How can i get a particular brand of Liothyronine and Levothyroxine on prescription?

Hello folks,

I had previously asked my Dr to prescribe me a specific brand of Liothyronine and she said she wasn't able to as she was just able to prescribe it as generic Liothyronine. I would like to stick to the same brands of Lio and Levo, is there anyway of the Dr doing this, and if so, any advice on convincing her to do this?

I asked the Pharmacy if the Dr writing it on by hand (if the computer system wouldn't let her specify a brand) would be acceptable but they said it had to be printed on it as otherwise when they scanned it in the system would just read the Liothyronine bit and that is what they would be paid for, not a specific brand.

Thanks for reading :)

28 Replies

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  • Kittenmittens,

    What brand T3 is it you want?

    Mercury Pharma T3 is the only T3 licensed for UK use. Your GP could write a named patient basis prescription specifying Thybon Henning (German T3) or Sanofi Cynomel (French T3) but as GP's accept personal responsibility for prescribing unlicensed medications s/he may not be willing to do so and can't be obliged to.

    thyroiduk.org.uk/tuk/treatm...

  • Thanks Clutter,

    Yes, she is doing it on a named patient basis. I was originally on Mercury but it really didn't work for me. So, I went back and asked to be prescribed the 5mcg tablets as a way to get a different brand. She did this and originally prescribed Cytomel, but the Health Board said it was too expensive, so then she said she could prescribe it as a generic. I then got Perrigo, and having thought that Perrigo and Cytomel (and Mercury) were the only available brands of Lio that could be prescribed going on this information thyroiduk.org.uk/tuk/treatm... I thought this was what I would always get. But this time I got tablets from Sigma Pharm.

    So I would like my Lio to be from Perrigo (which I am doing well on), and my Levo to be from Actavis, rather than chopping and changing which brand I get each time.

  • Kittenmittens,

    Your GP needs to specify on your prescription that you are to be dispensed Perrigo 5mcg tablets.

    Have you told your pharmacist that you only want Actavis? If pharmacist won't order in Actavis, either take the prescription to another pharmacist or ask your GP to specify Actavis on the prescription.

    The downside of having the make prescribed on a prescription is that if, for instance, Actavis is not available you would have to go back to your GP for an alternative prescription because the pharmacist can only prescribe what is on the prescription so couldn't dispense Mercury Pharma, Wockhardt or Teva instead.

  • Thanks Clutter, the GP said she was not able to do this, as it just came up as generic Liothyronine on her system. Is she wrong about this do you think?

  • Kittenmittens,

    There should be a way to over ride the system IF a GP needs or wants to. Perrigo 5mcg Cytomel is not generic and is considerably more expensive than 20mcg Mercury Pharma Liothyronine which is already extortionately priced so price is probably a consideration.

    Talk to your pharmacist about the generic makes you are being dispensed if you feel better on one make than another. Ditto, if you want Actavis tell your pharmacist and if pharmacist won't order it for you ask for your prescription form back and take it elsewhere to be dispensed.

  • Yes, I had to look into all the prices, and Perrigo is cheaper than Cytomel and Mercury. However, at the time I wasn't aware there were other brands, so not sure how Sigma Pharm fits in price wise.

    I am only allowed to get my Lio from Boots (the Health board has stipulated this as Boots provide Perrigo CONSIDERABLY cheaper than other pharmacies). And Boots said it has to be stated by the Dr if a particular brand is required.

  • For 100 Perrigo Liothyronine 5mcg tablets Lloyds charge £359.00, 2 independent pharmacies that I contacted charge £154.50, Boots charge £99.62. The Health board can refuse anything if they class it as too expensive, and if they know a product can be got more cheaply than what a pharmacy are quoting then they might refuse it. They are not stipulating where I can get it as such, but are stipulating the price they will accept it for (they are not directly saying this as such, but stipulating it by refusing it if it is more expensive).

    And they know the costs as every time my T3 prescription has to be filled the pharmacy has to contact the health board and the health board will ask for the costs. So, I don't know if they have a list of prices in different pharmacies as such but they will be aware of what the pharmacies charge and will be aware if it is more expensive than they have encountered before when they ask the pharmacy the price before they agree that the prescription can be filled.

    I don't know for sure that they would refuse the £154.50, but I'm pretty sure they would refuse the £359.00 price when they know it can be obtained for £99.62. I haven't actually been refused it as after they refused the Cytomel I looked into all the prices and went with the cheapest price to try and ensure they wouldn't refuse the Perrigo. This was on the advice of my Dr and a pharmacist who told me health board might refuse it if it could be obtained cheaper.

  • There are several USA makes of liothyronine - I think all are available in both 5 and 25 microgram dosages.

    Details of most, possibly all, USA FDA approved medicines are available here:

    dailymed.nlm.nih.gov/dailymed/

    From memory, makes of liothyronine include:

    Perrigo (formerly Paddock)

    SigmaPharm

    Mylan

    Pfiizer

    There are several re-branded products used by some of the major health providers such as Kaiser. Have no idea if they are always the same make or if that changes from time to time.

    Sometimes you really do have to go to photos of tablets to be sure what the products are. The actual tablet characteristics should be unique to each maker.

  • Thanks Hellvela, do you know if all these makes available on prescription in the UK (on a named person basis)?

  • In principle any UK doctor can prescribe almost anything.

    The issues end up being:

    Is there any way of a pharmacy getting hold of the product through legitimate channels?

    Is there funding - whether from the NHS or your own pocket - for the medicine?

    Occasionally there might be some extra controls such as with controlled drugs.

    Companies such as Idis are specialist medicine importers and, if they handle the product, any pharmacy could get hold of it. (They simply need to set up an account and put the order in. Big companies are probably less willing to do this than small ones.) There are extremely unwilling to communicate with patients.

  • Some pharmacies such as Boots and at least one other pharmacy local to me supply Almus - which is a Boots own-brand and has always actually been Acatavis. (Theoretically they could change, so do check the Patient Information Leaflet every time it is dispensed.)

  • Yes there is i had the same problem, i prefer to stick to Wockhardt thyroxine so my doc puts on my script patient prefers Wockhardt. It is printed on my prescription and there should be no reason why they cant do that, i have no problems now and get the same brand every time

    Dotti

  • Thanks Dotti, does the actual medicine name say Wockhardt Levothyroxine, or is it added as a note?

  • It is added as a note on my script it does say levo thyroxine then underneath it says patient prefers wokhardt, initially i had a bit of do with my G.p about it but i wouldnt give in and in the end they added it on.

    Dotti

  • I too have Wockhardt Brand Levo specified on my script. It took me a while to get - I asked my doctor about 3 years ago and as I always then received the same brand assumed that there was a note in the system. When I took home a batch of tablets recently from the pharmacist without checking the brand only to discover I had Mercury tabs (which make me feel terrible) and had to return them, the pharmacist told me that they could not be redispensed and had to be thrown away (6packs). She also said that the brand was not specified on the script. She was pretty miffed, so I sent an email to my doctor explaining what had happened and it was added to the script. I now always check but can see from my online notes that it has been specified. However there may not be a cost issue in my case.....

  • I have talked to the Dr now and hopefully my brands of Lio and Levo are now specified on the script. But I'll always need to check when the prescription goes in and when I get the pills to make sure I think.

  • That's good, and worth checking each time, as I don't think everyone realises that it can make a big difference. Although my pharmacist was a bit cross with me, she was also the one who had verified to me that in her experience different brands do make a difference when I first encountered problems, and suggested that I could specify on the script. Good luck!

  • You could print this out and highlight the section that clearly states if you have to change brands then GP must retest you as different brands give different results at same apparent dose

    endocrine.org/~/media/endos...

  • Thanks SlowDragon, but as those are American guidelines I don't know if the process is the same here in the UK.

  • I know it's US based BUT it is from recognised society of endocrinologists. Not just a thyroid support group.....so GP should take notice (can but try)

    20 + years ago when I said thought changing brands gave different results and definitely did not agree with me I was laughed out of GP's surgery. In the end they did listen (I was so ill I was in wheelchair by then) and since then I always ask for & get same brand (MP)

    Still always need to check what's in the bag before you leave the pharmacy. Only recently I found 3 different brands in same bag, despite very clear notes attached to my record.

  • I shall take the report with me and produce it if needs be, as you say, I can but try.

    I had no idea that different brands could be so different until I started on Lio, but the difference between Perrigo and Mercury is huge for me.

    I will need to start carefully checking what medications I'm being given if the Dr agrees to put a brand on the prescription.

  • Thanks ellismay,

    I shall indeed take that one too, it says it pretty clearly there, 'brands are not interchangeable!' Exclamation mark and everything!

    How I wish it wasn't always such a fight to be listened to.

  • The MHRA report (link below) considers but rejects make-specific prescribing. Go to the recommendations at the end. The way it is written suggests to me that it was seriously discussed and only just failed to be recommended.

    gov.uk/government/publicati...

  • Thanks Helvella, this is interesting reading.

    This report at the very least shows that there are concerns and that I am not alone in experiencing difficulties in changing brands (although this report is on levo and not Lio which I had the problem with, but I want to keep both of them on one brand to avoid any future problems).

    And these statements:

    " ...certain hypothyroid patients who are sensitive to

    minor fluctuations (either increases or decreases) in their thyroxine levels. For these groups of patients, the content of levothyroxine in the tablet (assay or potency) and bioequivalence (or interchangeability) is extremely important."

    and

    "Currently licensed levothyroxine products in the UK were approved many years ago, under

    previous legislative requirements. Consequently, these products, which are used interchangeably, are not supported by clinical data such as bioequivalence as expected by today’s standards."

    and

    "reports of adverse reactions associated with

    changes in TSH values were further analysed. Of these, 177 reports (88.9%) were associated with a change to a different make of levothyroxine tablet"

    and

    "There are

    also reports of formulation-related variability, where differences between the non-active ingredients (excipients) in different tablet products can cause changes in therapeutic response."

    Make me wonder how they came to the conclusion that maintaining consistency in brands wasn't necessary. They don't necessarily know if different brands have the same Levo bio-availability. Their conclusion seems to have been reached by saying, 'well it's been done for years so it's okay'. Thing is it's not okay for everyone and the Dr's/Health boards often don't listen. It would have been good if they had added that although it might not be 'necessary' to keep to one brand, it should be supported if a patient requires it.

    Do you happen to know if the 'recommended review of Liothyronine products' materialised?

  • Did that pig fly?

    You have very obviously read the report thoroughly. :-)

    An interesting point arises - as reformulated Teva levothyroxine is a brand new product, it should be formulated to be bioequivalent so as to support interchangeability. But with what as all the other products are old-regime...?

  • Rubbish she can prescribe a particular brand!

  • I get a particular type of calcium actually typed on my prescription

  • I have hopefully gotten this sorted now, I have talked to the Dr my brands of Lio and Levo are now specified on the script. But I'll always need to check when the prescription goes in and when I get the pills to make sure I think. Thanks for everyone's comments and advice. I really wish this was all a lot easier.

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