BRANDS OF LEVOTHYROXINE

[Dogsaregods__]

Hello Is there a brand that's less synthetic to ask for via NHS when getting levothyroxine on prescription?I've been told TEVA isn't great...and surprise surprise that's what I've been taking

Thanks

Nikki

[Obsdian]

Curious to hear the answer to this as it's my understanding the levothyroxine is all the same but the fillers can be different.

[helvella Administrator]

I really do not understand what you mean by "less synthetic"?

All levothyroxine sodium (active pharmaceutical ingredient) is notionally the same. It has to conform to the same minimum standards.

The excipients (all the other ingredients) vary. And if you want "natural" you might choose lactose (from milk), acacia powder (from certain trees), maize starch, gelatin, etc. But every single one of those natural excipients is a problem for some members.

So whether they are natural or not seems a poor basis for any decision. And for some of them, we simply do not know how they have been sourced, they could have been synthesised or natural.

It is often said that Teva causes some members problems. But, in general, we don't know why, we just suspect mannitol and/or acacia.

And other members find Teva the best product available in the UK - for them.

I assume you are in the UK? (It helps to add country to your profile as, if you don't, we all have to make assumptions.)

My UK medicines document lists every excipient in every approved UK thyroid hormone medicine.

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.

I highly recommend viewing on a computer screen, or a decent sized tablet, rather than a phone. Even I find it less than satisfactory trying to view them on my phone.

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 injectables and descriptions of tablet markings which allow identification. Latest updates include all declared ingredients for all UK products and links to Patient Information Leaflets, Dictionary of Medicines and Devices (dm+d), etc. PLUS how to write prescriptions in Appendix F.

Also includes links for anti-thyroid medicines (but not product details).

📄 dropbox.com/s/bo2jzxucgp9hl...

helvella - World Desiccated Thyroid

Contains details of all known desiccated thyroid products including information about several products not considered to be Natural Desiccated Thyroid (NDT/Desiccated Thyroid Extract/DTE).

📄 dropbox.com/scl/fi/gx6dmz5i...

helvella - World Liothyronine

Contains a list of liothyronine products from around the world including brief details.

📄 dropbox.com/scl/fi/ooslwy2j...

helvella - Thyroid Hormone Medicines - RotW

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

dropbox.com/s/dliou4fszbegw...

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.

Last updated 17/09/2024

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

If you find anything incorrect, misleading, typos, links that don’t work, etc., please let me know. Go to my profile and use the contact details there:

blogger.com/profile/1709507...

[Dogsaregods__ in reply to helvella]

Thsnkyou for this yes am UK

[Brigland27]

A few years ago I asked to be put on a certain brand supplied by NHS & my Dr told me, "we can't ask for certain brands, unfortunately you get what the pharmacy has in stock" (he said politely)

[SlowDragon Administrator in reply to Brigland27]

my Dr told me, "we can't ask for certain brands, unfortunately you get what the pharmacy has in stock"

Which is incorrect

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).

And here

pharmacymagazine.co.uk/clin...

Discussed here too

healthunlocked.com/thyroidu...

Many members have specific brand names on their prescription

And many more have note saying “no Teva” brand

[Sparklingsunshine in reply to Brigland27]

I get a named brand, Accord, on all my Levo prescriptions. That Dr either didnt know or couldn't be bothered.

[StitchFairy in reply to Brigland27]

That was my expereince too, years ago. I had a helpful pharmacist in a suoermarket pharmacy for a while who did her best to give me the same brand. But no-one believed there was any difference. It's all levothyroxine, so take what you're given.

[SlowDragon Administrator]

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 

July 2024

Crescent levothyroxine. Dosages: 12.5, 25, 50, 75, 100

(Not yet known if all approved dosages are or will be available).

Excipients: lactose monohydrate, maize starch, croscarmellose sodium, gelatin and magnesium stearate.

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)

Vencamil is lactose free and mannitol free. originally only available as 100mcg only, but 25mcg and 50mcg tablets became available Sept 2024

March 2023 - Aristo now called Vencamil

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

How to get Vencamil stocked at your local pharmacy

healthunlocked.com/thyroidu...

Helpful post about different brands

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.

If local pharmacy can’t/wont help try specialist pharmacies

thyroiduk.org/get-support/t...

[Brigland27]

I'd specifically asked my Doctor for brand name armour throid as I'd heard good reviews but was told no it's not on the NHS list, I asked- why? & was told it must be too expensive.

[helvella Administrator in reply to Brigland27]

The NHS doesn't prescribe Armour Thyroid but to a very large extent that is not due to cost but to the view that desiccated thyroid should not be taken. And they use the backwards logic this is because it is not licensed in the UK. Of course, if it isn't going to be prescribed, no-one will apply for a licence!

Sure, cost is significant, and it is another reason that Armour Thyroid isn't prescribed. But if doctors won't prescribe it, then cost is almost entirely irrelevant,

(A handful of people do get Armour Thyroid on the NHS but these are very but exceptional cases.)

There are some doctors, including some UK endocrinologists, who do not think the door should be slammed on desiccated thyroid.

Is there a role for natural desiccated thyroid in the treatment of levothyroxine unresponsive hypothyroidism? Results from a consecutive case series

onlinelibrary.wiley.com/doi...

helvella - The End of Thyroid BP

A brief note of one public statement about the final withdrawal of the UK product, Thyroid, BP. I suspect it summaries the attitude of the time. Includes several extracts and some extra information.

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

[Dogsaregods__ in reply to helvella]

Is Armour the same as morningside?

[helvella Administrator in reply to Dogsaregods__]

No.

Armour Thyroid is desiccated thyroid. Animal thyroid.

Morningside is a pharmaceutical company who make generic Liothyronine products (and other non-thyroid products).

Look in my UK medicines document and my Desiccated Thyroid document for more details. Links already posted in this thread.

[Poll8]

MHi Nikki.Sorry for delay in replying, I don't take my smart phone with me when I go on holiday, so just got the message a couple of days ago.

I have had 3 different cancers over the last 3 years and have so many meds causing so many side effects that I may not be the best person to ask. I have only been taking levo for about 12 months. Have had a few different makes but mostly Teva or Accord. I take 175mg. at moment and just about to drop to 150mg. Having quite a few issues..rashes, cramps, night sweats, swollen ankles..all things I never had before my thyroidectomy and have put them down to trying to find right dose rather than make of Levo. I did ask my pharmacy to prescribe only Teva which is what my consultant recommend but they struggle to get all doses from Teva. I generally research any new meds. when I start taking them and Teva seems most popular with medics and no more health threatening or causes any less or more side effects than any others in what I have read. My sister has taken Teva for 18 years without any complications so far.

Not sure any of this will help with your decision but good luck deciding and whatever you choose I pray it keeps you well

[Dogsaregods__ in reply to Poll8]

Thankyou for this except now I am confused as I've seen research and surveys on here concluding that Teva is the one to avoid!!

[helvella Administrator in reply to Dogsaregods__]

I hope the message isn't to avoid Teva levothyroxine. I repeatedly point out that for some of us, Teva is preferred. Whereas for others, it is intolerable. That is, it is highly individual any blanket recommendation (to avoid Teva, or to choose Teva) is a route of folly.

The only approach that makes any sense to me is to check the excipients (inactive ingredients) or Teva and the other makes, and exclude those which you KNOW cause you an issue. Otherwise, try any of them and see how it goes.

We do not have any useful and usable predicative tool to identify who does better on one rather than another make.

PS I did try Teva for myself. I did not get on with it. That is why I now avoid it. But if I had never tried it, I would give it a go.