Mixed brands of levothyroxine

[DaisyTed]

I recently increased my dose of Levothyroxine to 75micrograms per day. I just picked up my meds from the chemist today and they have given me Accord brand for the 50 and Teva for the 25. Is it ok to take mixed brands or should I go back to the chemist and try and change both to Teva? Thanks 🙏

[Jaydee1507 Administrator]

Ideally its best to get the brand written on your prescription to ensure that mixed brands aren't dispensed. If you're OK with Teva brand then get GP to write it like the image I have attached and this won't happen again.

named brand prescription

[DaisyTed in reply to Jaydee1507]

Thank-you! That’s a good tip. To be honest I haven’t noticed a difference with the different brands. It used to always be Teva and then switched to Accord.

[SlowDragon Administrator]

Ideally, especially when increasing dose, stick on same brand levothyroxine

Otherwise you won’t know if any issues are due to brand change or dose change

Have you only been on Accord up to now?

Many people find Levothyroxine brands are not interchangeable.

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, 

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

But 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 

Teva is the only brand that makes 75mcg tablet. 

So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or if on Accord just extra 50mcg tablets to cut in half to get 25mcg

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. 

March 2023 - Aristo now called Vencamil

healthunlocked.com/thyroidu...

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...

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.

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).

[TevaFan in reply to SlowDragon]

Thank you for your helpful information. Your advice is very informative.

I had my thyroid removed in 2017 following the discovery of a substernal multinodular goitre which was causing swallowing and breathing problems and was only diagnosed following a chest X-ray arranged by my GP who was concerned about the severe spasmodic cough that I had had for some time. I was informed by the consultant that I had been suffering from Hashimotos for several years which caused the goitre, yet my annual thyroid blood tests were always “within range” and Hashimotos was never diagnosed.

I have now been on 100 and 75mg levothyroxine for some time which I take on alternate days. However I find I feel very odd for a couple of weeks after starting each new prescription when brands are mixed so my GP agreed to add TEVA ONLY to my prescription as only TEVA make 75 or 25 tablets. This was ok for but recently nearly every local chemist in Surrey where I have tried to get my prescriptions filled informs me that I cannot specify which brand I prefer and have to accept whatever brand their suppliers send and they will only send 25mg TEVA. When I said I would take the brand they have in stock they say they can’t dispense them as my GP has specified Teva! They tell if I want a different brand I have to get another prescription issued by my GP with the TEVA specification removed. It is almost impossible to get the same brand dispensed on every prescription. So frustrating.

I did speak to TEVA UK and they state that there is no supply shortage and that chemists must dispense the specific brand if this has been specified by a GP or consultant.

Such a worrying situation if distributors can dictate which medications they will supply. I can only assume it is down to cost.

[SlowDragon Administrator in reply to TevaFan]

It’s frequently necessary to take prescription to several different pharmacies in order to get brand levothyroxine you require

Generally small independent pharmacies are able to be more flexible on trying different suppliers

[helvella Administrator]

It might help to know what products are available in the UK!

My UK medicines document has a table showing the dosages and products here.

Many of us have to consider how to achieve the doses we need. I take Aristo (100) and Wockhardt (25).

If you are OK on both products individually, it is fine to take them together. But if you feel something is wrong (e.g. you feel under- or over-dosed, or have side effects) it is more awkward to work out which product is the problem.

helvella's medicines documents (UK and Rest of the World) can be found here:

helvella - Thyroid Hormone Medicines

helvella has created, and tries to maintain, documents containing details of all thyroid hormone medicines in the UK and, in less detail, many others around the world.

This link takes you to a page which has direct links to the documents from Dropbox and Google Drive, and QR codes to make it easy to access from phones.

The UK document contains up-to-date versions of the Summary Matrix for tablets, oral solutions and liothyronine available in the UK.

helvella.blogspot.com/p/hel...

[DaisyTed in reply to helvella]

Thanks for this- that’s really interesting- I will check it out. I can’t say that I’ve noticed any side effects… good to know it is ok to mix brands.