Liquid Thyroxine: getting forced onto Zentiva

[singingtoad]

Here I am again asking about availability of liquid thyroxine. I have a wonderful traditional pharmacy now who try really hard for me, however, this time they can only get Zentiva - and I am always noticeably less well on that. I dread having to take it. In fact, I have previously done a Yellow Card for the stuff.

The formulation difference between Zentiva and my usual brands (Teva or Mercury) is that Z. lacks the sodium hydroxide which is in the other two. I guess this means that it is more acid/has lower PH.

I wonder whether anyone has tried taking Z. liquid with something slightly alkaline - and what happened if you did?

I have previously tried small adjustments to dose, up and down, and it has made no difference.

Is Z. the least expensive, and is that why other makes are disappearing? Obviously, pharmacies are struggling to survive, and many haven't - 5 have shut in my town over the last couple of years.

Would private prescriptions give me more choice of make, and what would the prices be (high, I know). I've previously been down the route of specification on the prescription, but pharmacies simply have to ignore that when they cannot get what is specified.

Any updates as to what is going on, also appreciated!

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People often find it helps to contact the manufacturer direct to see if there is any reason why there is a shortage

[helvella Administrator]

My UK medicines document contains all approved UK thyroid hormone medicines - solid and liquid. And includes the NHS prices - what the pharmacies should get paid by make. (If prescribed generically, they will get the NHS Drug Tariff price regardless which make.)

I do not know why some contain sodium hydroxide and others do not.

Previously I've speculated that it could depend on the ingredients they use - most obviously their water supply and, possibly, glycerol. Other manufacturers might find that their ingredients are within a tight window without adding any sodium hydroxide whereas Zentiva might have to add a drop!

It would be interesting to see what even pH paper showed if dipped into various products!

Even see if the liquid reacts with a solution of sodium bicarbonate? If it bubbles, it would look like the product is at least mildly acidic. (Very much at the bucket chemistry end of the scale. I have no idea of the exact pH at which this would start to occur.)

helvella - Thyroid Hormone Medicines - UK

The UK document contains up-to-date versions of the Summary Matrixes for levothyroxine tablets, oral solutions and liothyronine available in the UK. Includes injectables and descriptions of tablet markings which allow identification. Latest updates include all declared ingredients for all UK-licensed products and links to Patient Information Leaflets, Dictionary of Medicines and Devices (dm+d), British National Formulary, NHS Drug Tariff, etc. PLUS how to write prescriptions in Appendix F.

Now also includes latest pricing information from dm+d..

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

Direct link to PDF:

📄 dropbox.com/s/bo2jzxucgp9hl...

Blog last updated 28/12/2024 - documents are regularly updated

Link to blog:

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

Private prescriptions might open up the possibility of Roseway or another company producing an oral solution to order. Price would likely be utterly prohibitive.

Otherwise, you would almost certainly be limited to the UK licensed products.

Private prescriptions are often dispensed at NHS price plus a mark-up. But, so far as I know, there is no ceiling on the prices they charge.

[singingtoad in reply to helvella]

Thank you Helvella. I have my work cut out this evening studying all this. I wonder whether, as pharmacies struggle with any product that isn't the cheapest version, wholesalers don't find it worthwhile to stock the more pricey versions? Certainly stocking has really changed: the liquids which reach me are the same batch for months, which rarely used to happen, and it looks like an efficiency drive to eliminate waste. I've been on a long run of Mercury which was reduced in price to the NHS apparently because its expiry date was approaching.

[helvella Administrator in reply to singingtoad]

It has taken me a lot of effort to understand even as much as I do! The systems are obscure and complex.

A while back, there were more makes - though I think some were the same actual product. And Creo got taken over by Zentiva.

The biggest issue, I'm sure, is the jaw-drop that potential prescribers experience when they see the prices.

Wish I could answer better than this.