Thyroxine brand change

[SovietSong]

Hi, I am a 42yo male currently on 150mcg daily.I had no issues until 2-3 weeks ago when I noticed the packaging on my pills was different(North Star is written on box).I didn’t think much of it at the time as I thought all Levo was the same, however in the past few days I have been feeling generally unwell and tired.I am also getting pain in almost all my joints(hips,fingers,shoulders,hands,back,neck).I am getting TFT next Wednesday morning.I am not sure what to do in mean time, should I keep taking as normal?Any advice would be greatly appreciated.

[SlowDragon Administrator]

Which brand of levothyroxine did you have before

Many people find different brands are not interchangeable

gov.uk/drug-safety-update/l...

If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.

Bloods should be retested 6-8 weeks after any dose change or brand change in levothyroxine

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).

[SlowDragon Administrator]

Suggest you reschedule blood test for early morning 6-8 weeks after being back on your previous brand

Always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

[SovietSong in reply to SlowDragon]

Thank you very much for the reply, I was on Activis before and didn’t even know they had been taken over by Accord.So North Star is really only the packaging?they are just the distributors?

[humanbean in reply to SovietSong]

If you want to be absolutely certain of the make of your pills, check the blister pack itself. The cardboard box could have a make on it which is just a name used by a particular pharmacy e.g. Boots.

Oops, just realised SeasideSusie has already said this much more fully than I could.

[SeasideSusie Remembering]

SovietSong

What brand were you taking before?

Accord, Almus and Northstar are all the same, made by the same people, just different brand names to allow Boots and Lloyd's Pharmacy to have "own brand". Boots is branded Almus and Lloyd's is branded Northstar. However, the 2tmcg Northstar tablets only are made by Teva.

If you think the brand change is the cause of your symptoms you should do a yellow card report and ask GP to name your preferred brand on the prescription or ask the pharmacy to note their records to only dispense your preferred brand.

If you stop taking Levo altogether your test won't be accurate. If you continue taking the new brand at least the test will show how your results have changed, supporting the fact that it doesn't suit you.

[SovietSong in reply to SeasideSusie]

Many thanks for reply, I was on Activis before, the same dosage 150mg.I always take at the same time every morning about an hour before eating or drinking anything.I have to admit I never even noticed the name change on the blister pack from activis to accord.Would activis and accord be the exact same ingredients or is it possible there has been something added?

[SeasideSusie Remembering in reply to SovietSong]

Actavis was the old branding, it's now rebranded Accord but is the same tablet made in the same manufacturing facility by the same people.

Accord also make Northstar 100mcg and 50mcg and Almus 100mcg and 50mcg tablets. They are all exactly the same tablets, just when they come off the production line they are put into one of 3 boxes - Accord, Northstar or Almus. Boxes of all 3 brands will have Accord written on the long narrow side and on the foil back of the blister pack. Absolutely no difference between those 3 brands in the 100mcg and 50mcg dose tablets.

The only way you may have a problem is if you are given any Northstar 25mcg tablets as these are made by Teva and contain mannitol instead of lactose and this can cause adverse reactions in some people.

[SovietSong in reply to SeasideSusie]

Many thanks for taking time to reply SeasideSusie, very much appreciated.

[SlowDragon Administrator in reply to SovietSong]

So if it’s not the brand …it could be you might not be on optimal dose

We frequently need to fine tune dose

Just testing TSH is completely inadequate

You need TSH, Ft4 and Ft3 tested together

Also essential to regularly retest vitamin D, folate, ferritin and B12 at least annually

How much do you weigh in kilo approx

guidelines on dose levothyroxine by weight

Even if we frequently 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 eventually on, or near 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.

Also here

cks.nice.org.uk/topics/hypo...

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 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).

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

Guidelines are just that ....guidelines.

Some people need more some less

healthunlocked.com/thyroidu...

[J675 in reply to SovietSong]

Hiya, I was on Actavis with no issues for many years. It was the only brand that I'd tried that didn't give me problems and Actavis was specified on my prescription. I was suspicious a few months back when the outer packaging changed to Northstar but the blister strips inside were still Actavis. Then about two months ago I started getting really bad anxiety, chest pains etc. The only time I'd ever felt like that previously was when my levo brand was changed. And guess what? My Actavis had been changed to Accord without anyone discussing it with me. I had a really bad time with it and I'm still experiencing hypo symptoms after some time without any levo at all. I'm now about three weeks into trailing Aristo. So far, it hasn't given me any bad reactions, although I'm feeling very undermedicated on the same dose as I was in previously.

Yellow Card submitted, btw.

[SovietSong in reply to J675]

Hiya, I too was a little suspicious when the packaging changed but as I said earlier I thought nothing of it at the time.One of the other guys on here said earlier that although the name has changed it is the exact same tablets made by the same people and if that's the case I'm hoping my dosage just needs tweaking.Anyway good luck, I hope the Aristo does the trick for you.