levothyroxine increase

[Disey]

hi, I recently posted with all my results and was advised that I should ask doc to increase my dose, I did that and he increased from 25 to 75, feel bit anxious and bit different, was that too much of an increase in one go or should I just continue and it will hopefully settle down?

[Disey]

Only been on the increased amount for 4 days so far

[SlowDragon Administrator]

that’s probably too much in one go

Which brand were you on for 25mcg

Which brand for 75mcg

Assuming you have 25mcg and 50mcg tablets …not a single 75mcg tablet

Reduce to 50mcg ……..wait at least 6-8 weeks

Then consider either increasing again or retest first

[Disey in reply to SlowDragon]

I didn’t realise you had replied sorry. I did think it was too much at once, the 25 I was in was mercury pharmacy and the new 75 is teva, it is a 75 tablet but I have a full months worth of 25 as I had only just got my repeat prescription when they changed me, I just put to lalatoot that I have a wedding next weekend and then away so thought I’d take 2 x 25 until after that and then add the other 25 to the dose after that, my doc said 75 and test in 2 months but think I’m going to request to do it slower, does that seem the way to go

[SlowDragon Administrator in reply to Disey]

Teva brand upsets many many people

Teva is only brand that makes 75mcg tablets

suggest you request new prescription for 50mcg and 25mcg tablets and that these should be same brand as now …….Mercury Pharma

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, 

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 

Lactose free brands - currently Teva or Vencamil only

Teva makes 25mcg, 50mcg, 75mcg and 100mcg

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...

healthunlocked.com/thyroidu...

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...

[SlowDragon Administrator in reply to Disey]

The problem with changing dose and brand is it’s difficult to tell which is causing issues

We always recommend only changing one thing at a time

So increase dose initially to 50mcg …..but stay on same brand

If taking as 2 x 25mcg you could initially split the dose as well

25mcg waking and 25mcg at bedtime

You will probably be able to then tolerate as single dose after 6-8 weeks

Enjoy your daughter’s wedding

[Lalatoot]

It gets worse before it gets better. For me weeks 2 and 3 of an increase are bad. So much so that I have chickened out of increases I really needed. And of course because I really needed them I've had to go through it all again.You need to ask yourself how sensitive you think your body is to dose changes then consider the options

Stay on the increase and ride it out

Split your levo at Inc dose into 2 daily doses as it's gentler on the system

Reduce the increase to 12.5mcg daily.

I always found levo hard to take as doses over the 50mcg made me feel sick. The endo told me to split my dose and that way I was able to increase more easily.

[Disey in reply to Lalatoot]

Thank you so much for replying, ordinarily I’d just persevere cos I’m quite sensitive to any change in medication and have to work through it. My daughter gets married next weekend and then I’m away so I’m thinking maybe take it down to 50 and do it bit more gradual as I don’t really want to feel like this during the wedding and holiday and then after that I could take the 50 as usual and a 25 different time of day to ease it in, does that sound a good thing to do?

[ockerdoc in reply to Disey]

Also I tried TEVA and it made me feel weird aswell. I changed back pretty quickly and felt ok again on a different brand. Might be worth a try.

[Disey in reply to ockerdoc]

Oh really, didn’t realise the different brands made a difference, I have to have what the chemist gives me 🤦‍♀️ I’ve queried before about different brands on another medication I take but was told they get in what they can, probably what’s cheapest 🙄

[Charlie-Farley in reply to Disey]

They are lying 🤥

Sorry to state so bluntly and yes it will somewhere down the line a cost thing - clinical excellence is now the poor handmaiden.

I actually am one of the lucky ones as I’m ok on Teva and fixed brand with doctor as I had removed lactose from my diet and many forms of Levothyroxine contain lactose. So different brands have different excipients and these can create variation in how your body absorbs the Levothyroxine. If you are having adverse effects talk to GP. It says in the guidelines that the brand can be fixed if a problem with switching brands occurs. Don’t expect either pharmacy or doctor to know this - it’s a bonus if they do. If you have a meds management team at your surgery they can often facilitate this and GP just rubber stamps it saves an appointment for both you and the GP 😉

I’ll bob off and try to find the relevant section.

See below

[ockerdoc in reply to Disey]

I used to go in and ask specifically if they had the brand I wanted and if they didn’t I’d try another chemist. TEVA is well known for causing unwanted side effects.

[Charlie-Farley in reply to ockerdoc]

This is it ockerdoc and they know it and keep very silent. I was lucky to have no adverse reactions on Teva and settled on it, but of those who experience adverse effects, Teva does seem to be the issue. I used the fact it was lactose free to justify it being fixed for me. However the Government edict should be enough to justify the brand being fixed anyway.

I explained to my doctor the need to reduce the variables when managing a lifelong condition. If you start feeling off the last thing you need is the brand of Levothyroxine being changed on top of everything else. Most of us end up taking supplements to keep our levels healthy and possibly other medication for other conditions. Juggling and balancing is hard enough.

[Sharoosz in reply to Disey]

Teva made me nauseated. I agree with the above comments about the jump being too big. The doc I saw in UK dropped my dose from 112/100 (weekend /weekdays) and said to come back in a YEAR! Completely useless.

[Charlie-Farley]

Here’s one

pharmacymagazine.co.uk/clin...

I’ll try find another 😉👍

same but from the horses mouth! Always good to get a Gov.uk reference under your belt.

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

[MyOrangeDog]

I had to increase from 25mg to 50mg. I knew my body was sensitive to Levothyroxine and sure enough 3 weeks down the line I had terrible stomach upsets and diarrhea. In the past I got palpitations too. I’m now taking on alternate days 25/50 and it’s all settled down. You obviously need an increase but I think u need to listen to your body. I’d advise a gradual increase over the next few months until you get to 75. Good luck

[Disey]

thank you to everyone who has commented, I never knew about the different brands causing different side effects but it makes sense and I’m definitely going to speak up and get my changed and also going to increase more slowly too, it’s so good to have such knowledgable people to take advice from cos the docs have absolutely no idea and the thyroid is so important for us. Thanks again really appreciate it