NHS Clause supporting right to a particular brand

[Fifteen]

Hi, my new GP (I recently moved home) said he could not specify my levothyroxine brand. My last GP specified Elroxin as it was the only one that seemed to work.The tablets I now have are not working - the dry skin is unbearable.

Can anyone tell me if the NHS allows doctors to specify a particular brand. If so, where can I find the supporting NHS statement?

There is no way this new GP will prescribe T3 so I am glad I have access to the EU supplier.

Thanks for your help.

[bantam12]

My GP surgery specifies which brand I need on several of my meds.

[Fifteen in reply to bantam12]

My previous GP did. I just have to convince my new chap that he is allowed to under NHS guidelines.

[Jaydee1507 Administrator]

This might help.

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

If one doctor isn't helping, always try a different more helpful doc at same practice.

[Fifteen in reply to Jaydee1507]

Thanks for this. Yes, I thought I may try a different doctor at the practice. May be worth a try.

[Fifteen]

Thank you.

[helvella Administrator]

Sometime roundabout right now, a new product will be available - Aristo Vencamil. (Maybe a week from now for pharmacists to be able to order it.)

Absolutely 100% identical to their existing levothyroxine but technically a brand which can be prescribed by name.

Unfortunately, only in 100 microgram tablets.

[Fifteen in reply to helvella]

Thanks for this. Yes, I need 25mcg as well as 100mcg. Is Eltroxin no longer available?

[helvella Administrator in reply to Fifteen]

Afraid I still haven't got my head round the availability of Mercury Pharma Eltroxin (in any dosage) and the identical Mercury Pharma levothyroxine.

We have seen long periods when Eltroxin has not been available - then it suddenly comes back. And, at times, it has been difficult to get either product!

What make are you currently taking?

[Fifteen in reply to helvella]

I am on Aristo 100mcg and Wockhardt 25mcg. That's interesting about Eltroxin - I had an uninterrupted supply for at least 4 years.

[lolajone in reply to helvella]

excellent information thank you I’ve been struggling to get Aristo 😁

[helvella Administrator in reply to lolajone]

Probably best to check pharmacist can order it before getting any prescription changed!

I am just about to ask for my next prescription to be dispensed as Aristo - whether branded or not.

[SlowDragon Administrator]

Many people find Levothyroxine brands are not interchangeable.

Which brand are you currently taking?

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets 

Mercury Pharma also boxed as Eltroxin.

Both often listed by company name on pharmacy database - Advanz.

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

Northstar levothyroxine being phased out this month 

 

Many patients do NOT get on well with Teva brand of Levothyroxine. Teva is lactose free.

Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome 

But for some people (usually if lactose intolerant, Teva is by far the best option)

Aristo (currently 100mcg only) is lactose free and mannitol free. 

Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets 

 

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Government guidelines for GP in support of patients 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. 

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).

Guidelines here in photo for GP on how to write prescription correctly to specify brand of levothyroxine

Guidelines for GP to specify brand of levothyroxine on prescription

[Fifteen in reply to SlowDragon]

Thanks for this very comprehensive summary. I have Aristo 100mcg and Wockhardt 25mcg. I had been on Eltroxin for a few years and that worked well.

[Fifteen in reply to SlowDragon]

Thank you for this most comprehensive reply. I will now be well informed when I see my GP. As well as dry skin, I am now lethargic in the mornings and feel the need for an afternoon rest - not a good recipe for an active, successful life.

[Sailing14 in reply to SlowDragon]

I am thinking of changing to Mercury Pharma. Is this the same as Eltroxin? If so, what is the branded forms name? And is the branded form a better choice?

Also, I am also considering Wockhardt but will taking 4 x 25 mcg and 3 x mcg affect my levels in any way? (currently on 75/100).

I am taking Accord but I am unsure if it is agreeing with me like it was before brand change two years ago. Reducing down at present but due a blood test in a week.

Thank you for your help.

[helvella Administrator in reply to Sailing14]

Mercury Pharma Levothyroxine is absolutely identical to Mercury Pharma Eltroxin. The only issues are getting the right thing prescribed and then dispensed - reliably.

There is no particular reason to avoid taking any number of 25 microgram Wockhardt to make up your dose. Obviously two tablets have twice the amount of lactose, etc. as one tablet but if that isn't a problem - fine. Also, you might find a reluctance to prescribe multiple tablets.

[Sailing14 in reply to helvella]

Thank you for your quick response. I will take that into account. I am concerned about acacia in MP. Do most people get on well with it though?

[helvella Administrator in reply to Sailing14]

I think I've given up predicting tolerability of medicines!

Unless there is a known issue, I think it is hard to make any predications. Quite a few do well on it, but others prefer to keep away. I have no idea of the numbers!

[Djgmpg]

You should refer your GP to ‘Gov.UK document published 19th May 2022 -

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

Take a photocopy to your GP. (And your pharmacist if they ignore your requests for your preferred brand. I found it after trawling the internet for symptoms such as yours when my pharmacist ignored my request(s) to stop changing brands and the reason why.

[RedApple Administrator in reply to Djgmpg]

Djgmpg, We ask that wherever possible, you include a link to information you quote.

The link I have for this is to a document from 19 May 2021. Is this the document you refer to? gov.uk/drug-safety-update/l...

[Djgmpg in reply to RedApple]

Yes, this is the document.

[1tuppence]

Hello. Sorry to learn you're having difficulties getting the brand you need. I've had similar problems. Eventually I checked my local pharmacies could obtain Eltroxin, then spoke to my medical centre pharmacist. He was very understanding, and changed my prescription to read Eltroxin/Advanz/MercuryPharma only. Wishing you the same.

[Baggiesfan]

I get Eltroxin as the named brand from my g.p. but have occasionally had unbranded Mercury Pharma, then got unbranded from endo at hospital in Birmingham. Checked the patient leaflets and it's exactly the same except for the name. No difference at all, I couldn't tolerate Teva at all.

[Starfish123]

NICE updated their guidelines I think it was May 21, the guidelines stated you could specify the levothyroxine brand. I requested this from my gps and was told they would get back to me, they didn’t but my prescription was updated with the brand.