guidance about taking levo in the evening?

[ElephantShrew]

hi there! I'm wondering about starting to take my levo dose before bed rather than in the morning. Could i check what the guidance is about eating/drinking beforehand? I think i read that i need to take it at least 2 hours after a meal, but i'm not sure how that applies to drinks, eg i'm drinking a lot of fruit tea in the evenings to keep warm but also might have a glass of wine or a hot chocolate - should the levo dose be at least 2 hours after my last drink as well?

Also i'm taking blood pressure medication (ramipril) in the evening, might this interfere with the levo absorption or is the interference more about food items?

thankyou!!

[SlowDragon Administrator]

No other medication within 2 hours

At least 4 hours after any calcium rich foods - eg hot chocolate

An hour after fruit tea

Quite a few members take their levothyroxine in middle of night if regularly get up for the loo

A weekly pill dispenser makes that easier to do

[ElephantShrew in reply to SlowDragon]

lovely thankyou! The middle of the night sounds the most convenient but i don't know if i can guarantee i will always wake up!

At the moment waiting for an hour before my first cup of tea is throwing my morning routine out a bit (😴 ) so i thought i would try the other end of the day.

[spongecat]

Hi there. I take my levo at night when I go to bed. I would leave at least a couple of hours between ramipril and levo and ditto with food, though to be honest I have had a very small snack before bed with no ill effects!

Don't worry about the fruit teas, I always have a cup of "sleep" tea before bed and a small glass of milk kefir every night and have had no issues.

Everything slows down at night so plenty of time for the gut to absorb the levo....plus it's much more convenient!

[SlowDragon Administrator in reply to spongecat]

Even the NHS website advises no calcium rich food or drink within 4 hours of levothyroxine

nhs.uk/medicines/levothyrox...

There are some foods and drinks that do not mix well with levothyroxine:

drinks containing caffeine, like coffee, tea and some fizzy drinks, can reduce the amount of levothyroxine your body takes in. Leave at least 30 minutes after taking levothyroxine before you drink them.

calcium-rich foods, such as milk, cheese, yoghurt and broccoli, can reduce the amount of levothyroxine your body takes in. Leave at least 4 hours between taking levothyroxine and eating calcium-rich foods.

soya in food and supplements may stop levothyroxine working properly. If you regularly eat soya or take soya supplements your doctor might need to do extra blood tests to make sure you're getting enough levothyroxine.

kelp (a type of seaweed) can contain high levels of iodine, which sometimes makes an underactive thyroid worse. Do not take supplements containing kelp if you're taking levothyroxine.

If you always drink milk before levothyroxine, then you are likely to need higher dose levothyroxine

Problems arise if you only sometimes have calcium rich food near levothyroxine....as absorption rates and therefore dose will vary

[spongecat in reply to SlowDragon]

"If you always drink milk before levothyroxine, then you are likely to need higher dose levothyroxine" .....

I'm due to take my Blue Horizon test this month, I'll bear that in mind when I get the results back.. I have always been high in FT-4 as in a point over the max range, so maybe not a bad thing!

I never take the levo with the kefir but about half an hour or so before.

[helvella Administrator Thyroid UK in reply to spongecat]

If the levothyroxine can "catch up" with the kefir, it can interfere with absorption.

[ElephantShrew in reply to spongecat]

thankyou! that's very reassuring 👍 . yes, i'm hoping it'll fit into my usual routine much easier at night - will try it out and see how it goes!