In the UK there are ONLY THREE available formulations of Levothyroxine tablet which have marketing authorisation (product licence).
In 100 micrograms they are made for Mercury Pharma and Actavis.
In 50 micrograms they are made for Mercury Pharma and Actavis.
In 25 micrograms they are made for Mercury Pharma and Wockhardt.
At each dosage there are ONLY TWO formulations.
In some cases the packaging may differ. For example, Mercury Pharma products are packaged as Mercury Pharma Eltroxin, Mercury Pharma Levothyroxine and Forley Generic Levothyroxine. However, the contents of these three are all absolutely identical to each other.
Some products are packaged, in much the same way as supermarket own-label products, as Almus (owned by the Boots people) and Lloyds pharmacy. However, these will still be one of the above.
Always check the Patient Information Leaflet to be sure what you have received.
(I have written “made for” because the actual manufacture of many medicines is done by subsidiaries or contracted out. We do not know enough of the details to make useful statements about that aspect.)
In the past there have been other formulations and marketing authorisations – for example, until last year, we had Teva products in 100 and 50 microgram tablets.
The main Thyroid UK site has had this statement for a long time:
It has been confirmed by Mercury Pharma (formerly Goldshield), that all tablets in boxes marked either Eltroxin, Goldshield or Forley are in fact exactly the same product.
… plus much more detailed information. It is a page that is well worth visiting.
I actually think the most important and relevant point is indeed that the Mercury Pharma products are all identical. That is what matters to the person taking the tablet.
In the last ten years there have been other brands/makes/formulations of levothyroxine in the UK market. Unfortunately I cannot easily dig up full details but the list has included APS, Alpharma, CP, Ivax, Teva and, of course, now the Goldshield name is also disappearing.
Further, at some distant point, I suspect that Eltroxin was not identical to the other products being made for Goldshield.
There was a series of acquisitions - possibly only really to gain market share. And various other changes such as both APS and Alpharma names disappearing.
My guess (please, it is no more than a guess), is that at some point, Goldshield, with two or more formulations in their camp, decided that was an overhead too much. They probably did not wish to significantly change Eltroxin (because it had always been regarded as the premier brand), so the alternative was to change their other products to the Eltroxin formulation.
As Eltroxin has had a certain cachet, Goldshield (now Mercury Pharma) managed to command a higher price for it. And, quite honestly, if you could sell the same product for £1 or £2 it might be very tempting to sell as much as you could at £2.
Until it became obvious that the Mercury Pharma products are identical, people might have believed they were getting something somehow better. And certainly the reports we have read of pharmacists comments suggest that misapprehension was the rule rather than the exception.
When selling into overseas markets, retaining the Eltroxin brand might have been a very important asset. (Mind, be aware that the brand Eltroxin does NOT represent the same product, nor the same formulation, around the world).
I feel that the statement from Goldshield quoted on the Thyroid UK website demonstrates that, whilst not exactly advertised, it has been publicly available information for some time. Furthermore, the Marketing authorisation number for Eltroxin 25 microgram and Mercury Pharma Levothyroxine is the same - PL 12672/0016. (I think this commonality of numbers applies across the range but anyone else can go and check for themselves on the EMC site.)
Further, I have totally lost count of the number of times I have explained this to people here.
Of course it would be clearer to you and to me if, for example, Mercury Pharma only produced one formulation in one livery. But commercial decisions are sometimes driven by what appears odd logic to those outside.
I would like to point out (as I have recently realised) you are allowed to ask you GP to specify a particular brand on your prescription if you prefer one over the other. I will be doing this in future.
It is perfectly reasonable to ask if you feel it will help. There are some issues with so doing:
a) If there are supply problems and your preferred formulation is not available then the pharmacy may not be willing to substitute without referring back to prescriber. (Even though I think they might now be allowed to do so);
b) If the pharmacy has, say, Forley Generics Levothyroxine 100 mcg but your prescription says Mercury Pharma Levothyroxine 100 mcg and your pharmacist does not understand they are the same. Again, probably refer back to prescriber;
c) If there are changes in the market. Maybe another formulation (or simply another branding of an existing formulation) becomes available. Any such change would require you to get your prescription changed if you wanted to try it. Indeed, even the recent company name change (Goldshield to Mercury Pharma) might have caused a minor hiccup;
d) If you ask for Mercury Pharma Eltroxin, someone, somewhere is making more money out of that - probably at some cost to the NHS - for exactly the same tablets. (I am not 100% clear how these pricing issues affect money. Anyone with good knowledge of such things able to clarify?) Which seems, shall we say, unfortunate in a cash-strapped era;
e) If you get Almus or Lloyds named, then you are restricting your choice of pharmacy somewhat.
I feel that, with only two formulations at each dosage, I prefer the flexibility of a prescription written in a generic way and simply asking the pharmacy which they will supply before giving over the prescription form. That leaves me free to go round every pharmacy and to accept any variant of livery/packaging/branding.
So if there were only one pack of Helvella Levothyroxine in the area, I could get that packet without any artificial restriction due to the way the prescription was written. (That is, if I can find it! Might take a lot of calls or pharmacy visits. )
Interestingly I had Wockhardt until recently, and still have some 25 which are that brand, and I was progressing well, but my last lot of 50s which I started on 2 weeks ago are Actavis and I have begun to notice symptoms reappearing which had gone completely. My voice has become hoarse in the last 2 days and last night for the first time in ages I had swollen hands and ankles.
The tablets break up into crumbs and powder about one in five times when I try to remove them from the foil, so I went to the pharmacy with a bag of powder and crumbs and complained. He has promised I will not get the Actavis again, I wait to see what I will get instead!
I really am wondering if it is worth trying to get some decent thyroxine at my own expense. Can I ask the doctor to give me a private prescription so I can specify what I want? I don't think I could afford to buy it abroad to be honest, living as I do on nothing but my State pension and no magic Pension Credit to make everything else free or cheap!
Trouble is, marram, there are only three formulations/makes in the UK. Full stop. Regardless of how much money you have. Regardless of private prescription. (And a single private prescription might cost from £15 upwards - for the piece of paper alone.)
Any other tablets would have to be imported. And as soon as you import, you have the potential of your supply chain being less reliable. And levothyroxine can be surprisingly expensive in other countries.
Your only UK alternative to Actavis (who only offer 50 and 100 microgram dosages) is Mercury Pharma.
The Mercury Pharma have been fine in the past, and if it's the only alternative then hopefully that's what I'll get! Your comment about the price is spot-on as the prices seem very high to me and therefore totally out of the question.
The limited availability in this country is scandalous to be honest.
You could look at it the other way. Trying to keep on the same formulation in a country which has at least half a dozen different formulations is even more difficult.
They seem to have:
Synthroid, Levoxyl, Levothroid, Unithroid and several "generics".
My kindly local pharmacist has agreed to give me Eltroxin to keep my supply stable with a generic prescription, asking only that I pay the difference on the script at cost price to her. This varies - it was nothing last time and 98p the time before. She seems to understand the issues with varied generic supplies, and of course she has no control over the generics she gets. Maybe other pharmacists would be willing to do this if asked?
My pharmacist has actually agreed not to give me Actavis again so it should be Mercury Pharma which seems to be OK for me. Hopefully the problem will be solved, otherwise I can follow your advice and ask for the Eltroxin at a future date.
I felt that this extra charge was unethical, unprofessional and possibly illegal. There is an NHS prescription charge of £7.65 (from which most people here will be exempted) and that is an absolute flat rate.
In order to check if I am right, I contacted:
PrescriptionServices Nhsbsa (NHS BUSINESS SERVICES AUTHORITY)
and this is their reply:
Dear <helvella>
Thank you for your email.
The prescription charge, currently £7.65 per item, is a charge set by the department of health. Patients are not expected to pay any more than this for an item on prescription. Any extra charge incurred by a pharmacy in obtaining a product should not be passed onto the patient.
I would suggest talking to your local primary care trust about this matter.
Kind regards
Claire Lewis
I feel that your kindly local pharmacist is making an extra pound for, basically, nothing. After all, Eltroxin is identical to Mercury Pharma Levothyroxine.
I went to my local pharmacy to get a prescription filled this very morning. They were perfectly happy to try to get some Mercury Pharma product for me (instead of the Actavis on the shelf) for no charge. Which is how it should be.
We pay our gp consultation as no NHS here but glad to say we only pay £3.20 per item on prescription. The pharmacist I go to is very good about changing brand to whichever I want so I think that is the way I'm going to go. I see the points made about getting it changed on the prescription itself as it could complicate things.
Forgot to add, despite Eltroxin shortage, that is exactly what I got!
Mine is Activis and I got it stated as such on my prescriptions. I told my Pharmacist I would take my prescriptions elsewhere if I didn't get the same generic.
But we are ALL subject to the vagaries of supply. If, for example, Mercury Pharma cannot keep up with demand, then at least some people will have to accept Actavis. Or vice versa.
But once the labelled "brand" is stated on your prescription, you might make life a touch more difficult if whichever one is stated cannot readily be supplied.
For example, if your prescription says "Actavis", then you might not be given Almus or Lloyds which are (or were in 2012) the self-same, identical tablets. The pharmacist would need to understand the issues in order to confidently supply another labelled levothyroxine against a prescription which expressly states "Actavis".
My preference these days would be to establish a relationship with a pharmacy and request them to attempt always to supply the same product, rather than getting it written on the prescription. Simply to side-step possible future issues.
Notice of temporary unavailability of Eltroxin tablets
Dear Patient
Mercury Pharmaceuticals may have been supplying your thyroid medication in two forms; Eltroxin or levothyroxine tablets.
The Eltroxin tablets are likely to be temporarily unavailable in the near future. This may mean that the pharmacist will give you levothyroxine tablets instead at exactly the same strength (after checking with your doctor). Switching to levothyroxine tablets is very unlikely to cause any problems as the two forms are the same and are produced by the same manufacturer. The main difference between the two is their respective names and accompanying packaging.
If you have any problems please let your doctor know.
We apologise for any inconvenience that this may cause.
Please contact Mercury Pharma Medical Information department in case of any queries:
I was informed by Lloyds pharmacy on Wednesday the 3rd April that they couldn't supply me with Goldshield Eltroxin as there was a manufacturing problem.
My GP said for me to find a different brand/ manufacturer ... I made the effort to go and find one and gave him the info .... then low and behold lloyds turned up with 2 box's of Goldshield Eltroxin yesterday afternoon.
Funnily enough, I too was given 50mcg Goldshield Eltroxin a couple of weeks or so ago.
I am surprised that the packaging has not yet been changed to Mercury Pharma Eltroxin - and the date on the pack clearly meant it was fairly recently produced.
I really don't believe there is no difference between the brands! For several years I've been on Goldshield Eltroxin along with Goldshield Liothyronine and my health has been amazing. With all the hassle over the last 8+ months I've been on Mercury Pharma Eltroxin and Liothyronine until they couldn't get 100mcg of Eltroxin in recent months. When I take the Mercury Pharma 25mcg, the Activis 100mcg & my Mercury Pharma Liothyronine in one go I am on the loo within 15 minutes with the squits. However if I take the 25mcg of Mercury Pharma Eltroxin and Mecury Pharma Liothyronine together and 100mcg Activis later in the day I don't dash to the loo. However symptoms have reared their ugly head doing this! Something is not adding up here. I am off to my doctors tomorrow this time to ask that if 100mcg of Mercury Pharma Eltroxin in not available that I am given any combination of 50mcg or 25mcg of Mercury Pharma Eltroxin combination to make 100mcg of Mecrury Pharma Eltroxin. Maybe the Liothryonine plays some part in this, all I know it's not working for me.
Not sure if my post was unclear, of if I am not following quite what you are saying!
There most certainly is a difference between Actavis and Mercury Pharma.
But MP claim, repeatedly, that there is no difference between their levothyroxine and their Eltroxin. Even if people feel that MP has changed, well in general we do not have Eltroxin to compare! Perhaps both would have changed somewhat but still be the same as each other.
Rod
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