Lactose in levothyroxine.

[MissDemeanour191]

Trying to go gluten free and Lactose free, however notice that Mercury pharma brand of Levo that I take contains lactose as a filler. Why do they have to contain fillers like this? And....any brand of Levothyroxine that doesn't contain lactose?

[helvella Administrator Thyroid UK]

Teva levothyroxine is lactose-free - but some find they are not happy taking it for other reasons.

Aristo levothyroxine is lactose-free but only available in 100 microgram tablets.

Northstar is a supplier own brand - the 25 microgram tablet is Teva, but their 50 and 100 microgram tablets are Accord and contain lactose.

Do you need to go lactose-free?

What would you choose to put into the tablets instead of lactose?

I suspect that whatever answer you give, someone would find it not acceptable for them!

UK Levothyroxine Tablets

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Last updated 13/09/2020.

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 5.5mm diameter

  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)

  50 microgram – This is repackaged Accord – formerly Actavis.

  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...

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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 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.

[MissDemeanour191 in reply to helvella]

Thanks for your detailed reply!! Much appreciated. I am not medical person I was just asking ignorant question as to why tablets have to have fillers in them. I have suffered with bloatedness and fluid retention since being diagnosed hypothyroid. Am doing my own detective work (elimination of things) to try and get to bottom of it. Do feel better since cutting out dairy and gluten.

[SlowDragon Administrator in reply to MissDemeanour191]

Common when under medicated to have acid reflux and bloating due to LOW stomach acid

How much levothyroxine are you currently taking?

When were thyroid levels last tested

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 or if under medicated

Ask GP to test vitamin levels (and thyroid antibodies if not been tested yet)

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?

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

Also vitamin D available as separate test via MMH

Or alternative Vitamin D NHS postal kit

vitamindtest.org.uk

[MissDemeanour191 in reply to SlowDragon]

Hi been on 125 mcg levo for couple years now. Get palpitations occasionally and wonder sometimes if it's too high a dose for my age...58. Is it true that it's dangerous to take high dose when older? Keeps my TSH under 1 although last result was just over 1. T4 in higher range. Have noticed feel rubbish first thing in morning (take levo early morning), and feel lots better late afternoon into evening. Take Vit D3, iron, vitC , vit B12 and selenium when remember, or eat some brazil nuts!Gone onto lactose free milk and stopped eating bread...i know gluten in lots of other stuff too.

Have to get past 'gatekeeper' receptionists at Drs to have my blood done more than once a year. They will only test once in 12 months.

Seriously considering private tests.

Thank you for advice.

[SlowDragon Administrator in reply to MissDemeanour191]

NHS rarely tests more than TSH

If gone strictly gluten or dairy free you need to get full thyroid and vitamin testing minimum of 6-8 weeks later

[SlowDragon Administrator in reply to MissDemeanour191]

Have you managed to get full thyroid and vitamin testing done yet

[helvella Administrator Thyroid UK in reply to MissDemeanour191]

Not meaning to put you on the spot!

The actual size of the levothyroxine or levothyroxine in a thyroid hormone tablet is tiny. You are talking about the size of a single crystal of sugar - and not even a big one!

It would be impossible to supply such small amounts. Breathe out and the medicine goes flying! Drop and you'd likely never find it.

No possibility of ready identification by using markings.

There really does have to be something to bulk it up into tablets large enough to be handled.

For many, lactose is simply a less sweet form of sugar. It is widely used in medicines.

I'd like to see it not used as lactose-intolerance is an obvious issue. But when Merck changed from lactose to mannitol, many patients complained the product caused them problems. And we have a similar issue (possibly the same cause?) with Teva levothyroxine - which is also formulated with mannitol.

People have problems with some of the cellulose products, maize starch, povidone, sodium starch glycolate, etc., that are alternatives.