Can I mix brands?

[Angie10116]

I recently change doses following doctors orders. I’m taking 100 of teva levothyroxine on one day, then alternating 75 mg Of levothyroxine. For the 75 mg, I was given a 25 mg tablet and a 50 mg tablet. The only problem is the 50 mg is from mercurypharma, and the 25mg is from wockhardt. So essentially, I’m taking three different brands at once. Is this ok?

[SlowDragon Administrator]

Any idea what brand you prefer

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, 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 only make 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...

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. If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.

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, pill, 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

What vitamin supplements are you currently taking

When were vitamin levels last tested

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex

[Angie10116 in reply to SlowDragon]

Thank you! Yeah Not really. It’s hard to tell because I’m not optimal soo it could just be thyroid symptoms

[SlowDragon Administrator in reply to Angie10116]

Do you suspect you might be lactose intolerant…..if so you would need lactose free levothyroxine.

That’s either Teva or Aristo

Otherwise, probably best to avoid Teva

[Angie10116 in reply to SlowDragon]

I don’t think I am. But my doctor wanted to try me on lactose free anyway

[SlowDragon Administrator in reply to Angie10116]

Then they need to specify Teva or Aristo brand only

Are you on lactose free diet

[Angie10116 in reply to SlowDragon]

No I’m not, I still eat lactose

[SlowDragon Administrator in reply to Angie10116]

Then it’s pretty pointless being on lactose free levothyroxine

[shaws Administrator]

Sometimes a particular brand can affect us negatively, but if we take a selection of different brands we would not be sure which is causing unpleasant symptoms.

[Angie10116 in reply to shaws]

Thank you. I’m guessing it’s safe to do this though

[shaws Administrator in reply to Angie10116]

If the dose doesn't improve/relieve our symptoms there is no point in taking it.

[Angie10116 in reply to shaws]

Okay thank you

[thyreoidea]

Hi Angie10126, I have been taking Levothyroxine since 2006 and in that time have taken Accord packaged as Almus for 100 and 50 mcg tablets and Mercury for 25mcg as I have fluctuated between 125-150, I cannot say I have noticed any difference in taking Almus and Mercury together but I did discover recently that Mercury contains Acacia and I decided to take 1/2 50 tablet instead of the 25 Mercury, this only because I have palpitations and are trying to not add anything else in the mix just yet and requested my GP practice to carry on Prescribing 50mg with a note on the prescription to take 1/2 tablet daily which they agreed on.

I have never taken Teva or Wockhardt so cannot comment on them,.As manufacturers do not tend to produce every dose of Levothyroxine many people must be taking mixed brands.

[Angie10116 in reply to thyreoidea]

Thank you so much for your reply. I hope you’re well

[Sharoosz]

Hi, I had Mercury and Wockhardt together (25mcg of one and 50 of the other). That was fine. Then once the pharmacy substituted Teva for the Wockhardt. Awful. I was immediately nauseous and had to go and get them to give me the old brand. Instant relief. I then made sure with the pharmacy and my doctor to put on my file not to give me Teva. Everything fine since!