Levothyroxine is reaching retirement! It has been available for just over sixty-five years.
Despite that, we still have to accept formulations which are problematic. This review paper summarises in its abstract two major causes of these problems. It then identifies shortcomings in the United States Pharmacopeia's methods of testing products.
This is despite many previous papers identifying formulation issues. Even specific excipients (inactive ingredients) that are known to cause problems.
Why does no-one seem to listen? Not to the science. Not to patients.
But do note that the suggested effects are separate to any personal sensitivity to the excipients. We might be entirely tolerant of all the excipients when they are used in foods, supplements or other medicines. But when used in levothyroxine, it appears they affect the actual active ingredient, the levothyroxine, itself.
(Obviously we need to avoid excipients to which we are sensitive.)
Perhaps this is why we stare at list of excipients, comparing them to other things we take, and however much we scratch our heads, we fail to confidently identify why one product is more acceptable than another.
J Pharm Sci. 2021 Aug 9;S0022-3549(21)00405-6.
doi: 10.1016/j.xphs.2021.08.006. Online ahead of print.
Levothyroxine sodium pentahydrate tablets - formulation considerations
Navpreet Kaur 1 , Raj Suryanarayanan 2
Affiliations
• PMID: 34384799
• DOI: 10.1016/j.xphs.2021.08.006
Abstract
Even though levothyroxine sodium pentahydrate tablets have been in the market since 1955, there continue to be recalls due to sub potency. We have comprehensively reviewed the factors affecting its stability in solid oral dosage forms. A compilation of marketed formulation compositions enabled the identification of the potential 'problem excipients'. Two excipient properties, hygroscopicity and microenvironmental acidity, appeared to be responsible for inducing drug instability. In drug products, depending on the formulation composition and storage conditions, the pentahydrate can dehydrate to highly reactive levothyroxine sodium monohydrate, or undergo salt disproportionation to the free acid form of the drug. The USP assay method (HPLC based) is insensitive to these different physical forms of the drug. The influence of physical form of levothyroxine on its chemical stability is incompletely understood. The USP has five product-specific dissolution tests reflecting the complexity in its evaluation.
Keywords: Levothyroxine sodium; drug product stability; excipients; tablets.
Abstract linked below but full paper is behind a paywall: