WARNING-LIQUID LEVOTHYROXINE USERS

[Wua13262348]

On 11/11/22 I finished a bottle of Brillpharma Liquid levothyroxine which had a full size syringe .

I did not get Brillpharma again until 12/7/23. At this time, the syringe supplied to measure the 5ml dose changed to a short, stubby, clear plastic one.

Because my bloods have suspiciously risen , on closer examination, I have noticed that with this new clear, short, stubby syringe, if you draw a full dose of what you think will be 5ml, you actually draw 5.5ml if you fully extend the drawer of the syringe.

Since I started 75mcg strength Brillpharma liquid on 12/7/23 at a full draw which should be 5ml, my FT4 has risen. This is because a full draw is actually 82.5mcg, not 75mcg, as there is a 0.5ml space beyond the 5ml marking on this syringe.

McPammy is holding some Brillpharma on reserve for emergencies if she runs out of her current brand. She takes around 68 or 68.5mcg. If she measures that from a 75 or 100mcg strength bottle there is no problem as her dose is lower than a full draw. If, however, she measures her dose from a 25mcg strength bottle or 50 mcg bottle, pulling the drawer to its fullest extent, she will be overmedicated if the syringe is the new , short, stubby one. She had Brillpharma 25mcg strength at the end of last year or beginning of this year. She felt it didn't deliver the correct dose for her. If it was the short syringe she had then , it would overmedicate her if she pulled the drawer of the syringe to its fullest extent. Two full draws in this manner would be 5mcg over for her first 50mcg. The remaining amount drawn would be okay if she converted the ratio correctly. Whilst using the 25mcg strength bottle, she would be overmedicating by 5 mcg.

I do not have an old 2022 Brillpharma syringe, so don't know whether a full draw with it delivered 5ml or not, or whether it too had the extra 0.5 ml. Can someone tag McPammy so that she sees this post. My brain not up to attempting learning how to tag successfully.

The above scenario means that a full draw of Brillpharma, if you do not stop at the 5ml mark means that 25mcg bottle would overmedicate to 27.5mcg, 50mcg to 55mcg, 75 to 82.5mcg and 100mcg to 110mcg.

If McPammy has an old Wockhardt syringe (Used to be her regular brand) could she check it for me to see if it is white, full sized with MD within a square on it, then says CE0124, then a picture of a church or cathedral elm-plasticGmbH54647 Dudeldorf GERMANY.

I have kept an old syringe which has markings on it as described above. A full draw with this full sized, white plastic syringe delivers 5ml. I don't know whether it is a Teva, Wockhardt, Zentiva or old Brillpharma syringe. CAN ANYONE IDENTIFY WHICH BRAND THIS SYRINGE WAS SUPPLIED WITH?

I will start a new post asking for advice as I am overmedicated a tad, I think even when taking 75mcg., though strongerZentiva may have been implicated in this. I feel 82.5mcg ( by mistake as above) overmedicates me, as like Tattybogle, the overmedication seems to be affecting my bladder. Apart from that I have no symptoms of overmedication.

In light of the above information, I think all users of liquid levothyroxine of any brand, should now routinely check if the syringe supplied , when fully drawn delivers a dose in excess of 5ml. Otherwise, there is potential to unknowingly , and unintentially, overmedicate.

[SlowDragon Administrator]

McPammy

Flagged so hopefully she will answer

[Meerkat1234 in reply to SlowDragon]

Evening SlowDragon. I see from your bio that you have TED. I had a cataract removed four years ago and now have to have the other one done. Since the first surgery I have had pain in my eye and can’t move my eye up down or side to side. I didn’t know I had Hashimotos with the cataract surgery. I have just read about TED. Can you help me with your experience with it. I smoke which says makes it worse.

[SlowDragon Administrator in reply to Meerkat1234]

Can you write this as a new post of your own ….rather than on another member’s post

[SlowDragon Administrator]

please add your most recent TSH, Ft4 and Ft3 results

Plus vitamin D, folate, B12 and ferritin results

[Star13]

For elimination purposes, I’m currently using Zentiva and the syringe has CE 1639 a church silhouette then HDB.

I had cause to complain to Teva some time ago because their syringes did not pull up to the full 5ml so you had the potential to be under medicated. I have not had it since so don’t know if they have changed them. I’ve got some Brill at home (currently away) so can check in a couple of days what their syringe is like.

I would suggest you complain to Brill about the potential to over medicate but I expect they will just say you have to measure carefully when you draw up as Teva would not accept anything was wrong with theirs either.

[Wua13262348 in reply to Star13]

Thanks for that, very interesting. I had a good long run on Teva, dosing 75mcg from 50mcg strength. Honestly don't know if when drawing up the 5ml for the first 50mcg, whether it went all the way up to 5ml or not. Not aware if there was ever space beyond the 5ml marking, at the time either.

Well done you for noticing the syringe did not go all the way up to 5ml. I have been in the habit if drawing 5ml, of just drawing it as far as it will go on the naive assumption all is well and it will be 5ml. Never suspected the syringe may not be drawing as far as 5ml. So grateful to you for mentioning this.

Looks as if we have to be vigilant re. the syringes regardless of brand going forward as a matter of routine, or could over or under medicate unintentially, and unknowingly.

[Wua13262348 in reply to Star13]

I absolutely won't complain to Brillpharma as don't want to do anything to risk a delay in future supply, should they decide it might be something they should change. The supply situation is too dire to take risks like that! Awful I know!

[Wua13262348 in reply to Star13]

Can you tell me how much it did not pull up to 5ml e.g. was it 0.5 ml short? Also what month and year did you complain to Teva? If you complained by email , what date?

I have practically all my old boxes with the batch codes etc. Do you?

It will hopefully make sense of what has been happening with my bloods as I,ve been switched to and fro from brand to brand.

[McPammy]

Hi. I’ve just read your post. I’m on holiday in Croatia at the moment but returning home soon. As soon as I get my holiday head around your post I’ll post back. As a quick reply what I found if I changed to a higher strength 125mcg , as that’s what was only available at that time, in liquid form is that I went over medicated, even though I followed the draw amount to the line when changing quantity to take with a higher strength. I always check the draw amount by the lines on the syringe routinely. I did go over medicated taking a higher strength of 125mcg even when lowering the amount as directed by the pharmacist. This did surprise me. My T3 increased as well as T4 as I got my bloods checked during that period. Now back on my normal 50mcg strength T4 and T3 have gone back to where they were. Strange but true. Maybe higher strength converts higher amounts.

[helvella]

Just for clarification, is the syringe the one illustrated in the Patient Information Leaflet? Or different.

Line drawing of measuring/oral syringe from Patient Information Leaflet.

[Star13 in reply to helvella]

Yes

[Wua13262348 in reply to helvella]

Yes. Mea Culpa. The PIL tells you to " pull the piston down to the graduation mark corresponding to the quantity in milliliters prescribed by your doctor", so they have covered themselves .I ASSUMED a full draw would be 5ml, as the other syringe I have kept is 5ml at maximum draw.

The other syringe I have kept has a full draw of 5ml and may well be the Zentiva syringe. Rather than Zentiva being stronger than other brands as I previously was convinced of, it may well be the case that Zentiva is the accurate one true to dose by the syringe, at partial and full draw. Because I assumed all syringes would be 5ml at full draw, I may be underdosed on Teva, overdosed on Brillpharma, and on an expected true dose when I had Zentiva. I have 75mcg strength Brillpharma since 12/7/23. Previously I got my Brillpharma 75mcg dose from 7.5ml of 50mcg strength Brillpharma.

I had a fuller reply to you in progress which deleted when I sent a further query to Star 13 asking by how much the Teva syringe was under-drawing, and when she made the complaint.

Advice on how far to lower my dose and why , with regard to my past 4 blood test results, I had intended making a separate post for. This post is fundamental to the blood results. Therefore, although not ideal, I think I will have to make my request within this post as I do not know how to cross reference a past post , which I notice members do.

If the Teva syringe is or was 0.5ml under on a full draw, my 75mcg intended dose would be 70mcg on Teva, but 82.5mcg on Brillpharma, with Zentiva possibly 75mcg!!!

[helvella in reply to Wua13262348]

Thank you.

You can cross-reference a post easily on a computer!

Go to the "address bar" - where you can see the website you are on.

Select and then copy all the text in it.

Create you new post or reply and paste the link. It doesn't turn blue - and get dots - until you actually post it.

More difficult on a phone - and most particularly, more difficult to explain! But the process is similar.

You can also click on the More button under each post and reply. That displays a little list which includes Copy reply link.

Do that and paste into your new post/reply and it will take you to the exact reply.

The address bar in the browser I am using - Firefox.

[Wua13262348 in reply to helvella]

Thank you Helvella. That is double dutch to me! Never going to happen. Failed at the first step. when highlight address bar, no idea how to copy all the text in it. You would be flogging a dead horse even if I could find how to copy, as then have to paste.

Maybe not, have discovered 3 vertical dots in left hand corner and option there for copy and paste???? Probably won't manage it. I will try to do it.