Hi, does anyone know if taking Levothyroxine is a contraindication for propranolol? My anxiety is getting worse - mainly because I’m too unwell to work, stuck in my flat, no money (don’t even start me on the uselessness of Universal Credit!) and it’s affecting my relationship and I need to sort something before I do or say something I regret.
Thanks
Was the prescribing doctor or the pharmacist aware that you take Levo?
Have you checked the patient information leaflet of both medications?
You can find answers on Google but from what I understand Levo may make propranolol less effective.
From this patient information leaflet medicines.org.uk/emc/produc...
Beta Blockers: levothyroxine (thyroxine) accelerates metabolism of propranolol, atenolol and sotalol.
How long a gap do you leave between taking the two medications? I imagine if you take them opposite ends of the day any interaction may be lessened, but probably best to speak to either your pharmacist or GP.
I’ve not got propranolol yet...I’ve been on it before for anxiety.
Yes, is the answer and this is a previous link with comments:-
healthunlocked.com/thyroidu....
I hope your doctor will be sympathetic and next time you get a blood test (which should always be at the very earliest, fasting (you can drink water) and allow a gap of 24 hours between last dose of levo and test and take afterwards.
Unfortunately, clinical symptoms if hypo are usually prescribed something for the 'symptom' instead of maybe added some T3 which is good for anxiety and your doctor or Endocrinologist should also test the Free T4 and Free T3. These are rarely tested and it is T3 which is needed in our millions of T3 receptor cells - the brain and heart need the most. Quite a number of Research has shown than a combination of T4/T3 can be very beneficial. in a 3:1 or 4:1 basis. I know they withdrew it - without notice - a few months ago and left those prescribed it in a turnmoil. The case is now before the House of Lords.
There is no history on your Profile - only your name. It is helpful if you complete (if you wish), i.e. when diagnosed, with what, and thyroid homone replacement (ie usually levo (T4 alone). You don't need to then repeat some information :).
thyroiduk.org.uk/tuk/about_...
thyroiduk.org.uk/tuk/testin...
The aim, eventually, as your dose is slowly increased is a TSH of 1 or lower and FT4 and FT3 towards the upper part of the range.
Thanks for the information. I’m taking 75mcg levo at the moment, repeat bloods in 3 weeks (done as suggested - first thing before meds) then hopefully another increase. Endo today said to do this until TSH is at lower end of range and FT4 is at upper end of range...regular tests, regular increased dose, then review.
Ah I see. There’s a possibility your anxiety is linked to not yet being on the right levo dose.
I get anxiety when hypo (despite it being linked to hyperthyroidism) as I know I’m struggling mentally to think clearly and I feel low on energy - life is just harder like this! It affects your executive function. So then can create a secondary mental anxiety. Mental processes esp when anxious can take up a LOT of energy; viscous circle.
It’s whether your Gp thinks:
1.)it’s worth starting beta blockers to deal with mental stress now, and just go ahead with the regular tests and dose adjustments accommodating the beta blockers.
Or
2.) wait till you’re fully stable with tests and doses and see how you are for month or two.
I expect they’d suggest option 1 to be honest, but fully up to you as you and your Gp know your context best. Of course, when stable, and feeling happier you could come off the beta blockers and see how things are then.
I took slow release beta blockers for many years due to work stress and just had to raise my thyroxine a little - in me it was 12.5 (25 extra alternate days). I took them daily though so that there was consistency. I believe they reduce the conversion in ‘peripheral tissues’ so are used to combat mild hyperthyroidism.
The only thing (ideally) to check is a full blood test before you start, keep being consistent in how you take your meds and then get retested in about 2-3 months.
There’s always the possibility you’re not on the right thyroxine dose which for me adds to anxiety however I always found propranolol an absolute godsend. I discovered the need for a bit more (in me) after chronic constipation and then Gp noted she’d have preferred a better previous thyroid blood test. Went up extra 25 which was too much, settled on the alternate days.
I’d personally ask Gp of you can baseline it by testing tsh etc before you start propranolol; they may just suggest starting the propranolol and a follow up check up in a few months.
I have to say, life was so busy, I swallowed them all together. In my opinion, if you’re consistent in how you take them and monitor symptoms and tests, it’s ok. But I don’t have any conversion issues and was healthier as the stress was reduced.
Also, T4 - levothyroxine is an inactive hormone and has to convert to T3. T3 being the Active thyroid hormone needed in all of our millions of T3 receptor cells that enables our body to function as normal. However in the UK the pharma companies have raised the cost of T3 so high that the Organisations withdrew it from being prescribed but we're working towards getting it reinstated. Some members source their own but the majority of people on levo do convert it to T3 so they recover on levo.
I’ve never had my FT3 level tested because my doctors don’t/won’t do it. I’ve not got the ££’s to get it done private either
If by contraindicated, you mean they should never both be taken, then no, they aren't contraindicated; but they are cautioned as each does have an effect on the other (for instance propanolol affects RT3) so it is important like all meds and Levothyroxine, to take them several hours apart. I have taken propanolol for several years now, and only had a problem with slow release at a higher dose because it added to the effect of my three anti-hypertensives meds and lowered my HR too far. Otherwise no problem.
I had to take propranolol and Levothyroxine for almost 20 years. Levothyroxine on its own caused unbelievable anxiety. More on my profile. Turned out to be mix of low vitamins/gluten intolerance and Hashimoto's.
Getting Levo dose high enough to bring a TSH down should help. Obviously this has to be increased slowly in 25mcg steps and can't be rushed
Getting vitamin D, folate, B12 and ferritin tested by GP or endo. These are often too low and improving by supplementing can help significantly.
Also, especially with Hashimoto's, gluten can be hidden problem
I found anxiety just slowly improved once strictly gluten free and was able to very very slowly ween off and eventually stop propranolol.
Lots of links about gluten intolerance and anxiety on the net. Eg
ncbi.nlm.nih.gov/pmc/articl...
If you do start propranolol, be aware you must only stop it very very slowly
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