IS THERE A PREFERENCE IN LEVOTHYROXINE BRAND

[NIKEGIRL]

Thank you for your time firstly. Is there a preference on brand choice on Levothyroxine and are there brands to stay away from and avoid. Thank you ☺️

[helvella Administrator]

We see many people each with their own preferences.

I think every available make has its own adherents.

Some people believe that a specific ingredient causes them problems. Suggestions include mannitol, acacia and lactose. All perfectly reasonable suggestions but unless you know you have an issue, it does not help to narrow the field.

Some people seem indifferent to which one they get.

Some people can tolerate many of them but have preferences based on subtle differences.

Some people end up with particular makes because of the dosages available. If you are prescribed 25 micrograms, for example, you'd probably prefer to at least start on a make which includes that dosage. If you are on 100 (or more), you'd usually get a make that includes a 100 microgram dosage. You would not usually get multiple 25 micogram tablets to make up 100 micrograms.

Some people are happy mixing makes. I have been doing this for years. I take 100 of one make plus 25 of another. But I do very much care which makes!

And always be aware that different doages, even in one packaging, might actually be different formulations!

So you know what is out there, I'll paste in my usual list:

UK Levothyroxine Tablets

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Last updated 25/09/2020.

This is a list of currently marketed levothyroxine tablets in the UK.

Please note that re-branding (whether by a manufacturer or as an ‘own label supplier’) – which has happened with several products – does not mean any change to formulation.

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🔹 Accord (marketing authorisation holder) – formerly Actavis

🏭 Accord-UK (manufacturer)

🥛 contains lactose – 39.95mg in 50 microgram tablet, 54.90mg in 100 microgram tablet

  50 microgram  PL 0142/0104

  100 microgram  PL 0142/0105

🟢 50 microgram and 100 microgram PIL: mhraproducts4853.blob.core....

🟣 50 microgram SPC: mhraproducts4853.blob.core....

🟣 100 microgram SPC: mhraproducts4853.blob.core....

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🔹 Advanz (marketing authorisation holder) – branded both “Mercury Pharma Levothyroxine” and “Mercury Pharma Eltroxin” which are identical

🏭 Custom Pharmaceuticals Ltd. (manufacturer)

🥛 contains lactose – 30.49mg in 25 microgram tablet, 48.86mg in 50 and 100 microgram tablets

  25 microgram  PL 12762/0016

  50 microgram  PL 10972/0031

  100 microgram  PL 10972/0032

🟢 Eltroxin 25 microgram PIL: mhraproducts4853.blob.core....

🟢 Eltroxin 50 & 100 microgram PIL: mhraproducts4853.blob.core....

🟢 Levothyroxine 25 microgram PIL: mhraproducts4853.blob.core....

🟢 Levothyroxine 50 & 100 microgram PIL: mhraproducts4853.blob.core....

🟣 Eltroxin and Levothyroxine 25 microgram SPC: mhraproducts4853.blob.core....

🟣 Eltroxin and Levothyroxine 50 microgram SPC: mhraproducts4853.blob.core....

🟣 Eltroxin and Levothyroxine 100 microgram SPC: mhraproducts4853.blob.core....

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🔸 Almus ‘own label supplier’ – (a brand owned by Walgreen Boots Alliance – Boots pharmacies and Alliance distributor)

  100 microgram – This is repackaged Accord – formerly Actavis.

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🔹 Aristo (marketing authorisation holder)

🏭 Aristo Pharma GmbH (manufacturer)

No lactose ingredient

  100 microgram  PL 40546-0159

🟢 PIL: mhraproducts4853.blob.core....

🟣 SPC: mhraproducts4853.blob.core....

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🔹 Glenmark (marketing authorisation holder)

Note: This product may not currently be dispensed.

🏭 Glenmark Pharmaceuticals Europe Limited (manufacturer)

No lactose ingredient

  25 microgram  PL 25258/0293

  50 microgram  PL 25258/0294

  100 microgram  PL 25258/0295

🟢 PIL: mhraproducts4853.blob.core....

🟣 25 microgram SPC: mhraproducts4853.blob.core....

🟣 50 microgram SPC: mhraproducts4853.blob.core....

🟣 100 microgram SPC: mhraproducts4853.blob.core....

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🔸 Northstar ‘own label supplier’ – (a brand owned by McKesson – Lloyds pharmacies and AAH distributor)

  25 microgram – This is repackaged Teva. ❗

  50 microgram – This is repackaged Accord – formerly Actavis. ❗

  100 microgram – This is repackaged Accord – formerly Actavis. ❗

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🔹 Teva (marketing authorisation holder)

🏭 PLIVA Croatia Ltd (manufacturer)

No lactose ingredient

  12.5 microgram  PL 00289/1971

  25 microgram  PL 00289/1972

  50 microgram  PL 00289/0038

  75 microgram  PL 00289/1973

  100 microgram  PL 00289/0039

🟢 12.5 and 50 microgram PIL: mhraproducts4853.blob.core....

🟢 25, 75 and 100 microgram PIL: mhraproducts4853.blob.core....

🟣 12.5 microgram SPC: mhraproducts4853.blob.core....

🟣 25 microgram SPC: mhraproducts4853.blob.core....

🟣 50 microgram SPC: mhraproducts4853.blob.core....

🟣 75 microgram SPC: mhraproducts4853.blob.core....

🟣 100 microgram SPC: mhraproducts4853.blob.core....

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🔹 Wockhardt (marketing authorisation holder)

🏭 CP Pharmaceuticals Ltd (manufacturer)

🥛 contains lactose

  25 microgram  PL 29831/0130

🟢 PIL: mhraproducts4853.blob.core....

🟣 SPC: mhraproducts4853.blob.core....

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🔹 – identifies marketing authorisation holder

🔸 – identifies ‘own label supplier’ products

🏭 – identifies manufacturers (where known)

🥛 – contains lactose

❗ – Take particular note of the actual product which varies by dosage.

🟢 PIL – Patient Information Leaflet

🟣 SPC – Summary of Product Characteristics document

🟢🟣 Single document combining typical PIL and SPC information

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Only products which definitely contain lactose are identified (🥛 – contains lactose). Please always check other products. Where products are ‘own label supplier’, check the marketing authorisation holder for the specific product.

There are links to product information on the MHRA (Medicines and Healthcare products Regulatory Agency) website. products.mhra.gov.uk/ These are the latest versions known.

If there is anything inaccurate in this information, please let me know by Private Message, or on the forum:

healthunlocked.com/user/hel...

The British National Formulary (BNF) contains details of most medicines regularly available within the UK. This page has details of levothyroxine products, distributors and costs:

bnf.nice.org.uk/medicinal-f...

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This document is updated whenever I am aware of any changes or enhancements are needed. Please check the Last updated date. The current version is available as a PDF here:

dropbox.com/s/6h3h0qi4eqwi6...

The PDF version of this document has a QR code above this sentence. If your device has a camera and can interpret QR codes, this QR code should take you to the same place as the link and make it easier to download on devices, such as phones and tablets.

[NIKEGIRL in reply to helvella]

Being new to this a lot of that is overwhelming but thank you kindest regards always NIKEGIRL

[helvella Administrator in reply to NIKEGIRL]

I'm not for a single minute expecting you to take it all in! But it is there, on your thread, available whenever you want/need.

[NIKEGIRL in reply to helvella]

Could I politely ask. Have u heard of people with Graves’ disease bruising easily and what it might be a sign of? Thank you

[Lora7again in reply to NIKEGIRL]

Are you taking Carbimazole because bruising is listed as a side effect of the drug.

The most common side effects are feeling sick, upset stomach, headache, joint pain, skin rash and itching. On rare occasions carbimazole can cause problems with your blood cells, so you need to tell your doctor immediately if you develop a sore throat, mouth ulcers, bruising, fever or feel generally unwell.

[helvella Administrator in reply to Lora7again]

Quite right, Lora.

NIKEGIRL,

The Patient Information Leaflet for one make of carbimazole has the advice below. (I expect they will all say much the same thing.)

Stop taking Carbimazole and see a doctor straight away, if you notice any of the following side effects:

Any infection such as a sore throat or mouth ulcers

Fever

Unusual bruising or bleeding

Feeling unusually tired

You are feeling generally unwell or think that you may have an infection.

Your doctor may need to do some tests to check for something called 'bone marrow depression' before you start your treatment again.

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

Please contact your doctor. If that is not possible, call NHS 111. Do not take "I don't know" as an answer.

Do not leave it and hope things get better. They do not include the words straight away unless they mean it.

[NIKEGIRL in reply to helvella]

Thank you for the reply, I do take carbimazole. To my dr credit he does do a CBC every week. I seem to have episodes where I feel generally unwell but this week I have lost my appetite, I’m eating but just not as interested in food. I have a few bruises on my legs and feel sad. I see the dr today to get my CBC and tsh, ft3 and FT4 blood results and will talk to him. Thank you again. I did this blood test when I felt unwell. I suspect my blood may have got worse in 3 weeks and that the cut from 6 tablets to 3 tablets was too much too fast. Thank u again. You’ve been very kind and helpful 🍀

[NIKEGIRL in reply to Lora7again]

Thank you for that information. Lot of it is relevant. I see my GP today and will discuss with this with them. Kindest regards always NIKEGIRL

[Lora7again in reply to NIKEGIRL]

I changed to PTU from Carbimazole because I came out in a nasty rash, so you could ask him if you could do that. I didn't get any side effects from PTU which is very old drug and suited me better.

[NIKEGIRL in reply to Lora7again]

When I go today to the dr I will say that this is my third time feeling like this. Generally unwell and lethargic. Generally unwell is how I would describe how I feel. I’m pretty sure it’s the drugs as I got generally unwell when I first started on them. Thank you again.

[fuchsia-pink]

There's no single overall brand that people prefer - the issue is which brand do YOU prefer (if you have a strong preference) and are there any brands that you personally don't get on with?

I think I must have the gut of a rhino - I have never had problems with any brand of levo or when I was put on a ludicrous 40mcg starting dose of lio ... but ...

(a) If you are lactose intolerant, obv you need to steer clear of brands with lactose as a filler. The most widely-available lactose-free levo is Teva. Other brands are now available but some posters have struggled to get them

(b) Teva has mannitol in it which other people really cannot handle.

In fact, you will see from other posts (and the poll on it - see "polls") that Teva is the Marmite brand: some people like it the best; many others can't handle it at all; and some (like me) don't mind it one way or another.

Other people have found other brands that particularly do or don't suit them, but not in the same numbers. And a lot have found that they don't like switching between brands - there is strong scientific evidence to support them not all being the same even if they have the same fillers. So if you find you are "fussy", you can have a specific brand put on your prescription [or eg "not Teva" if there's one to avoid]. "Yellow card" anything that doesn't suit you and ALWAYS check you have been given the correct brand before you leave the pharmacy

Edited by Fuschia-Pink with grateful thanks to Hibs1

[Hibs1 in reply to fuchsia-pink]

As far as Coeliac UK state no UK medication contains gluten. It would have to be declared on the label. So how can you be stating that about gluten. Do you mean lactose?

[fuchsia-pink in reply to Hibs1]

ooops - yes sorry! Thank you so much for pointing it out - I'll amend post so it doesn't confuse people who don't read on. And have a cup of tea in the hope that this'll turn the rest of my brain on

[Hibs1 in reply to fuchsia-pink]

😀😀

[NIKEGIRL in reply to Hibs1]

Thank you for your reply NIKEGIRL

[NIKEGIRL in reply to fuchsia-pink]

Thank you for your insight. Kindest regards NIKEGIRL