Is it okay to drink zero soft drinks before taking medication, like Pepsi Max for example? It's not always feasible for me to take my medication when I wake up, so sometimes I opt to fast for 3 hours during the day, take my Levothyroxine, wait another hour and then eat. But from my other medications, I get an incredibly dry mouth, so I always feel like I need something to keep it moist.
Also, I take Mirtazapine at night, would this reduce the effect of Levothyroxine if taken together? Thanks 
To get the most effect out of levo it needs to be taken away from food and drink other than water,and other medications. It doesn't matter what time of day or night you take it. You can also split your dose if you want.If you take your levo with other things it may mean that you need a slightly higher dose to compensate
There are folks out their who can get away with taking levo with food or forgetting doses and they feel well. However most of us on here need to give levo every chance to work most effectively.
Fruit juice has acidity and so enhances levothyroxine absorption, so you could have a juice. Soft drinks shouldn’t affect absorption, just avoid coffee.
It's never alright for anybody to drink zero soft drinks. They contain aspartam and other artificial sweeterners which are worse for you that sugar. Why not try Perrier or some other naturally fizzy water, that will quench your thirst.
Thanks, but this doesn't answer my question.
I think that saying artificial sugars are worse for you than sugar is a bit of a stretch, based on distorted findings. Studies I've read about artificial sweeteners seem only to be tested on animals, and even then, they give them such a high amount that is waaaay above the RDA, so of course, there are negative effects in cases like this. The same goes for anything - too much is bad for you. Haven't seen any human studies indicating the same thing in relation to the RDA.
Unfortunately, it's not about thirst, I'm pretty good at staying hydrated but my medications cause my salivary glands to not work as well. So I'm trying to find something to help with this.
Roughwrap_995
Is it okay to drink zero soft drinks before taking medication, like Pepsi Max for example?
No, it contains caffeine and caffeine affects absorption of Levo.
pepsi.co.uk/products/pepsi-max
INGREDIENTS
Carbonated Water, Colour (Caramel E150d), Sweeteners (Aspartame, Acesulfame K), Acids (Phosphoric Acid, Citric Acid), Flavourings (Including Caffeine), Preservative (Potassium Sorbate). Contains a Source of Phenylalanine.
I take Mirtazapine at night, would this reduce the effect of Levothyroxine if taken together?
No.
go.drugbank.com/drug-intera...
The risk or severity of adverse effects can be increased when Levothyroxine is combined with Mirtazapine.
The product labeling for levothyroxine warns that concomitant use of tetracyclic antidepressants, such as the affected drug, may increase both the therapeutic efficacy and toxicity of the antidepressant. The most concerning adverse effects which may develop from this are cardiac arrhythmias and CNS stimulation.
Always advised:
Take Levo on it's own, one hour before or two hours after food, with a glass of water and water only for an hour each side. Any other medication or supplements should be at least 2 hours away (some need 4 hours).
Thank you, I didn't take into consideration that Pepsi Max has caffeine! Also thank you for the comment on Mirtazapine, I couldn't find anything about it online!
There is no evidence that caffeine has any effect on levothyroxine absorption, so feel free to take your levothyroxine with 'zero' soft drinks - although I prefer the full sugar ones!
Some commercial 'health' websites wrongly state that caffeine affects levothyroxine absorption and they go on to cite studies that make no such statement. This highlights the importance of reading the original research rather than using web articles that are often written in haste by people who have read summaries of the research.
This is the original study that found coffee and bran reduced levothyroxine absorption pubmed.ncbi.nlm.nih.gov/183... . Unfortunately it is behind a paywall. I have a copy, it discusses the complexity of coffee: agriculture, brewing, blending and roasting leads to hundreds of different compounds. "To find out which of the several components of coffee accounted for its T4-binding property was beyond the scope of our work." It also mentions that coffee substantially reduces the absorption of iron, calcium and zinc.
Fortunately, there is a very nice summary of the above paper which shows the results in a friendly format researchgate.net/publicatio... .
There was another study jandonline.org/article/S221... which is a case report of a single patient. It is behind a paywall and I haven't been able to get a copy. There is a summary of the case report here empr.com/home/features/case... . This review states "The specific compound which binds L-T4 and makes it less available for intestinal absorption is unknown, however, lipid sequestration may be a possible mechanism, as lipid content makes up 15–17% of arabica coffee and 10–11.5% of robusta coffee." This is a reasonable assumption since levothyroxine is lipophillic - it attaches to lipids (fat). This needs to be experimentally demonstrated. The review also states "no known interactions have been reported with caffeine, creamer, or sugar."
There is no evidence caffeine affects the absorption of levothyroxine.
This is interesting. Even the NHS says ‘no caffeine within a 30min window of levo’
Yes, I saw the NHS comment. Clearly they have drawn up recommendations without looking at the evidence. About par for the NHS, they talk about evidence based medicine but pick and choose which evidence they use. If I get time I will challenge them to supply the evidence.
It might not only be the caffeine that is an issue.
There is some evidence that suggests sweeteners (such as Aspartame and Acesulfame K) might have effects on the thyroid, thyroiditis including Hashimoto's, and thyroid hormone levels.
This is one such paper - just a case report, but interesting.
Cureus.2018 Sep; 10(9): e3268.
Published online 2018 Sep 7. doi: 10.7759/cureus.3268
PMCID: PMC6221534
PMID: 30430057
Autoimmune Thyroiditis with Hypothyroidism Induced by Sugar Substitutes
Monitoring Editor: Alexander Muacevic and John R Adler
Issac Sachmechi,1 Amna Khalid,
2 Saba Iqbal Awan,3 Zohra R Malik,4 and Mohaddeseh Sharifzadeh5
This article has been cited by other articles in PMC.
Abstract
The use of sugar substitutes (artificial sweeteners or non-nutritive sweeteners) has increased dramatically in the past few decades. They have been used as a substitute for sucrose (table sugar) in various diet-related disorders. Their excessive use has been linked to hyperphagia and obesity-related disorders. Hashimoto’s thyroiditis (chronic autoimmune thyroiditis) is a disease that involves the immune-mediated destruction of the thyroid gland, gradually leading to its failure. Animal studies report that artificial sweeteners affect the immune system. Moreover, animal studies show that sucralose diminishes the thyroid axis activity. We are presenting the case of a 52-year-old female with autoimmune thyroiditis with hypothyroidism (Hashimoto’s thyroiditis) induced by an excessive intake of beverages containing non-nutritive sweeteners. She was ruled out for any other autoimmune disorder. The association between Hashimoto’s thyroiditis and the excessive consumption of sugar substitutes is shown by the quick return of thyroid stimulating hormone and antibody levels to normal after eliminating the use of sugar substitutes. Thus, it suggests that the sugar substitutes were the culprit in the development of Hashimoto’s thyroiditis in our patient.
Keywords: hashimoto’s thyroiditis, sugar substitutes, autoimmune, formaldehyde, hypothyroidism
Full paper accessible here:
ncbi.nlm.nih.gov/pmc/articl...
SeasideSusie
helvella , 'quick return of thyroid stimulating hormone and antibody levels to normal '
Seems to be implying that the individual 'recovered' from autoimmune thyroid disease?
Ok, we patients know that TSH 'normal' doesn't mean 'not hypo', but normal antibodies and normal TSH suggests patient wasn't needing to take thyroid hormone? Would be so much more useful if there was a follow-up on this patient to see what happened further down the line.
Completely agree.
As it stands, it is sufficient to raise the red flag - something needs to be looked at.
But the flag itself never fixed anything!
Probably, in the language so often used, the patient was "lost to follow up".
I also want to emphasis that this paper opens with this sentence:
The use of sugar substitutes (artificial sweeteners or non-nutritive sweeteners) has increased dramatically in the past few decades.
Early days of taking one or two sweeteners in tea or coffee were as nothing to what we now see. They are in food after food after food. They are combined in multiple ways - it is not unusual to see three in one food.
And every use of sweetener tends to condition us to sweeter food. Though I have consumed vast quantities of sugar over the years, when it comes to supermarket foods, virtually all are considerably sweeter than I like. Often savoury dishes as well as desserts.
Totally agree about the inclusion of artificial sweeteners in everything, it's a dire state of affairs.
I have mine on a nightstand with a glass of water. I wake up around 5 am to pee, so I take mine then and go back to sleep. I find it best to take them as far away from food or drinks other than water.
I made a mental note never to drink Pepsi or Cola when a bottle of Pepsi split and the contents dissolved the Marley tiles on which the bottle was standing.
Whilst this might appear a non-sequitur in this discussion, in my levity I was actually trying to make a serious point - if Pepsi has such a dreadful effect on a Marley tile, what on earth is it doing to our stomachs/bodies? Add to the mix the chemical additions to the likes of Pepsi Max and Pepsi One then I'm amazed such products haven't been banned. I would encourage people to stop drinking these and similar drinks at any time, never mind a time of day conducive to tablet-taking.
Didn't they used to say years ago that cola was good for cleaning toilets?
Many years ago I used to work with a girl whose only drink was diet cola (and she didn't really need "diet" anything 🙄 ) and she used to travel to work on the train. One morning she passed out completely and her head landed in the .. ahem (rather embarrassingly) .. lap of the man sitting next to her.
it works very well . ( or at least the original one did .... don't know about all these new fangled zero/ artificial sugar varieties) pour a 2 litre bottle of coke in the loo at night before you go to bed and see the results the next day ... it will make you think twice about putting it in your gut .
also try an old penny in a glass of coke overnight .....
having seen AmandaK 's note , it makes me wonder about trying it to dissolve the indestructible glue left behind after removing stair carpet ...
Oh yes, I'd forgotten about the penny cleaning! It certainly does make you wonder what it does to your insides!
The prometabolic people say: wake, meds, wait half an hour, eat, then coffee. The are big fans of pure OJ. Stay away from processed junk as much as poss (including nasty drinks).
Orange Juice is a good source for vitamin C but is also very high in sugar, so really not a good idea for someone concerned about their weight!
There’s more to it than straight oj. It’s all about the balance baby.
RedApple was only highlighting the one issue - not doing a critique of prometabolic approaches.
After all, that and coffee were the two things you mentioned! And it's not even clear whether that is coffee alone or with any form(s) of milk/plant milk substitutes, sugars, sweeteners.
(Also, many are concerned about pesticide residues in orange juice - whether bought as juice or as fruit.)
Hi, my go to drink is Lucozade Sport (not regular energy) it’s perfect for rehydration especially in the hot weather and has electrolytes in it a bit like dioralyte. There’s a cheaper brand called boost which is just as good. I really feel rehydrated.
Hi (: do you drink this before taking your Levothyroxine (within 3 hours) or avoid it?
Roughwrap_995
Where have you got 3 hours from? You don't need to leave 3 hours between Levo any food and drink, as I mentioned above
Take Levo 1 hour before or 2 hours after food, with water only, and water only for 1 hour each side, this will ensure that no food or drink will interfere with absorption of Levo.
From multiple articles online, although tbf it's different on every site I look for answers. I also based it on the fact that you should take Levo on an empty stomach and it takes 2-4 hours for food to leave the stomach. 5 hours without eating would be too much for me, so I opted for 4.
You really don't need to leave that long, you can if you want to of course but it makes it very difficult to get other things slotted in during the day. If your Levo absorption is affected in any way by using the times we suggest here, then it would show in your test results and your dose would be based on your results. The key is consistency.
When I started taking Levo in 2010, there was no mention of taking it 30 to 60 minutes before eating or drinking caffeinated drinks. The only instruction was to take it before food.
For several years, I took my tablets with my morning tea/coffee, but before breakfast, and didn't have any adverse effects. I have tried leaving half an hour or an hour before eating or drinking anything with caffeine, and haven't noticed any difference in the way I feel, however I take it.
If anyone can show me a peer reviewed double blind study on the effects of caffeine on Levothyroxine absorption, I would be grateful.
Don't drink Softdrinks - they are pointless calories. And diet drinks are even worse, they do nasty tricks to you. Drink water and milk. Eat real meat, fish , chicken, bacon, eggs, veggies, more eggs, yogurt, gluten free grains. Don't eat anything you cant recognize - meat should look like meat (a steak or a chop) not a frozen pie from a packet.
For anyone else thinking about commenting in relation to the general consumption of soft drinks, just don't. I didn't come here for opinions on what I put into my body, after all, it is my body
I've just tried to send you a private message, but the facility doesn't seem to be working properly so I'm having to write this publicly.
I'm very sorry for upsetting you with my post - it was out of concern and care and not intended to cause offence.
Please accept my apologies,
AmandaK
Hi Amanda, you’re good, no need to be sorry, I’m not offended it’s just the third comment on this post stating the same thing.
Morning interactions with levothyroxine?
My experience with Levothyroxine interaction with Caffeine 
Magnesium Citrate Tablet and Levothyroxine interaction
Levothyroxine and other Thyroid medication for Thyroid
\"Interactions that result in changes of levothyroxine binding in blood\"
