Levothyroxine extra ingredients (excipients)

[Anthea55]

So many people want to know what is in the different brands of levo, so I prepared this table based on helvella 's useful file. I looked up the ingredients of current brands. I made it for a friend and it seems to make things clearer for me.

Please let me know any errors.

[SovietSong]

Thanks for taking the time to do this.Im sure many people on here will find it very useful.

[Anthea55 in reply to SovietSong]

I've now looked up 'sodium starch glycolate type A'. Type A is based on potato. I'm sensitive to potato so that explains why Vencamil disagreed with me. It's also in Armour which also disagreed with me.

[helvella Administrator Thyroid UK in reply to Anthea55]

Sodium Starch Glycolate type A doesn't actually have to be made from potato.

It is true that a lot is. But it can be made from other sources such as sago.

Technically, it could identify the source by saying Sodium Starch Glycolate type A potato (or whatever the source is).

[TiggerMe in reply to Anthea55]

That is interesting as nightshades are totally poisonous for me but I have no issue with Vencamil 🤷‍♀️

[Anthea55 in reply to TiggerMe]

Just shows I should have been careful with google!

I'm sensitive to oats and wheat as well as potato, but not gluten. Further googling shows that 'starch glycolates are also of rice, wheat or corn origin' so could be the wheat for me.

[TiggerMe in reply to Anthea55]

Could be... I'm ok with rice, wheat and oats but not barley, dairy or the dreaded nightshades

When it comes to the technical stuff I always rely on 🍄 he is so much more reliable 😉 and always puts me straight!

[helvella Administrator Thyroid UK in reply to Anthea55]

I thought exactly the same as you when I first searched for it! Took a bit more looking around to understand it isn't so.

That is why I am so aware - my own mistake coming back.

[Mlinde]

No wonder Teva has such bad side effects, it contains Mannitol, a nasty, synthetic sugar.

[Anthea55 in reply to Mlinde]

You can also see why some people find that Wockhardt is best for them even though it only comes in 25mcg tablets.

[Mlinde in reply to Anthea55]

Well I prefer Mercury and at a pinch, Accord

[Kimkat in reply to Mlinde]

I’m exactly the same as you. Touch wood I’ve been lucky for the last 6 months as I’ve been given Mercury 🙌

[Mlinde in reply to Kimkat]

You can ask your GP to specify a particular brand, it might work

[Kimkat in reply to Mlinde]

Yes it’s on my notes but the pharmacy do occasionally try to slip in Teva which give me terrible headaches. I open my prescription in front of the pharmacist now and if it’s Teva I refuse to accept them.

[Mlinde in reply to Kimkat]

I'm lucky, I have very friendly pharmacists and if I get the wrong brand, they'll switch.

[Kimkat in reply to Mlinde]

Yes, they’re pretty good now but I had a bit of a fight on my hands at first

[rosie61 in reply to Kimkat]

I do exactly the same, got caught out once as Teva was just in small writing on the side and I was so poorly. Luckily the chemist exchanged them for me as it was their mistake and my prescription said No Teva on it.

[helvella Administrator Thyroid UK in reply to Mlinde]

The mannitol used in any particular product might well be synthetic.

But mannitol does naturally exist in many plants.

It was originally made from the flowering ash

Natural extraction

Since mannitol is found in a wide variety of natural products, including almost all plants, it can be directly extracted from natural products, rather than chemical or biological syntheses. In fact, in China, isolation from seaweed is the most common form of mannitol production. Mannitol concentrations of plant exudates can range from 20% in seaweeds to 90% in the plane tree. It is a constituent of saw palmetto (Serenoa).

en.wikipedia.org/wiki/Mannitol

[grumpyold]

This is brilliant. Thankyou for taking the time to do it.

I intend to print it off and wave it under the pharmacist's nose next time he tries to palm me off with anything other than what it states on my prescription ie Accord/Almus/Northstar .

I'm sure he thinks I'm just being awkward by refusing to accept all the recognised brands he wants to offload.

[ShatteredofLee]

thanks Anthea, very useful. My new pharmacy keep giving me a different make/brand literally every month and this gives me a clue what to ask for

[Regenallotment]

we do love a spreadsheet, top marks 👏

[1Cass]

Many thanks Anthea. The breakdown is really helpful for me. I didn’t realise the brands were so different.

[Anthea55 in reply to 1Cass]

I don't think I did until I started looking them up.

That 2nd column - are they all interchangeable? Is Mercury exactly the same as Eltroxin? and Advanz? Same ingredients, but are they in the same proportions?

[helvella Administrator Thyroid UK in reply to Anthea55]

Yes - they are absolutely 100% identical. This has been explicitly conformed by the MHRA.

(Many years ago, there was a tiny difference in one of their 50 microgram tablets - and the MHRA got them to reformulate to make them identical. Until then, the two 'versions' had different product licence numbers.)

However, we do not have the details to establish if the proportions of the excipients are the same in the 25, 50 and 100 microgram tablets.

[Bellaowl in reply to helvella]

I need to ask a question I’m hoping Helvella can answer.

I have to take carbocisteine for a lung condition. It is made by a number of companies but almost all contain yellow dyes eg sunset yellow and quinolone. However Milpharm do not contains these.

BUT I have been told by my usual pharmacy and another, that it is illegal to specify a certain manufacturer. And it is the luck of the draw if the ones I want come in.

The same is so with Sitagliptin for diabetes. This is available without the colours as Januvia. But again the pharmacist cannot specify this.

Nor can they contact the manufacturer/ importer directly.

I get dreadful hives with these dyes.

And my HbA1c is going up and down because I cannot get them consistently

Has anybody found a solution?

Can I buy them privately, if so how?Surely I cannot be the only patient with allergies to excipients.

Bella

[helvella Administrator Thyroid UK in reply to Bellaowl]

I am entirely unconvinced that someone with a demonstrable intolerance cannot be either prescribed by brand or with a positive requirement to avoid the problem ingredient(s).

However, we see all too many members who have to jump through ridiculous hoops to achieve that.

And I do not know the formal and complete answer.

Regarding private purchase:

All medicinal forms of carbocisteine are Prescription-only (POM). So you first need to persuade a doctor to prescribe it on a private prescription. The rules about NHS doctors and private prescriptions are a bit odd and I do not know if you can get past that. So you might need a private doctor.

Then, the medicine itself isn't that expensive but you can probably add around £10 per item to the NHS price for dispensing a private prescription. Plus postage, if required.

I suggest you consider contacting Roseway, as their resident prescribing GP might be willing to prescribe especially if you have NHS prescriptions already.

Screenshot of February NHS Drug Tariff for carbocisteine

[helvella Administrator Thyroid UK in reply to helvella]

The SPS is NHS England's Specialist Pharmacy Service who are supposed to provide many sorts of support and guidance to professionals. (Not us patients, of course!)

They say this:

Handling questions about excipients

Source UKMi Quality and Risk Management Group · Published 26 October 2020

Topics: Excipients

Quality and Risk Management Group

Pharmaceutical excipients are constituents of a medicine that are not used for their direct therapeutic action, but to aid the manufacturing process, such as to enhance stability or bioavailability.

Patients may want or need to avoid certain pharmaceutical excipient(s) for a number of reasons. Medicines free from specific pharmaceutical excipient(s) may be requested for particular patient groups (e.g. neonates), patients with a severe allergy or with particular cultural or religious beliefs. This document aims to assist healthcare professionals in providing safe, effective and timely answers to support that decision. It outlines the steps involved in checking for the presence or absence of the substance in product information; and provides an explanation of the requirements for information about constituent excipients in the product labelling and patient information leaflet.

sps.nhs.uk/articles/handlin...

That page links to this document:

sps.nhs.uk/wp-content/uploa...

That is, they accept that avoidance of some excipients is necessary. They provide some background information. But utterly fail to provide any guidance as to HOW to ensure the avoidance is incorporate in prescribing and dispensing practice other than contacting manufacturers, etc.

[Bellaowl in reply to helvella]

thank you. I’v found another local pharmacist who is willing to try to obtain these.

And my GP is willing to give me a private script.

The main suggestion has been to try to get these from Germany as I have a German doctor with regular contacts.

What about hospital pharmacies?

Are they bound by the same rules?

I’m at Royal Marsden on Wed, I thought of asking there.

I’m told my HbA1c has to 5 or below to fight the cancer.

Belleowl

[helvella Administrator Thyroid UK]

This is for the ordinary T4 tablets available in the United Kingdom.

No specials, no compounding.

[Jackobee]

Thanks, this is really interesting. I’m fine with Teva, Wockhart or Mercury Pharma but have problems with Accord so will look into the differences.

[SiouxieQ]

Thank you - this is a hornets nest but Lactose removal from Teva in particular alters the bioavailability of the Levothyroxine . If you're on it and ok you need to stick with it. Ireland and the US do not allow switching of brands for patients and it should be that way in the UK . I cannot take Teva or other brands which have a Teva product licence without having an issue with my thyroid. One to be aware of and I'm not lactose intolerant.

[AddMegan]

Thank you.