Know Your Medicines - Keep the Packaging

[helvella]

We regularly get posts which say that someone has felt less well, even positively unwell, on their current or last lot of levothyroxine (or other medicine). Maybe they choose to switch to their next pack straightaway? Maybe they only realise when they start their next pack? All sorts of possibilities.

If, at some point, we want to check if it was a different batch, or if we want to make a Yellow Card report, it can be really helpful to know which batches we were taking!

For that reason, it can be a good idea to keep a record of batches (including expiry dates and makes/dosages). You could use a spreadsheet, a paper notebook, or even photograph each one (obviously making sure the batch details are clear and legible - most mobile phones are capable of perfectly adequate quality).

But I also suggest not throwing out the outer packaging but keeping it around for a few months. First, this acts as a record in itself. Second, it provides some proof you could send if you need to make a Yellow Card report. The packaging flattens down, or can be cut and opened out, so wouldn't take much space and or get confused with full packs.

You could write the date(s) when you start and finish each one on the packaging! (I have not been doing this, but suddenly realised that it is an obvious way of recording and needs nothing more than a writing implement! You don't have to open your computer/phone, find the notebook, or whatever. That can be done later.)

Obviously there are many options. All I'm really trying to do is suggest you think about it and do what suits you in your circumstances.

🟨 Making Yellow Card Reports 🟨

healthunlocked.com/thyroidu...

[SeasideSusie Remembering]

Good points Helvella.

I have a friend who has two or three medications on repeat (not thyroid) one for regular use, a couple for occasional use, plus occasionally a one off. She keeps them in a plastic box. The plastic box isn't big enough to accommodate the tablets in their original boxes so she takes the blister packs out and throws the outer packaging away.

She had a sort out the other day, couldn't fathom out which tablets were for what, even the name printed on the blister pack mean she was still clueless, so they were thrown away .... I wont go into what I said when she said she put them in the household rubbish rather than take them to the pharmacy 🙄

[Buzcat]

so if you are given ones from a bad batch will anything be done it wasn’t for myself and daughter still don’t know if it was a bad batch it wasTeva wee were given in 2018 put in yellow cards even sent some of the pills to MHRA they said they had been thrown out by mistake sent them more they said they were to old sent private blood tests to Teva they said they never got them yet they were signed for and Royal Mail sent me a letter saying they did receive them they clearly showed wee had multiple thyroid abnormalities after being switched from mp to Teva with all the cover ups I take it there was something seriously wrong with this Teva I ended up having a heart attack.

[helvella in reply to Buzcat]

I can't say what MHRA will do when they receive Yellow Card reports. But it is a complaint about their handling of reports. Which sounds to have been terrible.

But I can say that, if we do not send them Yellow Card reports, we definitely don't see any action.

In 2012, when old Teva was withdrawn from the market, it was Yellow Card reports which alerted MHRA to the issue. MHRA did act. The product did disappear. And when Teva re-launched it was an entirely different formulation.

That the new Teva has been a problem for all too many is extremely unsatisfactory. But we need to continue sending Yellow Card reports.

We do not know why new Teva is problematic. Some members find it excellent. Others suffer from it. The suspicion is that it is due to the mannitol ingredient but that is not proved. It does not appear to be a defective medicine so much as one that cannot be tolerated by a significant group of patients.

[Buzcat in reply to helvella]

the endocrinologist I went to said Teva is stronger maybe that’s the problem the government was supposed to have sent guidelines to all health care professionals if patients do well on a certain brand not to switch them so why is it no pharmacies seem to have got this not that it would matter it’s the suppliers that won’t get certain brands they get the cheapest.

[helvella in reply to Buzcat]

Merck Euthyrox changed from lactose to mannitol over the past few years. They had major issues in France but in countries which changed more recently they do suggest there might be better absorption. (Which obviously has the effect of being stronger even though it seems likely the actual levothyroxine content is very much the same.)

I think you mean this:

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...

Which does not seem to have been seen by any pharmacists or prescribers!

In South Africa Merck released this (chosen because it is in English!):

euthyrox-instructions.com/c...