Those little white pills (aka generic levothyroxine) - are they all made equal?

When you are officially diagnosed as hypothyroid by the NHS, here in the UK, you are prescribed levothyroxine. Levothyroxine is considered to be a ‘life sustaining’ medication. In other words, without it we would die (eventually!). In the UK, hypothyroidism is one of a small number of medical conditions that currently entitles you to receive your ‘life sustaining’ medication completely free of charge.

In order to keep the cost of supplying this medication to the absolute minimum, it is usual for the prescribing doctor to simply write ‘levothyroxine’, with the relevant dosage, on the prescription. No 'brand' name is specified. This is known as prescribing ‘generic’ medication. It means that your pharmacy must give you levothyroxine pills of the specified dosage, but they can be supplied by any manufacturer.

The theory is that whilst levothyroxine pills are made by a number of different manufacturers at various factories, the end products are all the same. So a 50 mcg pill from one manufacturer will do the same job as a 50 mcg pill from any of the other manufacturers. It goes without saying then, that two 25 mcg pills from any given manufacturer, do the same job as one 50 mcg pill from another manufacturer.

Or do they?

What is your experience?

Are you one of the fortunate people who just take their levothyroxine every morning, regardless of the name on the packet, and get on with life in glorious thyroid health?

Or is that an ‘idealistic myth’?

Have you ever had adverse reactions to levothyroxine from particular suppliers?

Have you ever asked your GP or Endo to prescribe a specific 'brand' of levothyroxine? If so, what was the response?

Do you always get your levothyroxine supplied through the same pharmacy?

Have you ever asked a pharmacist to supply you with the same levothyroxine product each time they fulfil your prescription? If so, what was the outcome?

Maybe you automatically always receive pills with the same apparent 'brand' name on the packet, even though you've never requested this?

If you have a tale to tell about your experiences in obtaining your levothyroxine, please share it here.

[Thanks to 'amraphster' for providing me with the inspiration for this blog!]

10 Replies

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  • years ago, researching on the condition, it was pointed out that there are very small differences in the generic brands so I decided that I had enough problems with the medication that to eliminate one factor would be a good thing. Ever since I have used Goldshield for my pills. It takes a little longer to get the script filled but I get it OK. I am about to go to Barts to ask about Armour but I don't hold out much hope of getting it on the NHS. I cannot afford to go private and I feel that I have been robbed over the years as a lots of the symptoms that I suffer with might have been avoided and it is the brain fog and extreme wearyness that is so depressing. Anyway I hope this helps.

  • Re: asking GP for another brand?

    When I had first prescription I mentioned the reaction I had to HRT because of the sodium/sulphate? and was aware that this was in levothyroxine and as I new about purified levo and of course Armour and other NDTs - which I didn;t let on - I asked GP if there was any alternatives and he his answer was - no, this is what everyone else takes in this country! I bit my tongue and realised by his response I had no chance of getting different from him.

    I suppose that the only benefit was that he dispenses from his surgery so he would likely order in the same brand of drug.

    Interesting question though - the receptionist wasn't sure whether I had to pay or not - because I was being trialed for 3 months. I didn't pay but they did mention that I would have to have an exemption certificate - SO, when do you officially do that when your GP says oh we'll trial you for 3 months???

    I do wrok and don'y mind having to pay initially but if I don't have to the since I have a like everyone, a raw deal I will get what I am entitled to.

    S

  • "Are you one of the fortunate people who just take their levothyroxine every morning, regardless of the name on the packet, and get on with life in glorious thyroid health?

    Or is that an ‘idealistic myth’?"

    Myth. The different components in tablets are broken down in different ways by the body, resulting in different amounts of thyroid hormones being available to cells, "bio-availability". Different manufacturers put different materials in their tablets, so 50mcg in one is not 50mcg in another when your body has broken it up. T4 alone does not work for me, I showed a huge reduction in symptoms when I was also put on T3.

    My blood results, even allowing for rampaging antibodies, used to show a marked difference depending on which brand I ended up with. Codswollop to anyone who tells me otherwise.

    "Have you ever asked your GP or Endo to prescribe a specific 'brand' of levothyroxine? If so, what was the response?"

    Yes, GP prescrbied Eltroxin, which costs the NHS more. Problem was it was in short supply and pharmacies could not get hold of it for me, even London's biggest independent pharmacy hadn't had it in for at least a month. *Rank alert* What's the point of having branded stuff but it's not available???

    "Do you always get your levothyroxine supplied through the same pharmacy? Have you ever asked a pharmacist to supply you with the same levothyroxine product each time they fulfil your prescription? If so, what was the outcome?"

    Yes, yes, yes. My local independent really looks after me and stocks up Goldsmiths for me. He knows I have varying results with other brands. I'd be so very stuffed without my wonderful local pharmacist.

  • A visit to a pharmacy yesterday (one which luckily had a very helpful pharmacist on duty) has proved RedApple's point about the different dosages.

    Teva 25mcg are made by Goldshield and are *different* to the Teva 50mcg and 100mcg tablets.

    Rod

  • When I began to take levothyroxine I did have an improvement, but after four months I began to get other symptoms (new to me), I was told it was nothing to do with the Thyroid (and referred elsewhere). It is only due to Thyroid UK that I learned of generic and Brand names and also became diligent in what the Chemist gave me. After two years I asked my GP if he could prescribe a Brand name but he told me he was only allowed to prescribe levothyroxine. I asked my Endocrinologist but was told 'no' - just remain on what I was taking. (I think I was Euthyroid after five motnhs). So theoretically I was fine.

    I accidentally discovered a generic brand was the cause of my widespread joint/muscle pain (shoulders particularly felt dislocated during the night).I avoided that generic brand. My other symptoms continued and (thank God) my Endo permitted me to add T3 to reduced T4 (as long as I remain in Range).

    Within two days of adding T3 I had a great feeling of wellbeing. After four weeks my palpitations began to get strong again and I had a private blood test (22nd June), I decided to reduceT4 for seven days but because I began to feel well and had no need of betablockers as well as my other symptoms diminishing I have not as yet begun T4. My pulse with T3/T4 ranged from 80 to 144 - my pulse with T3 alone is 60 to 80. I am now quite positive that I have a sensitivity to all generic T4 .

    It may be early days, but it is great to feel 'normal' health' nearly every day now.

  • I'm on this site because of my 22 year old daughter who was born with congenital hypothyroidism.

    My daughter was very ill last year with an infection after surgery & for almost six months she was pumped intravenously with high doses of antibiotics & I believe this has caused something to go wrong with her thyroid medication as she now has all the typical thyroid symptoms, always sleeping, cold, depressed, bowel problems, feeling anxious etc. I researched sites such as this site after the GP gave us no help preferring to prescribe antidepressants (we decided not to take them) and found out that people in New Zealand were having problems with Glaxo’s levothyroxine & this was the brand my daughter was on. We don’t know how long she had been on this brand as you pick the prescription up, collect from the pharmacy and my daughter take the tablets. We now always ask for Goldshield at the pharmacy as most people via my research seemed to be OK on this brand, we also asked for the tablets to be 25 mg even though she requires 125 mg; she now takes 5 tablets everyday instead of 2 tablets of 100 mg & 25 mg because I’d also read about the size issue you mentioned. Within 3 days of starting on Goldshield she said to me, ‘Mum my urine looks so healthy’, I asked her why she hadn’t told me there was something wrong with her urine and she said she didn’t know as it had always been smelly and cloudy so she thought it was normal. She has been taking Goldshield for about 6 weeks now; her thyroid symptoms are only slightly better on the Goldshield but her urine remains ‘healthy’. Will continue on Goldshield for another 6 weeks then try a different brand however my daughter will now always take the dose in 25 mg tablets. We’ve changed GPs but the new GP wants her to go on antidepressants & once again we’ve refused; however I asked the new GP what her thoughts were on my daughter taking T4 & T3, she said she has been asked this by other thyroid patients & she would refer us to an endocrinologist so I guess this is a small step in the right direction.

    The only place we can get the Goldshield tablets is at Boots.

  • Cherrybaby,

    You may already know all this, but Goldshield also make a 'branded' version of levothyroxine called Eltroxin. I believe this is exactly the same as the 25 mcg pills that say Goldshield on the box.

    Eltroxin comes in 25mcg, 50mcg and 100mcg, and all the tablets have the same ingredients, so I would think there's less likely to be a problem with combining different strength tablets. This used to be the only 'brand' that GPs were able to specify. I don't know if GPs are still able to specify Eltroxin on the prescription, but it might be worth asking.

    Even if your GP is not able to specify, pharmacies are sometimes able to obtain Eltroxin for you anyway if you ask. (The pharmacist probably won't even realise that Goldshield and Eltroxin are the same thing).

    I also found that mixing different brands and strengths caused problems. So, much to my GPs bemusement, I now get my dose prescribed only in 50 mcg tablets, and split them in half as necessary to make up a particular dose.

  • Jeez it is all so complicated! Thanks for the info regarding Eltroxin & Goldshield.

    I asked the GP about the prescription & she said that can't name a particular brand on the prescription.

    What brand are you on?

  • I'm on levothyroxin and I have always been on this and I'm pretty sure this is on my prescription when I collect from my doctors, I don't understand What this mean does it mean I should be worried about I take every day

  • This seems to be a very common issue.

    Even an NHS endocrinologist said that there can be differences and to stick with the same maker. This was after me explaining this:

    After the first dose, I thought I was having a bad day. Then day 2, I felt like I had gone all week without!

    I completed the yellow card to report it.

    I stick with the same pharmacy and ask for Actavis manufacturer.

    I am sure many are the same or wouldn't make a difference, but for some reason I had a horrendous experience that time, which I do not wish to repeat!

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