Changing tablets

[jencat]

Hi all, has anyone changed brands of thyroxine without telling a doctor?

[RedApple Administrator]

jencat, here in the UK, our GPs are rarely aware of the brand we are taking. The GP writes a prescription for levothyroxine and the pharmacy dispenses whatever brand they have in stock. Some patients have an agreement with their pharmacy to only supply a particular brand, but again, the doctors aren't usually involved in this.

[jencat in reply to RedApple]

Thankyou for your reply

[Shazy-B]

When you request your prescription from your GP ask for the specific brand you’d like, then it’s documented on your script and the pharmacy has to supply it (if they have it or can get it in stock) I ask for Actavis brand only when requesting mine. Hope this helps

[Partner20 in reply to Shazy-B]

Actavis were taken over by Accord quite some time ago, so the specific manufacturer request on your script will have to be changed. It has taken a while for all the old stocks with the Actavis branding and/or manufacturer's name to be used up, but all new stock will be issued with the Accord name on the blister pack and Accord named as the manufacturer on the packaging and the PIL. The actual product remains the same. My levo is now dispensed under the Almus branding, which is manufactured by Accord for Boots pharmacies.

[helvella Administrator Thyroid UK in reply to Shazy-B]

Have you ever been offered Almus or Northstar?

If a prescription is written for one brand, such as Accord (formerly Actavis), you might find a pharmacy unwilling to supply the same product under Almus or Northstar branding. Despite them being the exact same products.

That is, you might have cut out Boots and Lloyds as potential alternative pharmacies in case your usual pharmacy has problems.

(Northstar 25 microgram tablets are Teva. Their 50 and 100 microgram tablets are Accord.)

[jencat in reply to Shazy-B]

Thankyou, but i live in Spain not much choice of tablets, been taking eutirox, lots of side effects, so now got sanofi.

[SlowDragon Administrator]

Looking at previous posts you are based in Spain and looks like you have been left on ludicrously small dose of 25mcg Levothyroxine

Standard starter dose of thyroid is 50mcg unless over 65 years old

Even if starting on 25mcg we still need to increase dose

guidelines on dose levothyroxine by weight

Even if we don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.

RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

Being under medicated tends to dramatically reduce vitamin levels

Low vitamin levels tend to lower TSH

It’s essential to get FULL Testing

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)

Is this how you do your tests?

[jencat in reply to SlowDragon]

Hi slowdragon,can i pm you please?