Ingredients in Actavis causing bloating ?

[Boon79]

I am taking 1 grain of Armour and 50mcg of Actavis Levothyroxine and generally feel well, apart from feeling puffed up and bloated.

I take iron daily (away from other meds and calcium) and I take vitamin D spray and chewable Acidophilus.

I avoid lactose and am fine with wholemeal gluten products.

I was taking Wokhardt a few weeks ago and didn’t have bloating issues. However, I am now taking Actavis and feel puffy and bloated most days.

I took Actavis a couple of years ago and I am sure that this didn’t happen?

Any ideas what ingredients in Actavis could be causing my issues?

[helvella Administrator Thyroid UK]

Are you aware that Accord (Actavis is now branded Accord) contains lactose? (As does Wockhardt!)

6.1 List of excipients

Also contains:

Lactose

Magnesium stearate

Maize starch

Pregelatinised maize starch

Stearic acid

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

Each 100 micrograms tablet contains 54.90mg lactose and 2.9micrograms sodium.

Each 50 micrograms tablet contains 39.95mg lactose and 1.4micrograms sodium.

Of course, that would not explain why there is any change.

Wockhardt also contains lactose - but I do not know how much - could be significantly less.

[Boon79 in reply to helvella]

Thank you.I did request oral Levothyroxine without lactose but the cost to the NHS is ‘too high’ according to the GP.

She did tell me to try Eltroxin for a few weeks to see if that was any better, otherwise they would consider oral.

TEVA is not for me unfortunately. Perhaps Wokhardt has less lactose? Either way, I can no longer tolerate Actavis, which is a shame.

[helvella Administrator Thyroid UK in reply to Boon79]

Are you aware of Aristo? They offer a 100 microgram lactose-free tablet in the UK.

(Sorry the formatting you'll see is rubbish. Click on the link for a more readable format - and to see the prices of all UK levothyroxines.)

Levothyroxine sodium 100microgram tablets (Aristo Pharma Ltd)

Active ingredients Size Unit NHS indicative price Drug tariff Drug tariff price

Levothyroxine sodium anhydrous 100 microgram

28 tablet (POM) £1.77 Part VIIIA Category M £1.24

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

[Boon79 in reply to helvella]

Thanks for this. If I have no luck with Eltroxin, I will ask for one of the above.

[SlowDragon Administrator]

Lactose free levothyroxine

Teva, Aristo and Glenmark are the only lactose free tablets

Many people find Levothyroxine brands are not interchangeable.

Many patients do NOT get on well with Teva brand of Levothyroxine. Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/medications-f...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal