Any advice on when is the best time to take medication?

Hi,

Doctor has finally agreed to put me on levothyroxine (50mg). Feeling a bit confued about the whole thing as I don't feel that he explained it very well... He said that I was to come back in eight weeks time and get a blood test but that it didn't matter whether or not I took my levo that day. He implicated that I should take my levo on the day of the blood test, and after reading a lot of the advice on this site, I am not sure that is the best thing? Also, can anyone with experience of going on levo tell me when is the best time of day to take my medication? Thanks so much

8 Replies

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  • ada11 The best time to take your Levo is when it best suits you so you could experiment. I take mine in the middle of the night/early hours as it is easier to keep away from supplements. I never found any difference from when I was taking it in the morning but some people do.

    Whatever you decide, take your Levo on an empty stomach, one hour before food or two hours after. Also a couple of hours away from other medication/supplements but iron, calcium and magnesium you should leave four hours.

    On the day of your retest, book the earliest possible appointment for blood draw, leave off Levo for 12-24 hours, drink water only, no breakfast. You can take your Levo afterwards.

    I think I can more or less guarantee that between the members on this forum the collective knowledge is superior to your doctor's!

  • Hi SeasideSusie,

    Thanks so much for your reply. That is all really useful information.... My doctor didn't really explain at all about when I should take my levo, so I was a bit nervous about it! My weight has totally shot up with hashimotos- do you think that might have an impact on how much levo I need? Do larger people need a larger dose? I had no idea about when to take my levo on the day of the blood test as my doctor didn't say anything but I feel informed now so thank you!

  • Depending on your results after your retest, you will probably need an increase in your dose. Then there will be another retest after about 6-8 weeks, maybe another increase, and so on until the test results are good and your symptoms abate. Unfortunately the two don't always marry up. Doctors are obsessed with TSH regardless of FT4 and FT3. A patient on levothyroxine usually needs their TSH to be around 1 or below and their FT4 in the upper third of the range, and the FT3 in the upper quarter. But as long as your TSH is somewhere within the range GPs generally tend to not bother with optimal nor how you feel. You may have to arm yourself with knowledge and fight your corner.

    As you have Hashimoto's your levels will fluctuate as and when the antibodies attack. There is no treatment for the antibodies, the only treatment is for the hypothyroidism that results as the thyroid gland is destroyed by the antibodies.

    What your doctor probably wont tell you is that if you go scrupulously gluten free (and some people need to be dairy free too), this should help reduce the antibody attacks. You could feel a lot better if you do go gluten free.

    Dose varies with the individual. You may need more due to your weight, you may not. It's not set in stone although I think there is a general guide of something like 1mcg per 1lb (or whatever the metric equivalent is). But that doesn't work for me, I need a bit more, some people need a lot more.

    See how it goes. It's early days. You will need a few retests and probably a few dose increases until things settle down. It's not a quick fix unfortunately.

  • Ada11,

    You can take Levothyroxine any time of day or night as long as you take it with water on an empty stomach. Taking Levothyroxine at bedtime can be more effective than first thing in the morning as absorption may be better.

    For maximum absorption Levothyroxine should be taken with water 1 hour before or 2 hours after food and drink, 2 hours away from other medication and supplements, and 4 hours away from calcium, iron, vitamin D supplements and oestrogen.

    It takes 7-10 days for Levothyroxine to be absorbed before it starts working and it will take up to six weeks to feel the full impact of the dose.

    You should have a follow up thyroid test 6-8 weeks after starting Levothyroxine. Arrange an early morning and fasting (water only) blood draw when TSH is highest, and take Levothyroxine after your blood draw.

    Most people will find symptoms resolve after their TSH drops to around 1.0 with FT4 in the upper range but symptoms can lag a couple of months behind good biochemistry.

    thyroiduk.org.uk/tuk/about_...

    _________________________________________________________________________________________________

    I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

  • My doctor never told me to take levothyroxine after the blood test-- I am so grateful to have checked out if that was a good idea on this site! It was hard enough to convince him to put me on it in the first place, so I am glad that I will no longer be planning on taking it on the morning of my blood draw! I take iron supplements as have an issue with low iron levels, so I will probably take it first thing in the morning, a couple of hours before breakfast. Thanks for your reply and the help!

  • I take mine three minutes before my morning porridge or ten minutes before a full breakfast if I'm on holiday. Coffee is perhaps the worst thing to have with levothyroxine as it has a big effect on absorption. Certain medications can also affect absorption.

    I'd avoid taking the levothyroxine within a few hours before having the blood taken as it can affect the result. If you find your schedule is difficult you can always take it at bedtime as you are unlikely to have a large meal or coffee at that time.

    Some patients take medicine containing an active thyroid hormone called 'T3'. This has a short half-live and so the timing of the medication and the blood test is important. Levothyroxine has a long (7 day) half life and so the timing will only affect the blood test result by a few percent, less than the accuracy of the assay.

    It's more important to be consistent with the timing since if you are not fully absorbing you will simply be prescribed a slightly higher dose to achieve the same effect. We all have different rates of levothyroxine absorption. So take it morning or evening, whichever suits you.

  • Thanks, jimh111, I think I will take it first thing in the morning as I take supplements in the evenings and don't want them to interfere with absorption. I do drink coffee, but will have it at least 2 hours after I have taken my levo... which should be okay, I hope.

  • The research looked at coffee with and one hour after taking levo ncbi.nlm.nih.gov/pubmed/183... . I woud guess (I mean guess) that two hours would be OK. In any event if you have a regular routine it shouldn't be a problem as it will get factored into your dosage based on your symptoms and blood test results. I wouldn't go to any lengths or restrictions, the idea is to have a normal life.

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