Levo and mirtazepine together?

I'm hoping for any feedback about taking levo and mirtazepine together at night please .

This comes on the back of me stopping my levo for a week as I believed I was possibly over replaced ( or not even hypo at all) as I have been feeling hot, short of breath on walking etc etc but after days of no levo my results were :

Tsh 4 .7 (0.5 - 4.5)

T4 7.0 (9 -21)

Free T 3 1.1 ( unsure of labs ref range)

Clearly I was wrong so restarted but got quite unwell and nhs 24 sent me to A/E. My results there after 4 days of 75mcgs levo and one dose if 125mcgs were

Tsh 7.6

T4 12.0

They did do another T3 but said the result wld be sent to gp as it takes longer to get the result. ...all I can say is I felt dreadful. Unable to get breath in , faint etc.

They told me to take 100mcgs levo recheck in 6 weeks. My usual dose has been 125mcgs for 4 yrs . My tsh has been stable at 0.5 , T 4 around 14 for 4 yrs But last yr has been awful, lupus was questioned etc etc . I have also been on transdermal oestrogen hrt patch . With these latest results I have proved to myself that yes I am hypothyroid but also wonder if the oestrogen had been masking me becoming hypo whilst results looking ok? Also is it possible for my results to get that bad with one week of levo ? I must stread it was awful and a very misguided judgement on my part and wld never do it again or suggest that anyone else do the same.

So now I want to take me levo at night for max absorption as I have to have tea with milk in the morning to allow me to get to work! So I'm hoping I can take it mirtazepine before bed mirtazepine is taken at bedtime as it makes you very sleepy. Does anyone know of any possible interactions please ?

14 Replies

You can't take anything at the same time as levo. It would have to be at least two hours away, if not four. And levo 2/3 hours after eating.

Do you never get up in the night to go to the loo? If so, you could take your levo then.

Fraid not, the mirtazepine means I sleep like a little log which in most respects is very nice and welcome tho wld be handy if did!

But thank you for clarifying that for me ..I gave myself such a scare that I am going to concentrate on making sure I get the most out of my levo...so if that means going without tea or coffee for 4 hours so be it..I guess hot water wld be ok? Or maybe a herbal tea of some description? I'm afraid I get up for work 5.30, and need some form hot drink before heading out the door!

Waiting one hour would be sufficient.

I would not take hot water at the same time as levothyroxine as it's sensitive to heat.

Thank you , I didn't know that either..

It seems really tricky , is it possible to have anything to drink with it...what about non dairy rice drink?

No, anything you eat or drink except for cold/tepid water can affect the absorption of levothyroxine. I have to get up an hour early in order to take levothyroxine and give myself time to eat.

Thank you. I hear what you' re saying about having to make important adjustments and prioritise but I have to get up 5.30 am for work, get home around 6.45pm ...looks like I'm best with cold water and have hot drink once I get to work 😀

5.30 is awfully early. I used to have an hour's drive to work, it's no fun on an empty stomach.

..sorry do you mean I could have tea/ coffee an hour after levo ?

Yes, you could have tea/coffee an hour after taking levo.

Perhaps you need to take a flask of tea to work with you and drink it when you get there?

Have you considered that low vitamin levels might be affecting your ability to sleep soundly?

It might have been SlowDragon that posted this link and as people with hypothyroid conditions often suffer from low nutitional levels it might be worth considering?


Although it doesn't suit everyone there are some people who can fit in Levo or other thyroid meds better if they take them at bedtime. Have you ever tried that?

You would have to stop eating and drinking (except for water) a couple of hours before bed, and then take your levo just before you turn your light out to go to sleep.

Hi Humanbean, yes you rw tight originally that was my plan tho the snag is that I have to take mirtazepine at bedtime too and greygoose advises that levo must be taken by itself or 2 hours apart . mirtazepine makes you very sleepy within about an hr of taking so it's prescribed at bedtime so no leeway to separate levo and mirtazepine that I can see. I shall have to get used to it I guess and enjoy my tea at work !

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