Levothyroxine

Been prescribed levothyroxine starting tomorrow. Is there a best time of day to take it I usually take my tablets as part of my bedtime routine!

[Jazzw]

What else do you take at bedtime? It might be a good time to take your Levo too, if it doesn't clash with your other meds.

[Clutter]

Karen, Levothyroxine can be taken any time of day or night as long as you take it with a full glass of water on an empty stomach one hour before, or two hours after, food and drink, two hours away from other medication and supplements and four hours away from vitamin D3, calcium, iron and oestrogen.

[Hidden in reply to Clutter]

Does that include cup of tea?

[Clutter in reply to Hidden]

Karen, I'm afraid so. Both the tea and the proteins in milk can bind with Levothyroxine and affect absorption. A lot of people set the alarm early to take their Levothyroxine and go back to bed for an hour before having tea/coffee and breakfast.

[shaws Administrator in reply to Hidden]

This is an excerpt re food interfering with the uptake of levo.

Dr. Lowe: As a rule, our patients take thyroid hormone only once per day. An advantage of this one-per-day schedule is that it’s easier to find a window for good intestinal absorption—when the stomach or small intestine doesn’t contain food.

Most of our patients wait at least one hour after taking thyroid hormone before they eat. Or they wait at least two hours after eating before they take thyroid hormone. The two hour wait is a rough estimate of the time it takes for food to pass through the stomach and small intestine. It’s worth noting, however, that several factors can increase the time a patient should wait before taking thyroid hormone.

One factor is being female. Researchers report that on average, the woman’s stomach empties more slowly than the man’s. In a 1998 study, for example, researchers tested how long it took for half of a solid meal to empty from the stomachs of healthy women and men. The average time for women was 86 minutes and for men was 52 minutes.[1] This result is consistent with those of other studies; it suggests that women may benefit by waiting a while longer than men after eating to take thyroid hormone.

Another factor is the slower movement of food and stool through the gastro-intestinal (GI) tract of many patients who have hypothyroidism or thyroid hormone resistance. Doctors often diagnose the sluggish GI function as "constipation-type irritable bowel syndrome."[2,pp.681-687] Until the patient finds a thyroid hormone dose that relieves her constipation, it may be prudent for her to allow more than two hours—maybe three—for food to clear from her stomach and small intestine before taking the hormone.

Still another factor is food-induced slow emptying of the stomach. If a meal contains much fat, oil, or protein, food will pass more slowly from the stomach to the small intestine. This may be helpful when a person has ingested refined sugar as part of the meal. Slower emptying of the stomach will slow sugar absorption from the small intestine into the blood. This may reduce the amount of insulin that’s secreted and avert an episode of low blood sugar. But at the same time, slowed emptying of the stomach may allow food to remain in the stomach or small intestine too long—so long that thyroid hormone taken two hours afterward may bind to food constituents. Binding of the hormone to food constituents, of course, will reduce the amount of the hormone that passes into the blood. In one study, when patients took T4 on an empty stomach, 79% was absorbed; when they took the hormone with food, 64% was absorbed.[3] It’s hard to say, however, how much of the hormone, when taken with food, will be bound in the intestine and how much will be absorbed into the blood. The determining factor will be the chemical composition of the food. Few of us ever know for sure the total composition of the food in a meal we eat. Because of this, we can better calculate how much thyroid hormone we’ll absorb from a given dose by taking it on an empty stomach.

Some patients avoid problems absorbing thyroid hormone by taking it in the middle of the night.

[Hidden]

Thank you x

[shaws Administrator]

When you take levothyroxine it should be taken 4 hours apart from other medications/supplements. That can either be first thing, taken with 1 glass of water and not eating for around 1 hour or bedtime.

If you take it at bedtime, you should leave a gap of 2 hours after eating and before taking levo with a glass of water.

When having a blood test for your thyroid gland if you take levo in the morning, miss this dose until after the blood test. If you take a night dose, miss this and take after blood test and you can continue your bedtime regime as usual.

[monkey65]

Hi Karen

Levo can quite difficult to find a good Time to take because of needing to both keep apart from other medicines and from food. After trying different arrangements, I moved my other meds to the morning, and take just levo at bedtime. I do have to avoid evening snacks, but I just couldn't manage to wait an hour before breakfast!

[Hidden]

Not keen on breakfast but do like my morning tea so I'm going to try taking when hubby leaves for in morning. If that doesn't pan out I'm thinking hot water and lemon with levo in the morning and tea later. Starting tomorrow am

[harleychick]

take it in the morning when u get up every day at the same time

[Compo34]

I have recently received a note with my Levothyroxine that it must be taken on an empty stomach 30 mins before you have anything else and the best time is before breakfast.

[Mishella in reply to Compo34]

Me too. I am in the United States, if that matters. Both of my elderly parents are on it as well. My mom strictly follows what the bottles say and takes the pills according the the weekly dispensers I fill for her. She has breakfast about 30-45 min. after she takes it. Both parents take cholesterol lowering agents at bedtime, so that time doesn't work. Why does it say that on the bottle if all the information I'm reading on here contradicts that dosing schedule that close to a meal?

[helvella Administrator in reply to Mishella]

Partly because the evidence about bed-time dosing being a reasonable option was only published a modest number of years ago. (Though it has become quite clear that some individuals have done this for decades.)

Apparently it typically takes something like 17 years for evidence to get from research to clinical. This particular research shows that incredibly slow rate of information movement has had a supersonic boost by virtue of patients (i.e. us!) being able to read evidence from research papers, and to find them via PubMed, etc.

I suspect that there is even more delay in getting into Patient Information Leaflets (as they are called in the UK).

[Jcvickers]

I have been taking Levothyroxine in the morning with amour. Is that OK?