Concise Prescribing Info
Contents
Levothyroxine Na
Indications/Uses
Replacement or as an adjuvant therapy w/ antithyroid prep for hypothyroidism of any etiology. Suppresses TSH in simple non-toxic goiter eg, thyroid nodules & Hashimoto's thyroiditis. Post therapeutic treatment for radiological or surgical op. Concomitantly given to patients undergoing thyroid suppression test & patients taking drugs w/ goitrogenic effects eg, lithium.
Dosage/Direction for Use
Adult Hypothyroidism Initially 50-100 mcg increased by increments of 25-50 mcg every 14 days to achieve euthyroid state. Maintenance: 100-200 mcg daily. Suppression of TSH 2.6 mcg/kg. Elderly patient w/ CV disorder Initially 12.5 mcg daily increased by increments of 12.5-25 mcg every 4 wk. >60 yr Maintenance: 25% lower than in younger adult. Childn >12 yr 2-3 mcg/kg, usual dose of 100-200 mcg daily. 6-12 yr 100-150 mcg daily replacement dose is given calculated at 4-5 mcg/kg. 1-5 yr 75-100 mcg daily replacement dose is given calculated at 5-6 mcg/kg. >1 yr Starts w/ 2.5-5 mcg/kg daily. 6-12 mth 6-8 mcg/kg usually comprising of about 50-75 mcg daily. <6 mth 8-10 mcg/kg w/ daily replacement dose of 25-50 mcg.
Administration
Should be taken on an empty stomach: Take 30 min to 1 hr before breakfast. Take at least 4 hr apart from drugs that are known to interfere w/ its absorption. For infants being breastfed, do not administer a large vol of water in replacement dose. Tab may be crushed in small amount of water to give a paste which may be given to an infant for sucking.
Contraindications
Hypersensitivity to levothyroxine. Patients w/ rare hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption.
Special Precautions
Should not be used in the treatment of obesity or wt loss. Patients w/ euthyroid non-autonomous goiter. Larger doses may produce life-threatening manifestations of toxicity especially when given w/ sympathomimetic amines (eg, those used for their anorectic effects). Monitor & titrate dose carefully in elderly patients w/ CV disease. Initiate low dose w/ slow dosing increments in myxedema patients. Initiate corticosteroid replacement therapy prior to levothyroxine replacement therapy to prevent acute adrenal insufficiency in pituitary hypothyroidism. Perform TSH test to check T3 & T4 levels for dose titration.
Adverse Reactions
Vomiting, diarrhea; tachycardia, arrhythmia, angina pectoris, HTN; muscular weakness, cramp; headache; benign intracranial disorder; irregular menstruation; wt loss; hyperhidrosis, hyperthyroidism; restlessness, insomnia, tremors; palpitations, flushing, fever.
Drug Interactions
Decrease efficacy w/ cholestyramine, aluminum, Mg, Fe prep & ciprofloxacin. Increased biotransformation & elimination w/ phenytoin, carbamazepine, rifampicin & barbiturates. Increased serum conc of thyroxine-binding globulin w/ estrogen. Decreased thyroid hormone secretion w/ lithium & iodide. Decreased therapeutic effect w/ propranolol, amiodarone, some X-ray-imaging fluids & dexamethasone. May decrease plasma level of propranolol. Hypoglycemia w/ insulin or other oral antidiabetic drugs. May increase activity of anticoagulants.
MIMS Class
Thyroid Hormones
ATC Classification
H03AA01 - levothyroxine sodium ; Belongs to the class of thyroid hormones.
Presentation/Packing
Form
Thydin tab 100 mcg
Packing/Price
100's (P1,200/box, P12/tab)
Form
Thydin tab 12.5 mcg
Packing/Price
100's (P600/box, P6/tab)
Form
Thydin tab 150 mcg
Packing/Price
100's (P18/tab, P1,800/box)
Form
Thydin tab 25 mcg
Packing/Price
100's (P600/box, P6/tab)
Form
Thydin tab 50 mcg
Packing/Price
100's (P7/tab, P700/box)
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