Swapping brands every time I get my prescription

[Yoll]

Every 3 months I pick up my thyroxine prescription. I had to change pharmacy and now every time they give me a different brand. Accord, Mercury now Northstar. I didn't think it would matter but I have realised I don't feel well at all after about a week of the swap. Is it all in my head ? Can it really affect you that quick?

[helvella Administrator Thyroid UK]

Have you asked the pharmacy if they would be kind enough to always supply the same formulation? (Always worth a go.)

Northstar will be either Accord (100 and 50) or Teva (25).

I knew that people said they had issues when changing even before I was diagnosed. But I went in with the attitude that they would all be the same to me. They weren't - absolutely and definitively. So I became as careful as anyone to keep to the same formulations.

This document might help:

dropbox.com/s/shcwdwpedzr93...

[Yoll in reply to helvella]

Thank you, I wasn't sure if it was that as it is about a week after the swap

[helvella Administrator Thyroid UK in reply to Yoll]

My feeling - and I am absolutely NOT meaning you to take my words literally, they are a desperate attempt to explain how I felt!

Accord (and Actavis as they were) seemed to be very even. And I felt ready for for my next tablet as it was due.

Mercury Pharma seemed to have a more obvious impact, but fade before my next dose.

However, I tolerated both quite well - just didn't like changing between them.

Teva made me feel ill.

[Yoll in reply to helvella]

I was on accord then move to Mercury and felt a bit off for a week or so then on Northstar and feeling off again, Hope I can stay on this.

[Yoll in reply to Yoll]

I'll try sort this out with the pharmacy

[tcpace in reply to helvella]

Wow - that is a fantastic survey! Have you by any chance done anything similar for T3?

[helvella Administrator Thyroid UK in reply to tcpace]

Umm - T3 (liothyronine) and various non-UK combination products are already

in that one document!

[tcpace in reply to helvella]

So they are - hadn't got as far as Page 36 when I posted.

[helvella Administrator Thyroid UK in reply to tcpace]

It is quite long!

[Yoll in reply to helvella]

but very useful

[SlowDragon Administrator]

How much levothyroxine are you currently taking

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)

Teva, Aristo and Glenmark are the only lactose free tablets

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

[Yoll in reply to SlowDragon]

Thank you once again for the information.

I take 100 mcg at the moment but I'm about to go down to 75 mcg and adding T3 so your information is really useful. I was on Accord for years I don't feel 100% on any of them.

I don't know what symptoms to look for, but every time they switch Brand I crash into bad fatigue, dizziness, aches and pains and more gut problems. At the moment it is a little scary as I don't know if I'm coming down with Covid19 or just reacting to the change of brand, or something else....... I need it all to settle down.

I really don't know which brand suits me!

I will ask for 50 mcg and 25mcg and ask to stick to just one Brand. But which one....

Anyone test Glenmark???

All supplements are take at such and I have switch back to taking it in the morning as it keeps me awake if I take it at night.

[SlowDragon Administrator in reply to Yoll]

If on accord - they don’t make 25mcg tablets

2 x 50mcg tablets and cut one 50mcg tablet to give 25mcg

Glenmark - so rare don’t think anyone ever had it

[tattybogle]

I used to always get the same brand every 3 months for years, with only an occasional substitution. Then i changed surgeries /chemist and started getting different brand every 2 months, and with hindsight , that is when i started going downhill.

I don't have an 'obvious' reaction to any different brand, but did start to get the feeling that Teva was a bit 'slow and sluggish/depressed' and mercury was a bit 'fast/buzzy'

So i started to pay more attention to what i was being given and how i felt , and started asking chemist to avoid Teva.

Anyway....

I had a good couple of months , and as i was feeling good that day, i decided i couldn't be bothered with the fuss and condescending looks from the chemist when i asked to have something other than Teva , so just accepted what they gave me (Teva) telling myself "i'm not sure if it really makes a difference at all, i'm probably making a fuss over nothing, it's just coincidence how i feel sometimes"

After about a week i felt crap, nothing specific , just 'bleugh'

..I went from noticing i was enjoying driving fast , feeling more normal than i had for ages, and thinking ," i feel quite good really, maybe i'll drive somewhere else just for fun ?, maybe it's time i got a job again ?" .... to .... my arms just hanging off the steering wheel , just wanting to get straight home, an feeling 'flat/nothing'. and it stayed that way for weeks .

I'm still not sure if it is any particular brand i have a problem with , or if it is just the fact that changing from one to another messes me up for a few weeks till i get used to the different brand... but whatever is true , i've changed chemist to a smaller independent one rather than the big chain attached to the Doctors, because they were willing to avoid Teva brand, and so far i've always been given mercury 50's and wochhardt 25's since then.

As my forthright daughter pointed out when i was dithering.. " So what ? even if you ARE the only person in the world who feel s naff on different brands .. they should still look after you and try and give you the same one consistently.

It just seems to make sense to get the same brand if at all possible, that way, if you feel 'off' you've already ruled out the "am i imagining it/is it the brand ?" issue.

I think it should just be good practice to keep us on the same brand , and i'm sick of being made to feel like it's an unreasonable request... i feel a similar difference between Teva and Mercury as Helvella does, and was reassured when i found someone else who commented the same subtle difference's.

Since so many people now get prescriptions every 2 months or less! , and if it takes a week to feel the difference and then several more weeks to get used to it , and then it's time for another prescription and you get something different again.... how the heck are we supposed to know what's causing what.

I'm sick of chemists and receptionists and doctors telling us "it's all the same, it's just you making a fuss"... well, unless they are one of the 15% of people who struggle to feel well on Levo , how the hell would they know anyway.

Rant , rant rant.

[Yoll in reply to tattybogle]

My feelings exactly! I'm quite happy to insist on one brand, mercury did make me feel more buzzy to start with then I got used to it. now is just feel bleuhhh and want to sleep all daythanks for sharing

[SlowDragon Administrator in reply to Yoll]

Different brands are not not bio equivalent

This means 100mcg tablet in one brand will give different levels and results than 100mcg in different brand

As it takes 4-6 months to settle on a particular dose....if constantly changing brands you never get settled

[Yoll in reply to SlowDragon]

reading your link on Teva , I discover these brands could be the reason for my worse IBS in the last 3 month! never even linked it to the medication .I will keep a closer eye on all my problems. I'm supposed to be reducing my dose of Levothyroxine, so it could be all change again!Lets hope it all works out