Liquid levothyroxine

[Harlech]

Hi, Update just back from the dr's, asked about taking liquid levothyroxine with water, his reply was ask a pharmacist they know about the drugs, told him I had spoken to 2 plus the manufacturers, the answer I was given ask your Dr, so he went and spoke to the surgery pharmacist.

Answer came back YES IT CAN BE MIXED WITH WATER

[SeasideSusie Remembering]

Glad you got that sorted, what a journey to find the answer 🙄

The question now is, after all those people involved so far, can you trust the surgery pharmacist more than anyone else 🤔

[jimh111]

Levothyroxine is lipophillic so will be dissolved in a lipid friendly liquid. I've no expertise other than common sense but I suggest you stir it up after mixing and rinse with a little extra water to wash it down (the levo will not dissolve in the water, it will be a suspension). This way you will get the full dose.

[helvella Administrator in reply to jimh111]

If the levothyroxine is already dissolved (in the glycerol or the glycerol/water mix) then your suggestion requires an explanation of why it would come out of solution and then remain as a suspension?

[jimh111 in reply to helvella]

I'm not certain, I'm assuming glycerol will behave as a suspension or emulsion in water as it is to some extent a lipid. My suggestion is just to be on the safe side, stirring and rinsing with a little water is easy and ensures all the levo will be taken. The levo will not dissolve in water (it does to a small extent in warm water) but is presumably dissolved in the glycerol. I don't know if glycerol dissolves in water. So I'm suggesting a belt and braces approach.

[helvella Administrator in reply to jimh111]

The below is from memory!

There is a patent which describes dissolving levothyroxine in an alkaline solution of water, mixing it with glycerol, then acidulating to a suitable pH so that it remains stable. It was a surprise that it was stable in solution - that was not predicted. Not entirely sure that is what the current crop of oral solutions do - but am pretty sure the earlier ones did that.

I thought it feasible that the levothyroxine could remain in solution, change into a suspension or even precipitate out. Further, almost whatever happens could impact on the absorption.