Northstar and aristo levothyroxine

[Cablogin]

Is there any difference between the brands? I've ordered myself backup just Incase and got aristo I normally take northstar

[SlowDragon Administrator]

Many people find Levothyroxine brands are not interchangeable.

Teva, or Aristo (100mcg only) are the only lactose free tablets

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

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but Accord doesn’t make 25mcg tablets

beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

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)

Posts that mention Teva

healthunlocked.com/search/p...

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.

New guidelines for GP if you find it difficult/impossible to change brands

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.

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)

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

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

Was brand changed when dose was reduced?

Likely you never needed dose reduction

Never agree to dose reduction based just on TSH

Essential to test TSH, Ft4 and Ft3, plus vitamin D, folate, ferritin and B12

[Cablogin in reply to SlowDragon]

Brand wasn't changed I've privately ordered these as a safety net just Incase doctors refuse to keep me on my current dose. I have energy right now and much more calm walking over 10k steps a day too and I'm scared they'll take this away from me again

[helvella Administrator]

Yes - different formulation.

Aristo has neither lactose (present in most levothyroxine tablets) nor mannitol (present in Teva levothyroxine).

Northstar 50 and 100 microgram tablets are actually Accord. (Northstar 25 microgram tablets are actually Teva product.)

There have been quite a few posts about Aristo:

healthunlocked.com/thyroidu...

There are links to the Patient Information Leaflets for all UK levothyroxine product in my document:

helvella - Thyroid Hormone Medicines

I have created, and try to maintain, a document containing details of all thyroid hormone medicines in the UK and, in less detail, many others around the world.

dropbox.com/s/shcwdwpedzr93...

[Cablogin in reply to helvella]

Okay, but it will do the same job as my northstar ones? I'm feeling better on northstar right now but I've privately ordered aristo just Incase doctors refuse to keep my on the dose I need. These are back up pills if everything goes wrong in December with doctors ignoring my needs.

[SlowDragon Administrator in reply to Cablogin]

Never let GP reduce dose just because TSH is low

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

Essential to test TSH, Ft4, Ft3, vitamin D, folate, ferritin and B12

Vitamins need to be optimal

If Ft3 is not over range you are not over medicated

[Cablogin in reply to SlowDragon]

They've booked me in for a blood test early December at 2pm should I get that changed? How much does it affect results?

[SlowDragon Administrator in reply to Cablogin]

Definitely

TSH is lowest after lunch

TSH daily variation

healthunlocked.com/thyroidu...

Very important when you test TSH as its (incorrectly) all most medics look at

researchgate.net/publicatio...

“According to the current TSH reference interval, hypothyroidism was not diagnosed in about 50% of the cases in the afternoon.”

“Further analysis demonstrated inadequate compensation of hypothyroidism, which was defined in 45.5% of the morning samples and in 9% of the afternoon samples”

ncbi.nlm.nih.gov/pubmed/252...

TSH levels showed a statistically significant decline postprandially in comparison to fasting values. This may have clinical implications in the diagnosis and management of hypothyroidism, especially SCH.

What vitamin supplements are you currently taking

Remember to stop taking any supplements that contain biotin a week before ALL BLOOD TESTS

(eg vitamin B complex)

[Cablogin in reply to SlowDragon]

Okay that's interesting I will call up about that and change the time

I'm taking vitamin d spray, selenium, ferrous fumarate, b12 and magnesium do I need to stop taking any of these few days before bloods?

[SlowDragon Administrator in reply to Cablogin]

Stop ferrous fumerate a week before testing iron and ferritin levels. Also ferritin test should be fasting and don’t have high iron meal the night before

Otherwise, just don’t take any supplements on morning before test….delay until after

[helvella Administrator in reply to Cablogin]

It should do.

But all sorts of factors end up meaning that some of us find what appear to be the same dose but in different formulations have different effects on us.

For example, one formulation might simply be better absorbed than another. Imagine you are currently absorbing 75% and that changes to 85% - or vice versa. We might be sensitive to one excipient present in one make but fine on another make which does not include that constituent.

There is no telling in advance of trying (unless we absolutely know we cannot tolerate some excipient or other).

I suggest you change to the Aristo as soon as reasonably practical. Then, if you are fine, you can relax. If there is an issue, you still have some Northstar to revert to while you sort out what you can do.

[Cablogin in reply to helvella]

I may start taking aristo tomorrow morning see how i feel for a week or 2 if not I'll revert back. I just hope I feel the same on aristo as I've only just started to feel better last 2 weeks

[SlowDragon Administrator in reply to Cablogin]

Personally I wouldn’t change at moment

[Cablogin in reply to SlowDragon]

Should I stay on northstar till my next bloods? I was planning to use aristo as a back up if I get desperate..

[SlowDragon Administrator in reply to Cablogin]

Yes I would ….only use Aristo is have to