Teva Levo.

[foxglove]

I know this has probably been asked before but does anyone know what's in Teva brand of Levo that makes it so unsuitable for a lot of people? Thanks

[SeasideSusie Remembering]

You can check ingredients of all brands of Levo here:

thyroiduk.org/tuk/treatment...

Mannitol seems to be an ingredient in Teva but not in any others, and it was also in the French Levo that caused such a problem for many people and the manufacturers were required to go back to the original formula.

[foxglove in reply to SeasideSusie]

Thanks will do a check. Mannitol is indeed in Teva but I do not think it states the amount! Will have to do some "research" if ness. contact Teva suppliers !

[SeasideSusie Remembering in reply to foxglove]

I don't think the amount of any excipients is ever stated, just the amount of the active ingredient Levo.

[foxglove in reply to SeasideSusie]

On the limited bit of probing I have done you seem to be correct! I'm taking just 25mcg levo so I'm giving it a try as - rightly or wrongly ! I'm assuming not much mannitol in that dose

[Angel_of_the_North in reply to foxglove]

But if you consider that most tablets are much the same size, there are probably more excipients %age wise in a low dose tablet.

[foxglove in reply to Angel_of_the_North]

It's the ACTUAL amount I'm interested in!

[helvella Administrator Thyroid UK in reply to foxglove]

Contact Teva!

tevauk.com/contact-us/

[foxglove in reply to helvella]

Have tried ...and how. Get on to site fine but finding what I want? ...difficult. They seem to state that glycerol is what's in the Levo

[SeasideSusie Remembering in reply to foxglove]

They seem to be shy about giving contact details on that website but invite you to contact them via social media:

tevauk.com/contact-us/artic...

Or there are some phone numbers that come up with a Google search which you could try :

google.com/search?q=teva+uk...

[foxglove in reply to SeasideSusie]

Thanks for taking the trouble to help. Sadly no further on, hate admitting defeat but think will have to on this one!

[helvella Administrator Thyroid UK in reply to foxglove]

Their Patient Information Leaflets and Summary of Product Characteristics documents are available here for their levothyroxine products:

products.tevauk.com/p/levot...

I suspect you'll find the glycerol-containing products are their liquids.

[foxglove in reply to helvella]

Thanks I've stopped bothering about what amount of Mannitol Teva Levo contains, in fact at least I've found a lot of info re Mannitol, name comes from manna, (can't be bad) and though a form of sugar alcohol contains neither. Think in small amounts is just a sugar substitute I've been taking the Teva Levo for a week or so now and have no adverse reactions. Don't know whether to be pleased or not as I quite enjoy questioning the dr's prescribing! Should get out more!!!

[helvella Administrator Thyroid UK in reply to foxglove]

It does appear that some people are just fine with Teva levothyroxine - others not. It is only our suspicion that it is the mannitol - haven't got any good ideas what, but it could be some other factor.

When I tried it, I did not feel well on Teva despite it only being a small part of my dose.

[helvella Administrator Thyroid UK in reply to SeasideSusie]

I thought phoning or emailing!

Our Medical Information Service can help with enquiries about your medicine, for example its appearance, whether you have questions about what it contains, how it works, or the Patient Information Leaflet. Tel: [phone] / Email: [e-mail]

[SeasideSusie Remembering in reply to helvella]

Oh well done. I missed that!

[SlowDragon Administrator in reply to foxglove]

Mannitol can change gut flora

Standard starter dose of Levothyroxine is 50mcg unless over 60 years old

Can see you are over 60, so yes starter dose is 25mcg. But dose is still increased slowly in 25mcg steps

25mcg dose can make symptoms worse. Levothyroxine doesn't top up your own thyroid output. It reduces TSH and slows your own thyroid output and replaces it.

Most people eventually need somewhere between 100mcg and 200mcg Levothyroxine

nhs.uk/medicines/levothyrox...

Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)

NICE guidelines

cks.nice.org.uk/hypothyroid...

The initial recommended dose is:

For most people: 50–100 micrograms once daily, preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (such as coffee or tea), or other drugs.

This should be adjusted in increments of 25–50 micrograms every 3–4 weeks according to response. The usual maintenance dose is 100–200 micrograms once daily.

Very important to test vitamin D, folate, ferritin and B12

These frequently need supplementing when on Levothyroxine

[foxglove in reply to SlowDragon]

I am well over 60 and when I tried increasing to 50mcg became hyper and T3 ?)I think) increased a lot I'm just going to trial Teva....take a chance and live dangerously!!! I think will not actually do anything . I was just curious aat the tirade against Teva!!!

[SlowDragon Administrator in reply to foxglove]

Very common to have low vitamin B12 as we get older

This needs to be optimal (plus optimal folate, vitamin D and ferritin too)

[helvella Administrator Thyroid UK in reply to SeasideSusie]

Mercury Pharma levothyroxine/Eltroxin says:

Each tablet contains 100 micrograms Levothyroxine sodium anhydrous .

Excipient with known effect

Lactose 48.86mg per tablet

medicines.org.uk/emc/produc...

Each tablet contains 50 micrograms Levothyroxine sodium anhydrous.

Excipient with known effect

Lactose 48.86mg per tablet

medicines.org.uk/emc/produc...

Each tablet contains 25 micrograms Levothyroxine sodium anhydrous.

Excipients with known effect

Lactose 30.49mg per tablet

medicines.org.uk/emc/produc...

I have not found any other quantities of excipients.

[silverfox7]

It was formulated for people who are lactose intolerant as I understand and many are fine on it but bad news always travels quicker than good sadly!

[helvella Administrator Thyroid UK in reply to silverfox7]

There has been a widespread move towards mannitol, across a number of medicines, for several reasons.

One manufacturer of mannitol has this to say:

Mannitol is classified as a sugar alcohol and is derived from a sugar (mannose) by reduction. Other widely known polyols are xylitol and sorbitol. Mannitol and sorbitol are isomers, differing only in the orientation of the hydroxyl group on carbon two. The physical properties of mannitol make it suitable for use as a bulking agent in tableting. However, it also has unique chemical properties that enable it to stabilize a wide variety of pharmaceutical preparations, including liquid formulations, as well as protect proteins from denaturation/degradation upon lyophilization, spray drying, and reconstitution.

Pfanstiehl Brand High Purity Low Endotoxin Mannitol was developed specifically for biopharmaceutical use, to the highest quality and purity standards. It has been utilized as a key component to stabilize proteins during formulation, freeze drying, and finish/fill applications.

The various benefits imparted by Mannitol include but are not limited to:

• Enhanced Protein Therapeutic Stability

• Vaccine Stabilization

• Carrier in Lyophilized & Spray Dried Formulations

pharmaexcipients.com/organi...

[silverfox7 in reply to helvella]

That’s interesting! Thank you for posting. It was given to my husband following a RTA and was in a coma. I was told that it helped prevent swelling on the brain and he mustn’t be given too much fluid. I would have probably taken that on board except they monitored what liquids went in against what came out! He was probably in a coma for around at least three weeks though so the fact it contains sugars would have been more reassuring! I appreciate it was also important not to give him excess fluids but knowing the full remit would have put my mind more at ease.

[Achilles_Pain in reply to silverfox7]

The chemist dispensed Teva to me many times in the past and I was always fine on it, but when they dispensed it in February this year (the first time in several - has it been off the market for a while?) all my symptoms returned. It's only 1/3 of my dose (25 mcg out of 75) but ALL my symptoms returned. As soon as I went back on to my normal brand I slowly started to recover, and even now, 8 months later, I'm still in recovery mode. My running has gone downhill and I've gone part time at work as I was too exhausted to do 5 days, not waking up at the weekend until 11 o'clock some days.

[SeasideSusie Remembering in reply to Achilles_Pain]

Original Teva was withdrawn in 2012 and a new formulation Teva introduced in late 2016, it's this new formulation with Mannitol that has caused many side effects for lots of patients.

[SlowDragon Administrator in reply to Achilles_Pain]

Achilles_Pain

Perhaps it's time you retested levels. Low FT3 can be a problem especially if doing strenuous exercise like running

75mcg is only one step up from starter dose

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Ask GP to test vitamin levels

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

[Achilles_Pain in reply to SlowDragon]

SlowDragon

I've been getting regular Medichecks blood tests for 15 months.

Both antibodies are low (9 & 10),

T3 varies between 5 and 6 (range 3.1 - 6.8),

T4 varies between 18 and 20 (12 - 22) and

TSH 2.38 last test (0.27 - 4.20). The TSH is always higher than NHS test (1.41 last week, range 0.3 - 5.0). Always done first thing on an empty stomach, take my tabs afterwards.

B12 is around 90 (37 - 188),

Ferritin around 125 (30 - 400),

Folate around 11.5 (3.9 - 26.8) and

Vit D around 90 (50 - 175).

NHS hasn't tested T3 or T4 since January 2017.

I've never had any other vitamins tested.

Last week I just happened to be called in for an NHS health checkup and out of 30 odd different tests only one (mean platelet volume) was outside its range (11.5, range 5.9 - 9.9) The only Thyroid related test was the TSH mentioned above. Apparently I have a 4.3% chance of cardiovascular disease in the next 10 years.

[SlowDragon Administrator in reply to Achilles_Pain]

Your TSH is higher than many people would be happy with. But if you feel well then it's right for you. Your FT4 and FT3 are both good.

It's wrong NHS only tests TSH and that we are all forced to test privately

[Achilles_Pain in reply to SlowDragon]

Ah, yes, I know, and I don't feel well. The aches and pains, dry skin etc have all been getting worse of late. I thought my NHS health check last week was with a GP, but it was "just" with a nurse and she said I need to make an appt with a doctor. Free slots are as rare as hen's teeth, when I tried to make an appointment there were none available. I'll try again in a week or two. My official prescription is 75 mcg, but I take 100 four times a week - I should probably tell them.