Tablet levothyroxine (L-T4) malabsorption induced by proton pump inhibitor: a problem that was solved by switching to L-T4 in soft gel capsule
Abstract
Objective To report a patient in whom the impaired absorption of tablet levothyroxine (L-T4) due to a proton pump inhibitor (PPI) use was corrected by switching the patient to the soft gel capsule.Methods A woman with Hashimoto's thyroiditis-associated hypothyroidism (serum thyroid-stimulating hormone [TSH] 6.8-9.6 mU/L) had been treated with tablet L-T4 (100 μg/day). Because she used to take pantoprazole just before L-T4 in the morning, TSH failed to normalize (4.4-6.5 mU/L). Thus, the daily dose had been progressively increased to 125 and 150 μg/day, with serum TSH levels of 2.4 and 0.6 mU/L, respectively.Results While maintaining pantoprazole, we switched the tablet L-T4 (150 g/day) to a soft gel capsule (125 μg/day; Tirosint® capsule, IBSA, Lugano, Switzerland) and after 2 months, to 100 μg/day. Serum TSH was lower than under the equivalent regimens with the tablet: 0.5 versus 2.4 mU/L (125 μg/day) and 2.4 versus 4.4 to 6.5 mU/L (100 μg/day). Upon switching back to the tablet (100 μg/day), serum TSH increased to 3.2 and 4.7 mU/L and then dropped to 2.7-3.0 mU/L when the dose was increased to 125 μg/day. We also acutely evaluated the intestinal absorption of L-T4 by administering 600 μg LT4 as a tablet or soft gel capsule while maintaining pantoprazole. Pharmacokinetic indices showed better and faster absorption for the soft gel capsule versus tablet (area under the curve [AUC]0-4h = 16,240 vs. 10,960 nmol/L x 4 hours, maximum absorption [Cmax] = 108 vs. 73 nmol/L, and time of maximum absorption [Tmax] = 120 minutes vs. 180 minutes).Conclusion Confirming in vitro studies conducted by other authors, the soft gel capsule L-T4 is negligibly affected by changes in gastric pH compared to tablet L-T4.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
An absorption study showed better absorption of LT4 from the gel capsule.
“An absorption study showed better absorption of the LT4 from the gel capsule (114).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [114]
A case report describes a patient taking a PPI whose serum TSH was higher during treatment with LT4 tablets than with the same dose given as a gel capsule.
“A case report describes a patient taking a PPI whose serum TSH was higher during treatment with LT4 tablets than with the same dose given as a gel capsule.”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [114]
Malabsorption due to calcium supplements, PPIs, breakfast, H. pylori infection, and gastroparesis was eradicated after switching from tablets to capsules.
“Malabsorption due to calcium supplements (99), PPIs (226), breakfast (206), H. pylori infection (227), and gastroparesis (202) was eradicated after switching from tablets to capsules.”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [226]
Cites
Boelaert, K., Newby, P. R., Simmonds, M. J., Holder, R. L., Carr-Smith, J. D., Heward, J. M., Manji, N., Allahabadia, A., Armitage, M., Chatterjee, K. V., et al. (2010) · The American Journal of Medicine · doi:10.1016/j.amjmed.2009.06.030 · Cited by 480 · see citing works
Thyroxine in Goiter, <i>Helicobacter pylori</i> Infection, and Chronic Gastritis
Centanni, M., Gargano, L., Canettieri, G., Viceconti, N., Franchi, A., Fave, G. D., & Annibale, B. (2006) · New England Journal of Medicine · doi:10.1056/nejmoa043903 · Cited by 329 · see citing works
Timing of levothyroxine administration affects serum thyrotropin concentration
Bach-Huynh, T.-G., Nayak, B., Loh, J., Soldin, S., & Jonklaas, J. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-0860 · Cited by 198 · see citing works
Proton pump inhibitors: better acid suppression when taken before a meal than without a meal
Hatlebakk, J. G., Katz, P. O., Camacho-Lobato, L., & Castell, D. O. (2000) · Alimentary Pharmacology & Therapeutics · doi:10.1046/j.1365-2036.2000.00829.x · Cited by 169 · see citing works
Delayed Intestinal Absorption of Levothyroxine
BENVENGA, S., BARTOLONE, L., SQUADRITO, S., GIUDICE, F. L., & TRIMARCHI, F. (1995) · Thyroid · doi:10.1089/thy.1995.5.249 · Cited by 156 · see citing works
Self-citationPabla, D., Akhlaghi, F., & Zia, H. (2009) · European Journal of Pharmaceutics and Biopharmaceutics · doi:10.1016/j.ejpb.2008.10.008 · Cited by 124 · see citing works
Sachmechi, I., Reich, D. M., Aninyei, M., Wibowo, F., Gupta, G., & Kim, P. J. (2007) · Endocrine Practice · doi:10.4158/ep.13.4.345 · Cited by 112 · see citing works
Vita, R., Saraceno, G., Trimarchi, F., & Benvenga, S. (2013) · Endocrine · doi:10.1007/s12020-012-9772-2 · Cited by 91 · see citing works
Self-citationHuman Thyroxine Absorption: Age Effects and Methodological Analyses
HAYS, M. T., & NIELSEN, K. R. K. (1994) · Thyroid · doi:10.1089/thy.1994.4.55 · Cited by 67 · see citing works
Celiac Disease in Children, Adolescents, and Young Adults with Autoimmune Thyroid Disease
Sattar, N., Lazare, F. B., Kacer, M., Aguayo-Figueroa, L., Desikan, V., Garcia, M., Lane, A., Chawla, A., & Wilson, T. A. (2010) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2010.08.050 · Cited by 66 · see citing works
Wiebolt, J., Achterbergh, R., den Boer, A., Leij, S., Marsch, E., Suelmann, B. B. M., de Vries, R., & van Haeften, T. W. (2011) · European Journal of Endocrinology · doi:10.1530/eje-10-1172 · Cited by 53 · see citing works
Tönjes, A., Karger, S., Koch, C. A., Paschke, R., Tannapfel, A., Stümvoll, M., & Führer, D. (2006) · Thyroid · doi:10.1089/thy.2006.16.1047 · Cited by 28 · see citing works
Myo-inositol soft gel capsules may prevent the risk of coffee-induced neural tube defects
Grazia, S. D., Carlomagno, G., Unfer, V., & Cavalli, P. (2012) · Expert Opinion on Drug Delivery · doi:10.1517/17425247.2012.701616 · Cited by 25 · see citing works
Isolated Thyroxine Malabsorption Treated With Intramuscular Thyroxine Injections
Anderson, L., Joseph, F., Goenka, N., & Patel, V. (2009) · The American Journal of the Medical Sciences · doi:10.1097/maj.0b013e31817ee556 · Cited by 15 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., Celi, F. S., Cooper, D. S., Kim, B. W., Peeters, R. P., Rosenthal, M. S., et al. (2014) · Thyroid® · doi:10.1089/thy.2014.0028 · Cited by 1,928 · see citing works
“An absorption study showed better absorption of the LT4 from the gel capsule (114).”
Gastrointestinal malabsorption of thyroxine
Virili, C., Antonelli, A., Santaguida, M. G., Benvenga, S., & Centanni, M. (2019) · Endocrine Reviews · doi:10.1210/er.2018-00168 · Cited by 164 · see citing works
Self-citationFactors Affecting Gastrointestinal Absorption of Levothyroxine: A Review
Skelin, M., Lucijanić, T., Amidžić Klarić, D., Rešić, A., Bakula, M., Liberati-Čizmek, A.-M., Gharib, H., & Rahelić, D. (2017) · Clinical Therapeutics · doi:10.1016/j.clinthera.2017.01.005 · Cited by 133 · see citing works
Hashimoto’s Thyroiditis and Autoimmune Gastritis
Cellini, M., Santaguida, M. G., Virili, C., Capriello, S., Brusca, N., Gargano, L., & Centanni, M. (2017) · Frontiers in Endocrinology · doi:10.3389/fendo.2017.00092 · Cited by 120 · see citing works
Thyroid hormone therapy for hypothyroidism
Biondi, B., & Cooper, D. S. (2019) · Endocrine · doi:10.1007/s12020-019-02023-7 · Cited by 110 · see citing works
The administration of l -thyroxine as soft gel capsule or liquid solution
Vita, R., Fallahi, P., Antonelli, A., & Benvenga, S. (2014) · Expert Opinion on Drug Delivery · doi:10.1517/17425247.2014.918101 · Cited by 93 · see citing works
Self-citationCappelli, C., Pirola, I., Daffini, L., Formenti, A., Iacobello, C., Cristiano, A., Gandossi, E., Agabiti Rosei, E., & Castellano, M. (2016) · Thyroid · doi:10.1089/thy.2015.0422 · Cited by 80 · see citing works
Liquid and softgel levothyroxine use in clinical practice: state of the art
Virili, C., Trimboli, P., Romanelli, F., & Centanni, M. (2016) · Endocrine · doi:10.1007/s12020-016-1035-1 · Cited by 71 · see citing works
The emergence of levothyroxine as a treatment for hypothyroidism
Hennessey, J. V. (2017) · Endocrine · doi:10.1007/s12020-016-1199-8 · Cited by 66 · see citing works
Levothyroxine: conventional and novel drug delivery formulations.
Liu, H., Li, W., Zhang, W., Sun, S., & Chen, C. (2023) · Endocrine Reviews · doi:10.1210/endrev/bnac030 · Cited by 63 · see citing works
New Formulations of Levothyroxine in the Treatment of Hypothyroidism: Trick or Treat?
Nagy, E. V., Perros, P., Papini, E., Katkó, M., & Hegedűs, L. D. (2020) · Thyroid · doi:10.1089/thy.2020.0515 · Cited by 65 · see citing works
Levothyroxine therapy in gastric malabsorptive disorders
Virili, C., Brusca, N., Capriello, S., & Centanni, M. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2020.621616 · Cited by 52 · see citing works
Benvenga, S., Di Bari, F., & Vita, R. (2017) · Endocrine · doi:10.1007/s12020-017-1244-2 · Cited by 51 · see citing works
Self-citationLevothyroxine absorption in health and disease, and new therapeutic perspectives.
Ianiro, G., Mangiola, F., Rienzo, T. A. D., Bibbò, S., Franceschi, F., Greco, A. V., & Gasbarrini, A. (2014) · PubMed · Cited by 51 · see citing works
The levothyroxine absorption test: a four-year experience (2015-2018) at the Mayo Clinic
Gonzales, K. M., Stan, M. N., Morris, J. C., Bernet, V., & Castro, M. R. (2019) · Thyroid · doi:10.1089/thy.2019.0256 · Cited by 46 · see citing works
Effect of vitamin C on the absorption of levothyroxine in patients with hypothyroidism and gastritis
Jubiz, W., & Ramirez, M. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-4360 · Cited by 45 · see citing works
Seng Yue, C., Benvenga, S., Scarsi, C., Loprete, L., & Ducharme, M. (2015) · Journal of Pharmacy & Pharmaceutical Sciences · doi:10.18433/j36p5m · Cited by 41 · see citing works
Self-citationNovel thyroxine formulations: a further step toward precision medicine
Virili, C., Trimboli, P., & Centanni, M. (2019) · Endocrine · doi:10.1007/s12020-019-02049-x · Cited by 41 · see citing works
Trifirò, G., Parrino, F., Sultana, J., Giorgianni, F., Ferrajolo, C., Bianchini, E., Medea, G., Benvenga, S., Cricelli, I., Cricelli, C., et al. (2015) · Clinical Drug Investigation · doi:10.1007/s40261-015-0271-0 · Cited by 40 · see citing works
Self-citationGuglielmi, R., Frasoldati, A., Zini, M., Grimaldi, F., Gharib, H., Garber, J. R., & Papini, E. (2016) · Endocrine Practice · doi:10.4158/ep161308.or · Cited by 39 · see citing works
Tanguay, M., Girard, J., Scarsi, C., Mautone, G., & Larouche, R. (2019) · Clinical Pharmacology in Drug Development · doi:10.1002/cpdd.608 · Cited by 33 · see citing works
Rapid levothyroxine absorption testing: a case series of nonadherent patients
Balla, M., Jhingan, R. M., & Rubin, D. J. (2015) · International Journal of Endocrinology and Metabolism · doi:10.5812/ijem.31051 · Cited by 30 · see citing works
Bernareggi, A., Grata, E., Pinorini, M., & Conti, A. (2013) · Pharmaceutics · doi:10.3390/pharmaceutics5040621 · Cited by 30 · see citing works
Cappelli, C., Pirola, I., Gandossi, E., Cristiano, A., Daffini, L., Agosti, B., Casella, C., & Castellano, M. (2016) · International Journal of Endocrinology · doi:10.1155/2016/9043450 · Cited by 29 · see citing works
Medications and Food Interfering with the Bioavailability of Levothyroxine: A Systematic Review
Liu, H., Lu, M., Hu, J., Fu, G., Feng, Q., Sun, S., & Chen, C. (2023) · Therapeutics and Clinical Risk Management · doi:10.2147/tcrm.s414460 · Cited by 29 · see citing works
Hypothyroidism and Nephrotic Syndrome: Why, When and How to Treat
Mario, F. D., Pofi, R., Gigante, A., Rivoli, L., Rosato, E., Isidori, A. M., Cianci, R., & Barbano, B. (2017) · Current Vascular Pharmacology · doi:10.2174/1570161115999170207114706 · Cited by 27 · see citing works
Thyroid Hormone Replacement in Patients Following Thyroidectomy for Thyroid Cancer
Hannoush, Z. C., & Weiss, R. E. (2016) · Rambam Maimonides Medical Journal · doi:10.5041/rmmj.10229 · Cited by 27 · see citing works
Increased requirement of replacement doses of levothyroxine caused by liver cirrhosis.
Benvenga, S., Capodicasa, G., Perelli, S., Ferrari, S. M., Fallahi, P., & Antonelli, A. (2018) · Frontiers in Endocrinology · doi:10.3389/fendo.2018.00150 · Cited by 25 · see citing works
Self-citationErnst, F. R., Sandulli, W., Elmor, R., Welstead, J., Sterman, A. B., & Lavan, M. (2017) · Drugs in R&D · doi:10.1007/s40268-016-0150-z · Cited by 23 · see citing works
L-T4 Therapy in Enteric Malabsorptive Disorders
Fallahi, P., Ferrari, S. M., Elia, G., Ragusa, F., Paparo, S. R., & Antonelli, A. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.626371 · Cited by 23 · see citing works
Trimboli, P., Virili, C., Centanni, M., & Giovanella, L. (2018) · Frontiers in Endocrinology · doi:10.3389/fendo.2018.00118 · Cited by 21 · see citing works
Levothyroxine sodium pentahydrate tablets – formulation considerations
Kaur, N., & Suryanarayanan, R. (2021) · Journal of Pharmaceutical Sciences · doi:10.1016/j.xphs.2021.08.006 · Cited by 19 · see citing works
Benvenga, S., Capodicasa, G., & Perelli, S. (2017) · Frontiers in Endocrinology · doi:10.3389/fendo.2017.00321 · Cited by 18 · see citing works
Self-citationBenvenga, S. (2019) · Journal of Clinical & Translational Endocrinology · doi:10.1016/j.jcte.2019.100204 · Cited by 17 · see citing works
Self-citationGuzmán-Prado, Y., Vita, R., & Samson, O. (2021) · Journal of General Internal Medicine · doi:10.1007/s11606-020-06403-y · Cited by 15 · see citing works
Self-citationLiquid levothyroxine and its potential use
Formenti, A. M., Daffini, L., Pirola, I., Gandossi, E., Cristiano, A., & Cappelli, C. (2015) · HORMONES · doi:10.14310/horm.2002.1579 · Cited by 15 · see citing works
In vivo dissolution of levothyroxine soft gel capsules
Fiorini, G., Ribichini, D., Pasquali, R., & Vaira, D. (2016) · Internal and Emergency Medicine · doi:10.1007/s11739-016-1526-3 · Cited by 14 · see citing works
Kim, P. J., & Sachmechi, I. (2015) · AACE Clinical Case Reports · doi:10.4158/ep14051.cr · Cited by 14 · see citing works
EMPATHY: A New Tool for Identifying the Most Suitable Thyroxine Formulation in Hypothyroid Patients
Bellastella, G., Caputo, M., Maiorino, M. I., Longo, M., Scappaticcio, L., Giugliano, D., & Esposito, K. (2019) · Thyroid · doi:10.1089/thy.2018.0493 · Cited by 14 · see citing works
L-T4 therapy in the presence of pharmacological interferents
Benvenga, S. (2020) · Frontiers in Endocrinology · doi:10.3389/fendo.2020.607446 · Cited by 13 · see citing works
Self-citationLiquid levothyroxine formulations in patients taking drugs interfering with L-T4 absorption
Gatta, E., Bambini, F., Buoso, C., Gava, M., Maltese, V., Anelli, V., Delbarba, A., Pirola, I., & Cappelli, C. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1080108 · Cited by 13 · see citing works
Efficacy and Safety of Once-Weekly Thyroxine for Thyroxine-Resistant Hypothyroidism
Chellama, J., Nair, A., Khadar, J. P., Das, D., Prasad, N., Jessy, S. J., Gopi, A., & Guruprasad, P. (2019) · Journal of the Endocrine Society · doi:10.1210/js.2019-00212 · Cited by 13 · see citing works
Acute cell stress screen with supervised machine learning predicts cytotoxicity of excipients
Bieberich, A. A., Rajwa, B. P., Irvine, A., Fatig, R. O., Fekete, A., Jin, H., Kutlina, E., & Urbán, L. (2021) · Journal of Pharmacological and Toxicological Methods · doi:10.1016/j.vascn.2021.107088 · Cited by 12 · see citing works
Trimboli, P., & Mouly, S. J. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11123479 · Cited by 11 · see citing works
Santos Monteiro, S., Santos, T. S., Lopes, A. M., Oliveira, J. C., Freitas, C., & Couto Carvalho, A. (2022) · Endocrine Connections · doi:10.1530/ec-22-0355 · Cited by 9 · see citing works
Intestinal absorption and buccal absorption of liquid levothyroxine
Benvenga, S., & Di Bari, F. (2017) · Endocrine · doi:10.1007/s12020-017-1250-4 · Cited by 8 · see citing works
Self-citationDaily requirement of softgel thyroxine is independent from gastric juice pH
Virili, C., Capriello, S., Stramazzo, I., Brusca, N., Santaguida, M. G., Gargano, L., Bagaglini, M. F., Bruno, G., Severi, C., & Centanni, M. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1002583 · Cited by 8 · see citing works
Alternative schedules of levothyroxine administration
Geer, M., Potter, D. M., & Ulrich, H. (2015) · American Journal of Health-System Pharmacy · doi:10.2146/ajhp140250 · Cited by 7 · see citing works
Decreased expression of ileal thyroid hormone transporters in a hypothyroid patient: a case report
Chung, C. W., Mo, E. Y., Jung, G. S., Kim, Y. H., Cho, S. W., Park, D. J., Bae, J. M., & Park, Y. J. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.664839 · Cited by 5 · see citing works
Cherchir, F., Oueslati, I., Mouelhi, Y., Talbi, E., Feki, M., Yazidi, M., & Chihaoui, M. (2023) · SAGE Open Medical Case Reports · doi:10.1177/2050313x231209229 · Cited by 5 · see citing works
Cappelli, C., Pirola, I., & Castellano, M. (2020) · Case Reports in Endocrinology · doi:10.1155/2020/8858887 · Cited by 5 · see citing works
Liquid L-T4 therapy in hypothyroid patients with gastric diseases, an observational study
Fallahi, P., Ragusa, F., Patrizio, A., Mazzi, V., Botrini, C., Elia, G., Balestri, E., Barozzi, E., Rugani, L., Palmisano, E., et al. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1386629 · Cited by 4 · see citing works
Self-citationLevothyroxine personalized treatment: is it still a dream?
Cappelli, C., Gatta, E., & Ippolito, S. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1334292 · Cited by 4 · see citing works
Yue, C. S., Scarsi, C., Bettazzi, E., Mautone, G., Celi, F. S., & Ducharme, M. P. (2024) · Endocrine Practice · doi:10.1016/j.eprac.2024.03.388 · Cited by 4 · see citing works
Stupperich, S., Kotliarevskaia, J., Nies, R., Paparoupa, M., Wittig, A., & Schuppert, F. (2022) · Clinical Case Reports · doi:10.1002/ccr3.6223 · Cited by 2 · see citing works
Campanini, M., & Grandi, M. (2017) · Italian Journal of Medicine · doi:10.4081/itjm.q.2017.3 · Cited by 1 · see citing works
Luíz, H. V., Manita, I., & Portugal, J. (2016) · Springer eBooks · doi:10.1007/978-3-319-25871-3_7
Krátký, J. (2022) · Vnitřní lékařství · doi:10.36290/vnl.2022.010 · Cited by 1 · see citing works
Levothyroxine-sodium/pantoprazole
(2024) · Reactions Weekly · doi:10.1007/s40278-024-71483-z
Formulations for the Replacement Therapy of Hypothyroidism: State of the Art and Perspectives
Lugaresi, M., & Fugazzola, L. (2025) · Springer eBooks · doi:10.1007/978-3-032-01700-0_13
- Authors
- Vita, R., & Benvenga, S.
- Affiliations
- University of Messina (IT)
- Corresponding author
- Vita, Roberto
- Venue
- Endocrine Practice
- Publisher
- Elsevier BV
- Published
- 2014-03
- Volume
- 20
- Issue
- 3
- Pages
- e38-e41
- ISSN
- 1530-891X (ISSN-L)
- OpenAlex
- W2013324388
- Cited by
- 60
- References
- 14
- Citations by year
- 2025: 1 · 2024: 4 · 2023: 2 · 2022: 7 · 2021: 6 · 2020: 3 · 2019: 6 · 2018: 4 · 2017: 7 · 2016: 8 · 2015: 7 · 2014: 4 · 2013: 1
- FWCI
- 5.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Endocrine Practice (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Gastroenterology › Gastroesophageal reflux and treatments
- Keywords
- levothyroxine, drug malabsorption, proton pump inhibitors, pantoprazole, tablet formulation, Hashimoto's thyroiditis, hypothyroidism, thyroid-stimulating hormone, pharmacokinetics, drug-drug interactions, antacids, dose adjustment, TSH normalization, antithyroid drugs
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
