Hi everyone, had a quick check through previous posts regarding how to store levo during heat above 25°C & hoping someone has fresh ideas? All my bottles have reached above 25°C no matter what I've tried (including but jo limited to: mistakenly refrigerated; left bottles in their cardboard box surrounded by icepacks in a cool bag but evidently too cold for the meds, gave me an upset stomach it was too cold).
Like most people,this freak heatwave in the UK is over 30°s & heat is being retained in every part of the house. Pharmacy cannot guarantee to keep stock below 25 either so essentially the levo is doomed from the start.
I am having some real side effects including huge slumps throughout the day, excessive weigh gain despite eating normally (we all know levo regulates metabolism) & affecting menstrual cycle. Any advice regarding storage during this time is greatly appreciated, my GP is utterly useless with help in the matter!
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VikingMama16
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Thank you for your reply but with levo you shouldn't put it in the fridge (read the leaflet after I tried this as it upset my stomach). Appears extreme temperatures of hot & cold affect it greatly.
Small cooler devices (such as sold for a few beer cans or "camping" coolers) are often based on Peltier devices. These can reduce temperature by a few degrees (you see anything from 5 to 20 C quoted).
In the bad old days before we had a fridge we used to keep milk etc outside in a bucket of water out of direct sunlight. You could try that. Not 30 degrees here though.
More 'old school' solutions , still used by folk without electrickery, or houses,( when they can't find a convenient cave.)
1... Dig a hole under a shady bush, put a metal box (with lid) in hole,Army surplus Ammunition box is ideal, keep things in there. Cover hole with something insulating, and light coloured.
2.. DIY version of helvellas link to earthenware coolers...... use the Evaporation =Cooling principle. Washing up bowl with 2" water in, put some sort of glazed pot in that (size depends on shape of items you need to cool) Put item in pot. Wet a tea towel or similar, and wring it out,Drape it over the pot so that it's edges are in the water. Place outside in a place with some movement of air, but out of the sun.
Cheep and cheerful, effective as long as you keep the water topped up. In practice the success of this seems to depend on finding the 'right' piece of cloth, since some things wick water up better than others.
Also , just a thought . Fridge door compartments are much 'warmer ' than the rest of the fridge, according to the 'instruction leaflet on my new fridge.
Thank you for your reply. You are quite right with those medications being stored in hot countries but I believe they have different ingredients/formula to cope with the extreme heat, whereas in the UK it's rare for temperatures to reach over 25. I always keep them in their cardboard box in a cupboard in the coldest room of the house which is away from sunlight but chucked a thermometer in there the other week during the first heatwave & it was almost 28.
Hi there - I have just been in touch with Teva - because on taking my Levo liquid this morning it was warm. Believe it or not they have no answer and it is being treated as an urgent safety issue - I will be contacted as and when. Will report back.
Thank you for your reply. Yes I take Teva too, they have been utterly useless responding to me regarding this matter so thank you for commenting they have raised this matter as urgent. I will send them another email, thank you!
In Australia, some makes mandate refrigeration of levothyroxine tablets.
Some years ago, they had the choice of either shortening expiry dates or insisting they are refrigerated. They decided the effects of refrigeration were a better choice.
Two issues I am aware of with cooling levothyroxine tablets. First, condensation, especially if a pot is repeatedly taken out, opened, a tablet removed, and put back into refrigeration. Especially in a high humidity environment. (Blister packaging helps a lot.) Second, changes to the precise hydration of the levothyroxine molecules - though whether that makes any real difference, I do not know.
I have no idea about liquid levothyroxine in hot countries.
The other thing is that in quite a lot of very hot countries, those which are rich, air conditioning is taken for granted.
Don't send an e mail that is the problem - their number is:
0207 540 7117 Option 2
Good luck you should report as well. I have found I have had to reduce my dose in this hot weather so I offered to them that it may be making it stronger. Trouble is IF in hot countries they put an extra ingredient in to cope with higher temps - not sure I want anything else in it to cause us problems for just a few weeks of a year but there again...............
I used the "chat now" function & they provided that telephone number as well, thank you. Teva are investigating it but there is nothing they can advise other than "keep it under 25°C out of direct sunlight".
Thank you everyone for all the help & hopefully this thread will help others as well X
No. There are some which are categorically unaffected up to 50 C. But I think that 25 C is the universal "normal storage" top temperature.
Levothyroxine is both known to be affected by temperature and must have dosing very precisely controlled. If, for example, a paracetamol tablet reduced from 500 to 400 milligrams, so what? The patient might not notice anything at all. (Assuming there are no unpleasant breakdown products.) The same percentage reduction in potency of levothyroxine could be very significant.
The MHRA did stir things a bit in 2006 or thereabouts regarding pharmacy storage conditions.
There are some medicines which have mandatory cold storage conditions - for them, every step of the way must be managed and storage in pharmacy must be in an approved cooler. In some ways, that makes it easier - simply because it is recognised.
Well here is official and absolutely useless reply.
Dear Amanda,
Thank you for contacting Teva UK Medical Information Department.
Unfortunately we hold no Extended Stability Data (ESD) for Levothyroxine 50mcg/5ml oral solution (PL 00289/1594). We can only recommend that you follow the licensed precautions for storage as outlined within the Patient Information Leaflet (PIL), section 5 How to store Levothyroxine, which is the following: Do not store above 25°C. Store in the original package in order to protect from light.
Please note that you cannot refrigerate the product. We advise you to store the product in a cool place away from any direct sources of heat or light. We would not recommend the use of the oral solution outside the product's licence, as we will not be able to guarantee its safety and efficacy. Please speak to your doctor or pharmacist who will be the best person to advise you on your treatment and care and may be able advise a suitable alternative.
Additionally in your report you stated that you are altering the doses, since you feel that heat makes the medication stronger. Please have in mind that you should always take this medicine exactly as your doctor or pharmacist has told you. Please check with you doctor or pharmacist if you are not sure.
Following your report, our UK Drug Safety team may wish to contact you for further information as they conduct continuous monitoring of our medications for safety purposes.
Pretty much the exact response with my telephone call to them today. Thank you for posting their reply on here. I have checked the link to earthenware milk coolers helvella posted on here earlier today & I think that maybe a viable option in this excessive heat. A terracotta pot with some form of lid will probably do the trick too, anything to cool the meds down!
I hope they have the facilities to control the temperature: my pharmacy is struggling to keep their storage room below 25°C despite a temp control room, the heat in Sussex has been too intense. Got my fingers crossed for your chemist providing a better solution 🤞
I think we perhaps need an all-medicines issue raised with the MHRA.
Part of licensing should be to include safe storage information. I'd suggest a blanket 50 C for everything. That covers now with a margin to allow for most of the world. (Seems not unreasonable to accept that places which go over 50 C might need to take extra measures.)
Companies should have to include a statement saying either that the product is stable in extended storage up to 50 C. (And if precautions need to be taken against very low temperatures.) Or in what ways it isn't and what techniques are allowed (e.g. refrigeration or simply limited exposure - say one week in a year).
Well, I have simply emailed the MHRA in the past about various issues.
Trouble is, at present, they are severely overloaded.
Perhaps we should be helpful and do something like start a petition?
At least that would show that there is a need for the issue to be addressed?
Suggest start a new thread to discuss what we want from a thyroid point of view. I'll raise it with other admins. It is clear as day that writing a petition statement is not something to be rushed. Some fall by the wayside because they do not make sense, are unclear, too long, etc. Better take some time now and do a decent job of it.
Hi there - trouble is they will put a preservative in the product which might affect us all down the line - although they can't just dump on us like that.
Of course, something like that could happen. But preservatives only help with biological (bacteria, fungi, etc.) issues. Not physical where the actual substances change in various ways due to heat.
Asking for the manufacturer to have checked, and us to be told, doesn't necessarily imply any changes to products at all.
Thank you for the suggestion. I wouldn't even know where to begin with a petition but it sounds like you have considerably more knowledge & insight within this area which we all greatly appreciate.
Teva have contacted me with a questionnaire regarding symptoms caused by overheated levo & yesterday they emailed to ask for my address so I could send back any bottles that have been affected by the excess heat for them to test. They are providing a prepaid envelope & results from their testing should take between 6&8 weeks. Hopefully some answers as to the composition of the ingredients once heated above 25°C.
Also the past couple of days I've suffered extreme fatigue & a sensation I can only describe as my thyroid severely inflamed, like a lump in my throat (total thyroidectomy December 2018). Calling GP today as well regarding blood test results. Will keep you posted!
Helvella thank you & even after all of this with the heatwave my GP surgery refused a repeat prescription as it wasn't due until 20th August, despite all my problems etc. It all boils down to how much money they're willing to spend & apparently all my symptoms aren't severe enough to warrant fresh levo. Got an appointment with my GP this afternoon regarding my throat swelling & discuss blood test results.
Yes I got the repeat prescription on 20th aug just waiting for pharmacy to have it delivered to them for me to collect but I can't give all the bottles to TEVA otherwise I would be without for a week. It takes any pharmacy around here almost a week for my medication to arrive. Ridiculous isn't it?!
Hi all, a member sent me a private message last night suggesting a product which they used in the past to keep their insulin cool whilst on holiday. Thought I'd share as it may be of help:
FRÍO® keeps in-use insulin and 29 other temperature sensitive medicines cool and safe, within safe temperatures of 18-26°C (64.4-78.8°F) for a minimum of 45 hours, even in a constant environmental temperature of 37.8°C (100°F).
Another possible solution, think the bottle cooler maybe more suitable for my bottles but if anyone is finding their tablets/blister packs affected by the heat then the slimline wallets maybe suitable.
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