Change of brand

[Campy1967]

Hi ive been on 50mcg of accord levothyroxine since May this year just picked up my prescription and the brand has changed to teva just wondering if other people have had the same change and will or does it make a difference in the brands ?

[helvella Administrator]

Some people find Teva is the best for them; others find it the worst. I don't know of any factors we can use to predict our reactions to it.

It contains mannitol whereas most others contain lactose. This might be why.

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...

[SovietSong]

I received Teva on collecting my prescription a few months ago.I didn’t feel well on it.Some can’t take it and others can take nothing but.On contacting the pharmacy I found the change was due to sourcing issues.I then changed to a smaller independent pharmacy and get accord all the time now.One mans meat is another man’s poison I guess.

[Jaydee1507 Administrator]

It is recommended to always get the same brand of Levo at every prescription.

What brand you get given by your chemist is completely random depending on what they have in stock. If you have got on well with Accord brand then you can ask your GP to write Accord in the first Line of the prescription. This will mean that the pharmacy has to give you that named brand.

Named brand prescription

[13579-2468 in reply to Jaydee1507]

Can you insist that your GP names the brands?

[Jaydee1507 Administrator in reply to 13579-2468]

Most GP's would do this if they are being helpful. There is a recommendation on the government website about naming a brand of Levo.

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

[13579-2468 in reply to Jaydee1507]

thank you very much.

[SlowDragon Administrator]

How long have you been on just 50mcg now

Bloods should be retested 6-8 weeks after each dose increase

50mcg is only the standard STARTER dose

Highly likely you’re ready for next increase to 75mcg

ALWAYS Test thyroid levels early morning, ideally before 9am. Only drink water between waking and test. Last dose levothyroxine 24 hours before test

Essential to test vitamin D, folate, ferritin and B12 levels too

Have you had levels retested yet?

[Campy1967 in reply to SlowDragon]

Started me off in December 22 on 25mcg had bloods done about end of January it was:3.9 then they only checked the TSH i had to ask for a increase myself had another bloods done end of April full count liver function diabetes etc got a msg saying everything was normal no further action at this stage .

[SlowDragon Administrator in reply to Campy1967]

A) you’re legally entitled to actual results and ranges

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

Link re access

patients-association.org.uk...

healthunlocked.com/thyroidu...

In reality some GP surgeries still do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

B) just testing TSH is completely inadequate but frequently all that NHS tests these days

So you had dose increase to 50mcg at end of April?

Book new test now …..9am latest

For full Thyroid evaluation you need TSH, FT4 and FT3 tested 

Also both TPO and TG thyroid antibodies tested at least once 

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

[Campy1967 in reply to SlowDragon]

Think i would be better doing a private test for it all Drs some clueless with thyroid ranges etc so much hassle id rather pay any suggestions as to the best private test plz

[SlowDragon Administrator in reply to Campy1967]

we recommend either

Medichecks is usually cheaper

Possible has more private clinic options if want private blood draw

Blue horizon includes snap shot cortisol test

Test early Monday or Tuesday morning, ideally just before 9am. Water only between waking and test

Last dose levothyroxine 24 hours before

Stop any vitamin supplements that contain biotin 5-7 days before ALL blood tests

Avoid testing in very hot weather, as risks blood getting too hot in post to lab

Examples of Medichecks results

healthunlocked.com/search/p...

Examples of BH results

healthunlocked.com/search/p...

[SlowDragon Administrator]

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 just extra 50mcg tablets to cut in half

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).

Discussed here too

healthunlocked.com/thyroidu...

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

verywellhealth.com/best-tim...

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)

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here 

cks.nice.org.uk/topics/hypo...

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine: 

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months. 

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range. 

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[SlowDragon Administrator]

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning. 

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism 

thyroiduk.org/wp-content/up...

Tips on how to do DIY finger prick test 

healthunlocked.com/thyroidu...

or Medichecks and Blue Horizon offer private blood draw at clinic near you

[Poppycat999]

According to to site yes it does matter and Teva is the brand on here most people moan about!!!

[Xmrkn20]

I had my brand changed when I increased from 50mcg to 75 mcg, as Accord didn’t make a 75mcg pill. I was worried about it because of the things I’d read here about people feeling ill and I asked the pharmacist to change it but he wouldn’t. So I gave it a go and have been absolutely fine. Suggest you try it and, if you feel bad, get the doctor to stipulate the brand on your prescription. But you may be fine.

[helvella Administrator]

I do try to emphasise that we are all different and have no way of predicting!

[Lisajane747]

Teva made me feel really ill, accord is good but everyone is different Lloyd's direct give Accord

[Bearo]

The advantage of getting a private blood test is that you can get FT4 and FT3 tested, as well as vitamins and antibodies if you’re willing to pay for a full test.

Then if you want a dose increase on the NHS you can go to the GP with your request knowing what their NHS test outcome will be - if only TSH - so are forewarned as to whether you need a dose change and whether GP is likely to agree. ( although I don’t generally let on that I’ve done my own test)

What I really dislike about the GP tests is the refusal of the surgery to release the results until after the GP has spoken to you. This gives you a lesser chance of knowing what you want to say - the GP is prepared but you are not, so much.

[KatrinaN]

My dose has just been increased to 75mcg and my prescription was for 50mcg Accord (my usual brand) and 25mcg Teva. I was a little nervous to try it but I took it for the first time today and didn’t have any immediate side effects. Give it a go and see how you feel.