Levothyroxine intolerance

[GREENcard13]

I also have intolerance to most brands of levothyroxine. Can anyone recommend a brand with no additives. Does anyone get the liquid solution prescribed on the NHS . I'm currently taking Wrockhardt which I seem to tolerate better

[SlowDragon Administrator]

Welcome to the forum

How much levothyroxine are you currently taking

How long at this dose

Are you sure issues aren’t due to being under medicated?

Or low vitamin levels

Brand of levothyroxine

Yes Many people find Levothyroxine brands are not interchangeable.

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 

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, 

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.

If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.

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).

And here

pharmacymagazine.co.uk/clin...

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...

markvanderpump.co.uk/blog/p...

markvanderpump.co.uk/blog/p...

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)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

Liquid levothyroxine

Currently in very short supply

Very expensive and unlikely to get GP to agree to prescribe unless endocrinologist recommends

[GREENcard13 in reply to SlowDragon]

I've been on levo for 30 years but it's only been the last 6 months the chemist has been giving me different brands. I'm on 75mcg Wrockhardt now and he prescribes it in 25mcg for me. I've tried all the other brands you mention and checked the ingredients . Wrockhardt doesn't have acacia in its ingredients and it is much smaller than most other brands indicating to me there are less fillers. Apparently quite a lot of people are allergic to acacia

[jamesal0]

What are your symptoms that make say you are intolerant to levo

[GREENcard13 in reply to jamesal0]

I had flushing of my torso for 6months which my gp said was a reaction to meds ..levo only med I take. Also I had left sided numbness followed by tests at the stroke clinic which neurologist said was migraine this subsided over the weeks after changing to Wrockhardt. So he confirmed my suspicious it could be the brands of levothyroxine

[jamesal0 in reply to GREENcard13]

Yeah - my GP kept telling me I had a migraine too. I had peripheral nephropathy, tingling hands and feet. On levo I worked out myself that can't run a TSH less than 5 or I get tingles. But on low dose Levo I get fat, feel massive anxiety, depressed, dry eyes etc. I switched to NDT almost 10 years ago and once I sorted out split dosing haven't looked back.

[Moon0110]

Hi Aristo produce levothyroxine under their company brand name of Aristo and also as a tablet called Vencamil.

It’s the same product and pharmacists/Doctors can request it under either name.

It is lactose and mannitol free.

As this group have advised me ,your doctor can register it on your prescription so it is the only one dispensed by your pharmacist.

Hope that helps,I know how difficult it can be to try to manage with the others.

Hope it goes well

[TiggerMe in reply to Moon0110]

Needs to be requested as Vencamil now as they have dropped the generic one off the order list

[GREENcard13 in reply to Moon0110]

Thankyou so much I'll look into that if I don't get on with wrockhardt

[helvella Administrator Thyroid UK]

The quantity of levothyroxine in a tablet is absolutely minute. Of the order of a single grain of sugar.

Levothyroxine tablets consist almost entirely of other ingredients (known as excipients) - and it is impossible that this wouldn't be the case.

The liquids (formally oral solutions) actually contain even more excipients (in terms of quantity). A tablet might weigh 100 milligrams. a 5 millilitre spoonful will contain over 5 grams of excipients - even though some will be water that is much more in quantity.

Overall, I think the tablet excipients which appear to cause the most issues are Acacia, Lactose and Mannitol. There is a matrix of the makes which contain each of these in my medicines document.

Full lists of ingredients are in section 6.1 of the Patient Information Leaflet for each product.

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...

[GREENcard13 in reply to helvella]

Very informative thankyou

[Moon0110]

😀

[Titian]

According to the manufacturers of the thyroid drug, Tirosint, the information posted on their website states the following.

“For people with food or ingredient sensitivities, Tirosint offers effective relief of hypothyroidism without sugars, dyes, alcohol, wheat starch (gluten), lactose, or any other excipients (inert ingredients) used to make traditional levothyroxine tablets. It is produced in a dedicated facility, where no other products are made, eliminating the risk of cross-contamination and providing you with additional peace of mind.”

[GREENcard13 in reply to Titian]

Thankyou

[helvella Administrator Thyroid UK in reply to Titian]

Tirosint might be the best levothyroxine product on the planet.

But it is effectively unobtainable via the NHS - indeed, hard to get at all in the UK.

[Kitten-whiskers]

Good evening

I have had issues with every form of Thyroxine, but I do find the liquid the best option for me, I am prescibed it but to get it, I had to ask Endocrinologist.

[GREENcard13 in reply to Kitten-whiskers]

Do you get it privately or NHS

[Kitten-whiskers in reply to GREENcard13]

NHS

[HealthStarDust]

Another member posted a similar post very recently, which you may be interested in healthunlocked.com/thyroidu...