Hi.I have been taking Thyroxine 100mg for years fairly successfully.
When I picked up my last prescription, the box was still coloured orange & looked the same but wider. The tablets composition had changed - were larger & harder to digest.
Since I have been taking this batch I have had terrible hot flushes day & night & awful joint flare/stiff/moderate pain
I'm convinced my new symptoms are from the tablets (nothing else re food lifestyle etc has changed)
Does anyone know if the tablets have changed ? Has anyone else noticed this?
Thanks
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Seahorse0
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Many people find different brands are not interchangeable
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
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.
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.
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).
I must have one of the old packs of Aristo and they’re awful as they start to dissolve the moment they enter your mouth , barely time to grab a glass of water!!!
I currently have Aristo and Wockhardt - and both start to disintegrate as soon as they get damp - as in being on my tongue before swallowing with water. It reassures me that they are not going to fail to disintegrate.
Yes, many tablets are coated. Terms like gastro-resistant and enteric-coated are used to described tablets which are expressly designed not to disintegrate in the stomach.
No UK levothyroxine tablets are coated. (I'm not sure, and would need to check, but from memory I cannot think of any levothyroxine tablets that are coated.)
Levothyroxine tablets are expressly intended to disintegrate quickly. The acidity of the stomach contributes to satisfactory absorption.
Years ago, one particular USA make was so bad at being absorbed, they had to withdraw it from the market and completely reformulate it. There were reports of tablets passing right through without disintegrating. And not only was absorption impaired, but it was inconsistent from one tablet to the next.
The reformulated version starts to puff up in the mouth and requires to be taken with a decent glassful of water to prevent it getting stuck in the throat or oesophagus! They might have overdone it. But its absorption is massively more consistent.
Both Aristo and Wockhardt disintegrate well but do not puff up like that USA product.
Furthermore, we have levothyroxine oral solutions and gel caps. And we used to see advice about dispersing crushed tablets in water on levothyroxine tablet Patient Information Leaflets. None of these would be viable if stomach acid were an issue.
That the caps dissolve easily in your mouth can be an advantage. Years ago, my endocrino recommended that I put the Levo under the tongue instead of swallowing it, so that it would be absorbed through the skin and mostly bypass the digestive system. It's worked out well, my FT3 &FT4 readings are consistently good... and I don't have to worry about avoiding caffeine x 2 hours before and after taking Levothyroxine.I take Sanofi, brand name L'Thyroxin.
The doses for eltroxin have changed. My American friends informed me. I checked on medscape and is correct.
The sizes are now. 25mcg, 50mcg, 75mcg, 88mcg, 100mcg, 112mcg,
125mcg, 137mcg, 150mcg, 175mcg, 200mcg, 300mcg. Now also in liquid and capsules. Guessing larger sizes are because of the huge obese population increase. But the 88, 112, and 137 sizes are interesting.
Some of the reasons for higher dosages would have been the lack of blood tests, the poor control over potency of product, and that higher dosages represented lower cost to patients. That is 300 costs less than 100 + 200 or 3 * 100. Even if it means the patient then splits the tablets.
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. There is now a specific world desiccated thyroid document.
The link below takes you to a blog page which has direct links to the documents from Dropbox and QR codes to make it easy to access from phones. You will have to scroll down or up to find the link to the document you want.
The UK document contains up-to-date versions of the Summary Matrixes for levothyroxine tablets, oral solutions and also liothyronine available in the UK. Latest updates include all declared ingredients for all UK products and links to Patient Information Leaflets, etc.
Before you pick up your new prescription ask the chemist to give you what you had before. Once you leave the premises you can’t change them back but you can refuse to accept them.
I had awful cluster headaches with TEVA. Reported.
Wockhardt is the only Levothyroxine I can tolerate. Hard to get though for some reason although produced in UK. The manufacturers constantly rebrand their products too - and always have to check small print for TEVA.
hi seahorseo...interesting ro read your post .. my levothyroxine was increased a couple of months ago ,I now have joint pains ,wonder if there is a connection 🤔🤔
Hi helvella..I get different makes all the time. ... I am taking 50mg...and then after the last blood test 2 or 3 months ago .. it was increased to an extra 25mg every other day ..
I have taken TEVA without any problems for 30 years. Since last August I was unaware that I had been given Mercury Pharma. That led to a huge spike in T4 and a reduction in dose that was too low and all my hypo symptoms came back. I have since seen a private Endo and NHS ENT Consultant. They both agree that a change in brand can cause problems and I should never be given a mixed brand dose. I was on 175mcg so had 100mcg 50mcg and 25mg tablets from 3 different manufacturers. I now check what I have been given before leaving the pharmacy and my GP has put TEVA brand only on my prescription.
My recent levothyroxine package and tablets have also changed. Different manufacturer and the tabs are larger. I've been experiencing pain in my right thumb and little finger. I don't know if there is a corelation but now I wonder!
My recent levothyroxine package and tablets have also changed. Different manufacturer and the tabs are larger. I've been experiencing pain in my right thumb and little finger. I don't know if there is a corelation but now I wonder!
I normally have Almus/Accord. But this time the pharmacy messed up (I swear it’s the extra pressure they are under with the new “no GP needed” rules), they gave me 50mcg packs instead of 100mcg! And I went in to ask for either 2 more packs of 50 or to change for 100s. They gave me Mercury. I’ve had them before, a long time ago, so took them.
A month in and I’ve been so fatigued in the last 7-10 days. Needing crazy amount of sleep, constipation and migraines increased and more severe. I had upped my levo by a tiny 12.5mcg twice a week from Dec as my FT4 was only 30% in the range back then. It could be something else, but my (meagre amount) of money is on the change of brands, maybe with a bit of natural thyroid level decrease too.
I’ve changed my pharmacy back to Boots so I can get Almus again from the next repeat (3 weeks and counting). I’m going to see if my GP will do a blood test too. I’ve given up with home fingerpick tests as I can’t get enough blood first thing especially in the winter.
Hope you get sorted Seahorse0 we have enough to contend with, without the added aggro of different brands affecting us too
A little update to my previous post (i didn't know how to edit it !). I went to pick up my prescription and was given my usual (Accord) - must say i feel a lot better just in a few days .
I spoke to the pharmacist who tried to tell me there is no difference between Accord and Teva I quote 'its just like choosing to shop in Tesco or Asda '. Although I don't think he realised I was given a different brand (do they just pick up what's in stock on their shelves ?),
He advised he will write on my file not to dispense the Teva brand and told me to check before I left the chemist
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