Concerns about brand change of t4

[LaurieRose]

Today I noticed the little white levothyroxine pill in my latest prescription doesn’t have any markings on I.e identifying letters. This was a concern as I’ve recently been given an unbranded form and it has lactose in it. Although small amounts of lactose in medication when taking more than one I’m wondering if that’s what accounts for inflammatory side effects. Anyway, my main concern was the change in levothyroxine and I saw an article Which said change in brand can lead to needing a different dose.

[SlowDragon Administrator]

Which brand of levothyroxine are you normally taking

Are you on strictly gluten free or dairy/lactose free diet

How much levothyroxine are you currently taking

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

ALWAYS test thyroid levels early morning, ideally before 9am and last dose levothyroxine 24 hours before test

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, 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

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

[LaurieRose in reply to SlowDragon]

Thank you so much this post and links really helpfulAh I see the lactose is replaced with mannitol. I’m known allergic to mannitol. I’ve had reversibility testing and was given extra measurements to average the results out but the normal amount of tests put me within the brackets.

Anyway thanks for your post

I’ll try and answer any questions later as I’m stuck in bed currently and can’t remember some details without looking.

Very difficult to get drs appointments at the moment I’m probably not alone in this. God help us all x

[SlowDragon Administrator in reply to LaurieRose]

Are you lactose intolerant

If lactose and mannitol intolerant then Aristo brand is both lactose free and mannitol free

How much levothyroxine are you currently taking

Are you on strictly gluten free diet

[LaurieRose in reply to SlowDragon]

Oh that’s interesting aristo is the brand it’s been changed to. I can’t remember the other brands but there’s been a few different ones. Yes I’m lactose intolerant

[LaurieRose]

I’m currently taking 100 one a day

[SlowDragon Administrator in reply to LaurieRose]

100mcg is not a high dose

Do you always get thyroid levels tested early morning, ideally before 9am and last dose levothyroxine 24 hours before test

Testing TSH, Ft4 and Ft3 together

What vitamin supplements are you currently taking

Essential to regularly retest vitamin D, folate, ferritin and B12

Are you also gluten free.

Dairy intolerance and gluten intolerance often go together

[LaurieRose in reply to SlowDragon]

I always get tested in morning usually between 9am and 10am but seems to be less than once a year must be due for another test. Last test was in ok zone after years of being under active, I don’t feel any better though.

I know my ferritin is low and triglycerides are high cholesterol slightly high but gp says normal no action required known diabetic. I’ve not been told I’m diabetic before and wouldn’t have found out had I not asked dr receptionist to print out my results.

So already taking vitamin d3 everyday that brand was changed too from cultism d3 to strivit I did get a letter about that but not about the thyroid med change.

As you say lactose free and mannitol free I assume it was changed to aristo for my benefit and not just for cost benefits.

I haven’t got a lot to complain about really, people have it worse. If I could lose weight the inflammation and bloating might be less of a side effect. Brain fog is bad I keep losing things.

Anyway, I do appreciate your replies they been informative and I will chat to pharmacist if I can’t get a gp appointment

Thanks again take care x

[SlowDragon Administrator in reply to LaurieRose]

For levothyroxine to work well we need OPTIMAL vitamin levels

Ferritin and folate at least half way through range

Serum B12 at least over 500

Vitamin D at least over 80nmol

Request all four vitamins are tested alongside TSH, Ft4 and Ft3

How much vitamin D are you currently taking

Many Hashimoto’s patients need much higher dose than average

Are you currently taking iron supplements

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)

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

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

[helvella Administrator]

My medicines document has details of all UK (and many other) thyroid hormone medicines, including markings.

Other than a couple of makes which have never actually been distributed, all have markings of some sort that are listed.

If they do not have any markings at all, I cannot think what they could be.

Further, every time you have a medicine dispensed, you are entitled to a Patient Information Leaflet (PIL). That absolutely MUST be the PIL for the specific medicine you have had dispensed. Never one that is for another make, not even another dosage of the same make. Even if they have to photocopy one, or download one from the manufacturer and print it.

Please, always ask for the PIL. In my view, they should make sure you get one without having to ask.

My document also identifies which ones have lactose, acacia or mannitol.

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.

From Dropbox:

dropbox.com/s/shcwdwpedzr93...

From Google Drive:

drive.google.com/file/d/12N...

The following text is in my Vade Mecum document, but is UK government safety advice:

Levothyroxine Advice

Levothyroxine: new prescribing advice for patients who experience symptoms on switching between different levothyroxine products

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.

Advice for healthcare professionals:

• generic prescribing of levothyroxine remains appropriate for the majority of patients and the licensing of these generic products is supported by bioequivalence testing

• a small proportion of patients treated with levothyroxine report symptoms, often consistent with thyroid dysfunction, when their levothyroxine tablets are changed to a different product – these cases are noted in UK professional guidelines

• if a patient reports symptoms after changing their levothyroxine product, consider testing thyroid function

• if a patient is persistently symptomatic after switching levothyroxine products, whether they are biochemically euthyroid or have evidence of abnormal thyroid function, consider consistently prescribing a specific levothyroxine 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

• report suspected adverse reactions to levothyroxine medicines, including symptoms after switching products, to the Yellow Card scheme

Above is directly quoted from link – where there is also further information:

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

helvella - Vade Mecum for Thyroid

The term vade mecum means:

1. A referential book such as a handbook or manual.

2. A useful object, constantly carried on one’s person.

Please don't get put off by the number of pages!

Not everything is in this one document - my major medicines document is still separate!

From Dropbox:

dropbox.com/s/vp5ct1cwc03bl...

From Google Drive:

drive.google.com/file/d/1ZW...

[LaurieRose in reply to helvella]

Thank you

[Heighway]

Hi Laurie Rose. My brand is levothyroxine the tablets have 25 on one side which is the micro grams, on the other side is L T,.

[SeasideSusie Remembering in reply to Heighway]

Heighway

"Levothyroxine" isn't a brand. It's the active ingredient in the tablets, it's replacement thyroid hormone.

Brands in the UK most often seen are

Accord

Almus (which is Accord rebranded/reboxed for Boots)

Northstar (which is Accord rebranded/reboxed in 50mcg and 100mcg dose size for Lloyds Pharmacy, and the 25mcg Northstar tablets are Teva rebranded/reboxed for Lloyds Pharmacy).

Mercury Pharma (made by Advanz)

Eltroxin (which is the same as Mercury Pharma made by the same company - Advanz)

Teva

Wockhard.

The box will have the name of the brand on, and the foil back of the blister pack also has the brand.

Helvella has linked to his medicines document above, all brands are listed from page 17 of the document on Dropbox, here is the link again

dropbox.com/s/shcwdwpedzr93...

[helvella Administrator in reply to Heighway]

LT on one side, 25 on the other indicates Mercury Pharma 25 microgram tablet.

See my medicines document (linked earlier) for more information.

Always ask for a Patient Information Leaflet when you get your prescription fulfilled.