I started my Combination Journey early this year and I know I am not quite there yet but making progress on my symptoms. And all that thanks to you all!!!
I have a question though: My doctor said to me last time that he could not write in the prescription any particular brand for me. I have just gone to the chemist and they have giving me a different one to the one I was taking. This one 3 times the size of the other one!!!!
I am monitoring myself after I got my dosage changed in September 22 and I am really worried that given the fact that I am quite sensitive to changes.
I am getting really dishearten about how long the journey is being and all the obstacles that I find along.
Any advice?
Many Thanks
Carla
Written by
Carlax
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For liothyronine, T3, ask to be swapped to capsules.
They are less expensive than equivalent tablets. And, because there is only one product, from Roma, it cannot simply be substituted.
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. It is sectioned by UK - rest of the world, and by T4, T3, desiccated thyroid, etc.
And do keep up to date. I edit it frequently- sometimes trivially, sometimes extensively. If your copy is more than a few weeks old, please download it again. (You must download - not just view in a browser- for the Table of Contents to work.)
I am familiar to your file, which I find quite useful.
You said: For liothyronine, T3, ask to be swapped to capsules.
Do you mean, ask the pharmacist directly when I go and collect the meds? My repeat goes via electronic method so my only interaction with the Pharmacist is once they have already put the sticker with my info.
Possibly - but I really meant ask your prescriber to change what they write. The pharmacist might be able to refer back to prescriber and get it changed but might not!
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.
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)
Glenmark or Aristo (100mcg only) are lactose free and mannitol free. May be difficult to track down Glenmark, not been available very long
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
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
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
Similarly if normally splitting your levothyroxine, take whole daily dose 24 hours before test
Thanks both for the response. I have read all the info. I am just not sure I can challenge the doctor. It has been a nightmare for me to get where I am right now. I am a very agreeable person and really somatize conflict.
Everything is being very difficult and challenging for me...I am only where I am thanks to your encouragement and understanding.....as well as knowledge. Thank you all for your time and willingness to help others. Xx
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