Brill Pharma Levothyroxine oral solution 100mcg sugar free

[Spongemum]

I had problems when first starting treatment feeling chest pain and just abnormally weird when on Teva tablets. Once on the liquid solution I have been fine.

Now my pharmacist say they can only source Teva and they gave me instructions I needed 75 ml not 5ml of this product which is also not sugar free.

As I take mine in the night I have to clean my teeth after or wake up in the morning with a foul taste.Initially I did not have the symptoms as after the Teva tablets but now having been on this for almost two weeks I have suddenly developed violent sneezing sessions, wheezing and heart pain again.

I am now resorting to taking an antihistamine with this Teva stuff.

I have tried everywhere to find the Brill Pharma product and would buy it online if I could.

I do not understand why the brands are different but I know Teva makes me feel unwell.

[helvella Administrator Thyroid UK]

I think there is something odd about needing 75 ml not 5ml of this product.

75 ml would be three quarters of a whole bottle!

Where you say which is also not sugar free is also confusing. The widespread definition of "sugar-free" in medicine is in this link:

BNF - Sugar-free

Definition of Sugar-Free in British National Formulary

helvella.blogspot.com/p/bnf...

Both BrillPharma and Teva have almost exactly the same ingredients and both are classed sugar-free. Ingredients are listed in my UK medicines document.

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.

helvella - Thyroid Hormone Medicines - UK

The UK document contains up-to-date versions of the Summary Matrixes for levothyroxine tablets, oral solutions and also liothyronine available in the UK. Includes descriptions of tablet markings which allow identification. Latest updates include all declared ingredients for all UK products and links to Patient Information Leaflets, etc.

helvella - World Desiccated Thyroid

Contains details of all known desiccated thyroid products.

helvella - Thyroid Hormone Medicines - RotW

Contains details of all levothyroxine, liothyronine and combination products - excluding desiccated thyroid products. Details available vary by country and manufacturer.

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.

helvella.blogspot.com/p/hel...

However, you are not the only person to find that the BrillPharma is strongly preferred over Teva. We just have no explanation.

I urge you to file a Yellow Card report:

🟨 Making Yellow Card Reports 🟨

healthunlocked.com/thyroidu...

And the BrillPharma product does seem to be in short supply. Is there any possibility that they could supply a different strength and adjust your dose?

I suggest you try contacting BrillPharma to ask what is happening.

I also suggest you consider trying a tablet product again - obviously not Teva as you said Teva tablets were unacceptable. Maybe Aristo Vencamil? Does not contain lactose, mannitol nor acacia - ingredients which are widely suspected to be the cause of intolerance issues. However, only available in 100 microgram tablets at present.

[Star13]

I Strongly suggest you ask the Pharmacist to clarify his instructions.

I’m on 100mcg/1x5ml on the Syringe. I’ve had both Teva and Brill and they are EXACTLY the same. The taste may be slightly different but then most bottles no matter any brand can taste different.

Are you sure that the GP has not reduced your dose to 75mcg and you therefore have to take LESS than 5ml - 3.75ml because he didn’t have any 75mcg or couldn’t get any? Just a suggestion but you should NOT be taking 75 ml daily that’s ridiculous!!

[Spongemum in reply to Star13]

As I said I mean't 7.5 ml but as regards to taste I disagree.

I have had Brill pharma oral ordinary and brill pharma sugar free and the sugar free is much more preferable and doesn't leave my mouth feeling like the bottom of a parrot's cage in the morning. I am back to that with the Teva oral and I'm not sure if they do sugar free oral solution if that is what I'm stuck with.

I am wondering if my chest pain has another cause and I'm blaming the Teva as I certainly did not get on well with the Teva tablets so the positive point of the oral is that the carriers are more neutral.ie glucose.

I am going to try Boots as suggested by SlowDragon if Almus is similar to Mercury Pharma otherwise it will have to mean buying online I suppose.

I do take mine in the night with water as I always have to visit the loo and if I do wake up in the morning having slept through, rare but can happen, being retired I can at least delay a cuppa for half an hour.

My older sister had thyroid cancer in 2001. Her tumour was encapsulated fortunately so after treatment where she was imprisoned behind glass as radio active for several days she is happily still with us. She is reluctantly being forced to retire when she is 75 in August!

She had sunlight treatment as a child which was one possible cause of this rare cancer but she also had investigations as a teen into why she was born with a hole in her neck and suspects they may have irradiated the site during that interference she blames the medical profession for! It seems she could have been born with a cleft palate or hare lip but instead her neck just didn't close together properly. We shared a double bed as children and I used to gaze at this red lump just above the hole with fascination at night. She said it stung if she got soap in it.

She blamed my Mum's total faith in the NHS that she was subjected to this unnecessary investigation in her teens where the doctors just wanted to see where this hole led. She was also left with a rather ugly scar and thought she would never find someone and ever marry!

Not much later she became a medical student herself at the same hospital at the end of the 1960s. Only 8% of students were women at that time and yes she did get married!

My granny developed myxoedema in the 1950s and was hospitalised in a Mental Institution as they thought she had depression.

[helvella Administrator Thyroid UK in reply to Spongemum]

Just so no-one perpetuates this, no current levothyroxine oral solution in the UK contains glucose.

[Spongemum in reply to helvella]

Glycerol metabolized to glucose in liver.

Basically it is to make it sweet which is what I meant.

Some posters on here seem rather aggressive IMO.

I was given an oral levothyroxine after having problems with the Teva tablets and although my prescription stated sugar free the pharmacist could not source sugar free oral levothyroxine at first. As it was about 2 years ago maybe that first one was not a Brill Pharma brand, I cannot remember but it was horribly sweet.

I was then provided with Brill Pharma with 'sugar free' written on the box and found the product much better especially when taking it in the night.

The Brill Pharma sugar free does not appear to contain glycerol like this Teva one I have at the moment does and which is again very sweet.

Anyway thank you SlowDragon Boots do have Pharma tablets apparently but I will now have to obtain a new changed prescription for 25 mcg 3 times daily.

[helvella Administrator Thyroid UK in reply to Spongemum]

I'm sorry if you feel I am aggressive - I am trying to maintain the highest level of accuracy I can.

I do believe that the placement of the claim "Sugar Free" on packaging has changed. The issue that the MHRA, etc., seem to care about ois whether the ingredients are officially cariogenic rather than their impact on digestion and even blood sugar/glucose. However, I do not think any of them were ever based on glucose as an ingredient but I could be mis-remembering.

There have been other branding/labellings of such products:

Advanz Pharma (Mercury) Eltroxin - same as the unbranded version but no longer available.

Colonis

Creo - taken over and renamed to Zentiva.

DLRC Helmroxin

Helm AG

Kappler

Northumbria

Syri

Ten Pharma

Teva (there was a very slightly different formulation until 02/07/2023).

Wockhardt (which used propylene glycol)

(These are from a variety of sources including memory and should not be taken as a 100% definitive list.)

[Spongemum]

7.5 ml sorry I 'm not feeling very well at mo and a bit stressed.

The Teva stuff is 50 mcg per 5ml so I have to draw up 2.5 ml then 5ml to get 75 mcg which is what my Brill Pharma sugar free was.

I was on the Brill Pharma not sugar free initially which was repulsive but the pharmacy sourced the sugar free for me. This Teva 50 mcg is not sugar free.

I started on Mercury Pharma tabs 50 mcg which were ok. Quite hard to get down the throat but then was given Teva tabs 50mcg which I found made me feel really horrible as well as getting chest pain so I went onto the syrup and all has been ok for a couple of years until now.

Nobody has anything at all the pharmacies except Teva.

[SlowDragon Administrator]

Have you tried different brands of tablets

Many people get on very well with Vencamil which is lactose free and mannitol free

Currently only available in 100mcg tablets

Available in summer as 50mcg and 25mcg tablets too

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 

[Spongemum in reply to SlowDragon]

I started off on Mercury Pharma tabs and I think they were ok except hard to get down.

It was when I went on to Teva tablets I felt bad so hence trying the oral solution in case it was a carrier.

The liquid is so much better absorbed I believe.

I would be happy to try Mercury Pharma again as tablets but after 8 pharmacies all only stocking Teva there doesn't seem much hope.

Thanks for your suggestions though.

[SlowDragon Administrator in reply to Spongemum]

You can try online pharmacies too

Other options

Vencamil 100mcg tablets

Wockhardt 25mcg only

Accord 50mcg and 100mcg

[Guost]

hi I had the same problem. I can only take Zentiva oral solution. Try that . I got a private consultant to write to my doctor and say I had to have that brand. They write it on the prescription and Boots order it xx

[RedApple Administrator]

'I have had Brill pharma oral ordinary and brill pharma sugar free '

Brill Pharma do not make an 'ordinary' as well as a 'sugar free' oral solution. The only Brill Pharma Oral solution is, by it's listed ingredients, sugar free.

As far as I'm aware, all levothyroxine oral solutions dispensed in the UK are sugar free. In fact, most of them have the exact same ingredients, they are just sold under different brand names. (They may also be made in different factories).

[helvella Administrator Thyroid UK in reply to RedApple]

The differences across the various levothyroxine oral solutions are extremely slight:

Advance - Mercury Pharma excluding Eltroxin

glycerol, citric acid monohydrate, sodium methyl parahydroxybenzoate

(E219), sodium hydroxide and purified water

Brillpharma

glycerol (E422), citric acid monohydrate (E330) (for pH adjustment), Sodium

Hydroxide (for pH adjustment), sodium methyl parahydroxybenzoate (E219)

and purified water

Teva

glycerol (E422), citric acid monohydrate, sodium methyl

parahydroxybenzoate (E219), sodium hydroxide and purified water

Zentiva

glycerol, citric acid anhydrous, sodium methyl parahydroxybenzoate (E219),

citric acid 10% and purified water