000146
Extended release potassium salts.

http://www.ncbi.nlm....pubmed/21370943
http://informahealth...650.2011.559472
Review, These include enteric-coated aspirin, activated charcoal, clomipramine, iron, theophylline, and venlafaxine, as well as verapamil-SR and nifedipine-XL preparations. There are 84 references.
See more at: http://www.thepoison...h.vC0lJlHs.dpuf

http://link.springer...?no-access=true

http://www.medscape....warticle/781850
http://www.giendo.th...(06)00015-8/pdf
Enteric coatings and time release coatings.

http://www.ulusalcer...-metin/1168/eng
Heavy doses of multiple medications.

http://www.ijccm.org...1;aulast=Tawfic
Eosopageal pharmacobezoars

http://europepmc.org...cles/PMC3966178

https://www.ncbi.nlm...les/PMC4485820/



Enteric Coatings And Time Release Coatings and other Excipients that contribute to pharmacobezoars.

Methyl acrylate-methacrylic acid copolymers - The methacrylates have numerous uses, most notably in the manufacture of polymers such as Lucite and Plexiglas. The production of Methyl acrylate-methacrylic acid copolymers can involve the use of acetone cyanohydrin (contains cyanide) and formaldehyde.

Hypromellose - (Hydroxypropyl Methylcellulose, Hydroxy propyl methyl cellulose acetate succinate, hypromellose acetate succinate, cellulose acetate succinate) is a synthetic polymer also used in adhesives and eye drops.

Polyvinyl acetate phthalate (PVAP) synthetic polymer. Polyvinyl acetate phthalate - symthetic polymer for enteric coatings/time release. The gastrointestinal tract appears to be the target organ and effects seen (irritation, laxation, colitis with erosions and submucosal fibrosis in the dog and ulcers, polyps, and cecal wall thickening in rats) were dose dependent.
http://www.researchg...imental_animals
Evaluation of the toxicity of polyvinylacetate phthalate in experimental animals.
http://www.preventio...es-pill-coating

Shellac is a resin secreted by the female lac bug. Shellac, edible, is used as a glazing agent on pills and candies. Because of its acidic properties (resisting stomach acids), shellac-coated pills may be used for a timed enteric or colonic release. Shellac is used as a 'wax' coating on citrus fruit to prolong its shelf/storage life. It is also used to replace the natural wax of the apple, which is removed during the cleaning process.

Cellulose acetate trimellitate is soluble in mild aqueous acid and readily dissolve in neutral or aqueous base. A polybenzene compound.
Sodium alginate is an synthetic anionic polysaccharide.

Zein a corn protein

Polyvinyl acetate (Poly(vinyl acetate) (PVA, PVAc, poly(ethenyl ethanoate) is commonly referred to as wood glue, white glue, carpenter's glue, school glue, Elmer's glue and is is an aliphatic rubbery synthetic polymer.
http://www.ncbi.nlm....pubmed/20643750
transaminase elevations

Povidone (Polyvinylpyrrolidone (PVP), also commonly called polyvidone, is a water-soluble synthetic polymer made from the monomer N-vinylpyrrolidone.

Polysorbates are oily liquids derived from PRG(polyethylene Glycol)-ylated sorbitan (a derivative of sorbitol) esterfied with fatty acids.

Polyethylene glycol (macrogol) is a polyether compound. Used in coatings and time release.

Polydextrose is a synthetic polymer of glucose.

Polyvinyl alcohol is a watersoluble synthetic polymer.

Croscarmellose Sodium is an internally cross-linked sodium carboxymethylcellulose.

Medications that contribute to pharmacobezoars

Sucralfate (Carafate) is a sucrose sulfate-aluminum complezx that binds to the mucosa, thus creating a physical barrier that impairs diffusion of hydrochloric acid in the gi tract and prevents degradation of mucus by acid.

Cholestyramine (colestyramine, Questran, Questran Light, Cholybar, Olestyr) a quarternary ammonium group attached to an inert styrene-divinylbenzene copolymer.

Nifedipine XL (Adalat CC and Procardia)

Meprobamate (Miltown, Equanil, Meprospan) is a carbamate derivative.

Venlafaxine (Effexor)

Quetiapine (Seroquel)

Kayexalate resin (Polystyrene sulfonates are polymers derived from polystyrene but containing sulfonic acid or sulfonate functional groups.

Clomipramine (Anafranil and Clofranil)

Theophylline (1,3-dimethylxanthine)

Verapamil-SR

Most of the above drugs contain one or more of the above listed chemicals. There are many more drugs as well.
 
By the way, did I mention that nost Cymbalta contains Sodium lauryl sulfate?

Caution!!
Sodium lauryl sulfate
http://www.ncbi.nlm..../pubmed/9656847
http://www.ncbi.nlm....pubmed/22435470
Aggrevates ulcers.

http://www.ncbi.nlm....pubmed/11417628
1,4-Dioxane Contamination
The Campaign for Safe Cosmetics maintains that sodium laureth sulfate requires processing with other chemicals to reduce harshness. Ethylene oxide applied to SLES can result in 1,4-dioxane--a U.S. Environmental Protection Agency known carcinogen. Acute inhalation exposure ranging from a few minutes to a few hours, causes headache, vertigo and irritation to the eyes, nose, throat and lungs. The Campaign for Safe Cosmetics recommends avoiding products that list sodium laureth sulfate, including sodium myreth sulfate, as an ingredient. Although many personal care product manufacturers insist that only a little amount of 1,4-dioxane is present in items such as baby shampoo and body wash, it is prudent to recognize that exposure to this carcinogen may pose a threat to your health.
Irritation of the skin and eyes
Organ toxicity
Developmental/reproductive toxicity
Neurotoxicity, endocrine disruption, ecotoxicology, and biochemical or cellular changes
Possible mutations and cancer
https://en.m.wikiped...laureth_sulfate

Wiki
Some products containing SLES have been found to also contain traces (up to 279 ppm) of 1,4-dioxane; this is formed as a by-product during the ethoxylation step of its synthesis. The U.S. Food and Drug Administration recommends that these levels be monitored.[8] The U.S. Environmental Protection Agency classifies 1,4-dioxane to be a probable human carcinogen (not observed in epidemiological studies of workers using the compound, but resulting in more cancer cases in controlled animal studies), and a known irritant with a no-observed-adverse-effects level of 400 milligrams per cubic meter at concentrations significantly higher than those found in commercial products.[9] Under Proposition 65, 1,4-dioxane is classified in the U.S. state of California to cause cancer.[10][11] The FDA encourages manufacturers to remove 1,4-dioxane, though it is not required by federal law.[12]
https://en.m.wikiped...laureth_sulfate

^ Black RE, Hurley FJ, Havery DC (2001). "Occurrence of 1,4-dioxane in cosmetic raw materials and finished cosmetic products". Journal of AOAC International 84 (3): 666–70. PMID 11417628.
http://jofamericansc...704_535_541.pdf

Awareness of Sodium Lauryl Sulfate & Sodium Laureth Sulfate Health Hazards among Users
Ghada F. El-Sharkaw

[invalidusername]

All this needs to go under its own heading somewhere so we can refer back to it in days, week, months to come. You know it will come up many more times. I would offer to undertake, but head is not in favour of such organisational skills at present!!

[fishinghat]

This info is already on the side under the heading "Pharmacobezoars". I posted it a few years ago. It is also in the Summary of Cymbalta Withdrawal as well.

[invalidusername]

apologies - as I said - unorganised

[fishinghat]

No apologies necessary IUN. You did not know.

 

So with Cymbalta you have the terrible withdrawal, several severe potential health effects (seizures, low sodium, etc.), Pharmacobezoars risk, possible carcinogen or two, artificial colors, and more. What else can we want in a prescription drug?

[KathyInFL]

Actually Kathy I see things a little different than IUN. From my perspective it appears that the FDA allowed the generic companies to use a cheaper less effective way to produce their products. I think it was all about money. I hate to say this but it appears that Eli Lilley makes the best "Cymbalta" on the market. Maybe I should say 'less worse' instead of best.

 

Great points. "Less worse" is the best way to put it.

[ForLyla]

I knew before I even read your post that you just have cold turkeyed. These guys know their stuff. Reinstating until your stabilize and tapering the right way is sound advice.

[DavidfromTexas]

Hi, everybody. I just posted in another thread "Tapering with Duloxetine" concerning exactly what you guys have been discussing here!

 

I have been trying to figure this out because I am concerned about whether I need enteric-coated capsules or not. You can read my post on that thread, but basically I have run into an issue of the original capsules cracking sometimes when I try to separate them in order to divide the beads. Which means I cannot put the beads back into those cracked capsules in order to take them. This lead me to wondering about ordering capsules to use, and which kind of capsules they needed to be.

 

The manufacturer of my generic prescription is Rising Pharmaceuticals. Is that the same as the Rising Health LLC mentioned earlier in this thread?

 

This all makes me wonder if going with the duloxetine powder formula (including capsule and time-release filler) in a compounded small dose would be the best option? PCCA is the company that has the duloxetine powder, so you can get a compounded powder form of the drug through any of their Member Compounding Pharmacies in the country.

 

It ALSO makes me wonder... for somebody like me who is just now reinstating on a TINY dose (1-1.5mg), would it be better to switch to a completely different drug? Like Zoloft or Prozac, or something else that would have better options for compounding and tapering with tiny doses.

Edited by DavidfromTexas, 07 August 2019 - 03:29 AM.

[fishinghat]

"The manufacturer of my generic prescription is Rising Pharmaceuticals. Is that the same as the Rising Health LLC mentioned earlier in this thread?"

They are two different companies and furthermore Rising Health LLC has been on Chapter 11 bankruptcy since Feb 2019.

PCCA - Professional Compounding Centers of America dba PCCA - The last time I checked on this the powdered duloxetine at a compounding pharmacy ran around $1200/mth and was not covered by my insurance. Other members have had similar experiences.

Professional Compounding Centers of America
From Wikipedia, the free encyclopedia



In 1981, the Professional Compounding Centers of America(PCCA) was incorporated to provide compounded medications to patients, when the medicine became unavailable commercially.
PCCA services pharmacies who provide these compounded medications, giving them training, recipes, and materials.[1] However, according to Science-Based Medicine, " the enthusiasm can outpace the evidence, and there may be a lack of evidence that compounded products really are safe and effective."
The organization supported pharmacies in 2011 who were helping provide alternatives to hydroxyprogesterone in an attempt to prevent early labor.[2] In 2014 the company acquired two manufactures and distributors of materials and compounded medications.[3] They were sued in 2019 for providing the formulation of an injection that caused 68 people to go blind. Wiki

https://oag.ca.gov/p...tice-2013-00836
FDA Court Case
Professional Compounding Centers of America shall not manufacture for sale in the State of California, distribute into the State of California, or directly sell in the State of California, any product listed in Environmental Research Center's September 13, 2013 notice of violation that exposes a person to a daily dose of lead more than 0.5 micrograms per day when the maximum suggested dose is taken as directed on the product's label, unless each such product displays a clear and reasonable warning as discussed in section 3 of the Stipulated Consent Judgment.

"It ALSO makes me wonder... for somebody like me who is just now reinstating on a TINY dose (1-1.5mg), would it be better to switch to a completely different drug? Like Zoloft or Prozac, or something else that would have better options for compounding and tapering with tiny doses."

Not a bad idea but a new ssri would take 4 to 8 weeks to kick in and some work for some people and don't work for others.

[DavidfromTexas]

"The manufacturer of my generic prescription is Rising Pharmaceuticals. Is that the same as the Rising Health LLC mentioned earlier in this thread?"

They are two different companies and furthermore Rising Health LLC has been on Chapter 11 bankruptcy since Feb 2019.

PCCA - Professional Compounding Centers of America dba PCCA - The last time I checked on this the powdered duloxetine at a compounding pharmacy ran around $1200/mth and was not covered by my insurance. Other members have had similar experiences.

Professional Compounding Centers of America
From Wikipedia, the free encyclopedia



In 1981, the Professional Compounding Centers of America(PCCA) was incorporated to provide compounded medications to patients, when the medicine became unavailable commercially.
PCCA services pharmacies who provide these compounded medications, giving them training, recipes, and materials.[1] However, according to Science-Based Medicine, " the enthusiasm can outpace the evidence, and there may be a lack of evidence that compounded products really are safe and effective."
The organization supported pharmacies in 2011 who were helping provide alternatives to hydroxyprogesterone in an attempt to prevent early labor.[2] In 2014 the company acquired two manufactures and distributors of materials and compounded medications.[3] They were sued in 2019 for providing the formulation of an injection that caused 68 people to go blind. Wiki

https://oag.ca.gov/p...tice-2013-00836
FDA Court Case
Professional Compounding Centers of America shall not manufacture for sale in the State of California, distribute into the State of California, or directly sell in the State of California, any product listed in Environmental Research Center's September 13, 2013 notice of violation that exposes a person to a daily dose of lead more than 0.5 micrograms per day when the maximum suggested dose is taken as directed on the product's label, unless each such product displays a clear and reasonable warning as discussed in section 3 of the Stipulated Consent Judgment.

"It ALSO makes me wonder... for somebody like me who is just now reinstating on a TINY dose (1-1.5mg), would it be better to switch to a completely different drug? Like Zoloft or Prozac, or something else that would have better options for compounding and tapering with tiny doses."

Not a bad idea but a new ssri would take 4 to 8 weeks to kick in and some work for some people and don't work for others.

 

Hi, fishinghat.

 

When I checked on the possibility of compounding the powder at a nearby Pharmacy, the Pharmacist gave me the pricing rundown. It would only come out to about 200/month for 1mg, I assume it would be more for 2mg and so on, but not sure how much more.

The other option would be to have the compounding pharmacy simply divide the doses of the beads for me, and if they were unable to use any of the original capsules they would have to use others of similar design. But I am not even sure they'd  know whether they needed to be enteric or non-enteric capsules.

 

I am not quite sure what I should do now. It seems to me that trying the powder compound may be the best option at this point. I spoke to Dr Larsen today, she is the Clinical Compounding Pharmacist at PCCA. She said that for the delayed-release option with the powder compound, the capsule would have to be enteric, and there is an additional filler they use to help with slow-release. It is called Methocell E4M. She said it basically turns into a gel in order to help the meds slowly ooze out of the dissolving capsule.

 

This is scaring me. I DO NOT want to run into the situation that a couple others here have mentioned...where they used the wrong kind of capsule and ended up getting very sick due to the toxicity of the enteric beads. But I also do not want to use a coated capsule if it doesn't require it, because then we could run into problems of it not dissolving correctly like you mentioned, having the effect of not absorbing the medicine and also the danger of an undissolved capsule in there.

 

If I need to find a Dr that will help me do a bridge onto another drug I will try to do that. I just don't know what to do.

 

I guess I could also try to get 2 separate prescriptions of the drug and just pay for one out of pocket so that I would be sure to have enough of the original capsules to use.

 

In your experience does opening the capsules and putting them back together ever diminish the enteric quality of the prescription (either the beads or the capsule itself)? The manufacturer (Rising Pharmaceuticals) was warning me about this when I called in.

 

Also, are you sure Rising Health and Rising Pharmaceuticals are different companies? When I searched for both they are in the same city in New Jersey. That would seem a bit too large of a coincidence to me.

Edited by DavidfromTexas, 07 August 2019 - 03:30 PM.

[fishinghat]

Opening the capsules and putting the beads back inside does not effect the enteric coating as it is on the beads and not on the capsules. The gelatin capsules usually dissolve in less than 5 minutes.

 

I will double check on those two companies again.

[fishinghat]

Well, this is interesting I did find this info...


Contact Information


Rising Health, LLC


Park 80 W Plaza 1 250 Pehle Ave
Saddle Brook, NJ 07663


Contact: Steven S Rogers
Title: Chief Legal Officer
Phone: (201) 961-9000
Website: www.risingpharma.com


Rising Health, LLC is the only company located at Park 80 W Plaza 1 250 Pehle Ave, Saddle Brook, NJ 07663

The FDA site lists two totally separate permitting requirements for the two(?) companies though. I guess they are the same after all.

[DavidfromTexas]

Opening the capsules and putting the beads back inside does not effect the enteric coating as it is on the beads and not on the capsules. The gelatin capsules usually dissolve in less than 5 minutes.

 

I will double check on those two companies again.

 

I thought you guys were saying in the other thread that the capsules I use DO need to be enteric-coated...

If the capsules ARE enteric it would keep it from dissolving in 5 minutes.

[fishinghat]

That is correct IF you continue cutting the small tablets inside BUT if you change to a different brand with enteric coated beads and don't cut those beads then a gelatin capsule is fine.

[DavidfromTexas]

That is correct IF you continue cutting the small tablets inside BUT if you change to a different brand with enteric coated beads and don't cut those beads then a gelatin capsule is fine.

 

I'm sorry, there must be some confusion here. I am taking the capsules with the beads inside, not the tablets.

Does that make a difference as to which capsule I should use?

 

I'm so concerned about this that I have actually picked up a second order of the same prescription so that I would have enough of the original capsules to make up for any that get broken in the process of opening. I just paid $170 for it out of pocket. I am even willing to do this every few months after I run out of the extra manufacturer capsules. I'll pay for it if I have to.

 

I would love to NOT have to, but until I can feel confident that I'm choosing the right kind of capsule for my prescription...Im not sure what else to do.

Edited by DavidfromTexas, 08 August 2019 - 02:34 AM.

[fishinghat]

My apologies DFT. I got confused with someone else.

 

A gelatin capsule is just fine as that is what the manufacturers use in their capsules. I always error on the side of caution however and recommend enteric coated capsules just to be sure the med gets inside the small intestines before releasing. Either will do however.

 

One side note that just recently came to my attention was that one should not use "hard gelatin" capsules as they are brittle and sometimes break when being used.

[DavidfromTexas]

One side note that just recently came to my attention was that one should not use "hard gelatin" capsules as they are brittle and sometimes break when being used.

 

Yes, I have run into this problem a couple times when taking the original capsules apart. And since I've so far been putting the divided beads back into the original capsules I have been double checking each one before taking the drug to make sure I see no cracks in it.