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Levothyroxine Doses

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Last Updated: 10 October 2020

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General | Latest Info

Primary hypothyroidism is a common medical disorder that usually presents secondary to autoimmune thyroiditis. Symptoms of hypothyroidism include fatigue, weight gain, cold intolerance, and constipation. Treatment of hypothyroidism with Levothyroxine is effective, but starting doses vary. There are two strategies for initiating Levothyroxine in healthy adults younger than 65 years: low - dose and full - dose. Traditionally, lower starting doses of 25 to 50 mcg per day are recommended for patients 65 years and older or who have ischemic heart disease. Low - dose initiation of thyroid supplementation usually takes four to six months before plasma thyrotropin and free thyroxine levels become normal. Roos and associates compare full starting dose of Levothyroxine with low dose in individuals with primary hypothyroidism without knowing cardiac disease. The study was a prospective, randomize, double - blind trial of patients with hypothyroidism who received care at one hospital during a three - year study. Patients diagnosed with primary autoimmune hypothyroidism for the first time were included in the study. The age range of patients in the study was 22 to 86 years, with a median of 46 years. Patients were excluded if they had a history of cardiac disease or were taking cardiac medication. Patients were randomly assigned to receive a starting Levothyroxine dosage of 25 mcg per day or 1. 6 mcg per kg per day. Levothyroxine doses were adjusted by 25 mcg every four weeks until 24 weeks. Doses then were adjusted every 12 weeks with the goal of maintaining serum thyrotropin and FT 4 levels within normal reference ranges. Clinical scores of hypothyroidism and general quality of life survey were evaluated at each visit. Cardiac symptoms and events were assessed at every visit, and bicycle ergometry was performed at baseline and repeated at weeks 12 and 24. Twenty - five patients were randomly assigned to a low - dose group and 25 to the high - dose group. The two groups were similar in severity of hypothyroidism and age. At week four, 13 patients reached euthyroid levels in the high - dose group compared with one in the low - dose group. This trend persists until week 24, when 21 in the high - dose group and 20 in the low - dose group meet criteria for being euthyroid. Rate of change in clinical scores and quality of life were similar between the two groups. Body weight, heart rate, and blood pressure were unchanged in both groups. There were no palpitations, angina pectoris, or other cardiac events documented in either group. The Authors conclude that starting healthy primary hypothyroid patients on full dose of Levothyroxine is safe and effective for those who do not have a history of cardiac disease. They add that this strategy may be more convenient and cost effective than the method of starting low and titrating slowly.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

What is Synthroid?

Table 1. SYNTHROID Dosing Guidelines for Pediatric Hypothyroidism

AGEDaily Dose Per Kg Body Weight a
0-3 months10-15 mcg/kg/day
3-6 months8-10 mcg/kg/day
6-12 months6-8 mcg/kg/day
1-5 years5-6 mcg/kg/day
6-12 years4-5 mcg/kg/day
Greater than 12 years but growth and puberty incomplete2-3 mcg/kg/day
Growth and puberty complete1.6 mcg/kg/day

Fast or irregular heartbeats, chest pain, shortness of breath, fever, hot flashes, sweating, tremors, feeling cold, weakness, tiredness, sleep problems, memory problems, feeling depress, nervous or irritable, headache, leg cramps, muscle aches, dryness of skin or hair, hair loss, changes in your menstrual periods, vomiting, diarrhea, appetite changes, weight changes get medical help right away, if you have any of symptoms list above. Muscle weakness, headache, leg cramps, nervousness, trouble sleeping, diarrhea, skin rash, partial hair loss tell doctor if you have any side effects that bother you or that do not go away. These are not all possible side effects of SYNTHROID. For more information, ask your doctor or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1 - 800 - FDA - 1088. Thyroid hormones, including SYNTHROID, either alone or with other therapeutic agents, should not be used for treatment of obesity or for weight loss. In euthyroid patients, doses within the range of daily hormonal requirements are ineffective for weight reduction. Larger doses may produce serious or even life threatening manifes tations of toxicity, particularly when given in association with sympathomimetic amines such as those used for their anorectic effects.


Effectiveness

Synthroid is approved for TSH suppression and to treat hypothyroidism. And although Armour Thyroid is also prescribed for these purposes, drug isnt FDA - approved for these uses. Use of levothyroxine and Armour Thyroid in treating hypothyroidism has been directly compared in clinical study. However, Synthroid and levothyroxine are always equivalent to each other. So this study might not have shown actual difference between Armour Thyroid and Synthroid. Higher T3 and TSH levels than do people taking levothyroxine lower T4 levels than do people taking levothyroxine. Keep in mind that T3 and T4 are the main Thyroid hormones in your body. And TSH levels indicate how much your body needs Thyroid hormones. So higher TSH level means that your body needs more Thyroid hormones than it has. The study also shows that after using both drugs over a period of 16 weeks each, 48. 6% of people preferred Armour Thyroid over levothyroxine. This may be because people lose, on average, 4 pounds more while taking Armour Thyroid than while taking levothyroxine. In addition, people report having fewer Thyroid symptoms when taking Armour Thyroid than when taking levothyroxine. There is also an ongoing clinical trial comparing Armour Thyroid with levothyroxine. But remember that Synthroid and levothyroxine are always equivalent to each other. So this study might not show difference between Armour Thyroid and Synthroid.


Side Effects

In some cases, Synthroid may cause weight loss. This is because thyroid hormones are responsible for your body's metabolism. * If you dont have enough Thyroid hormones in your body, your metabolism will be slower than usual. And this may lead to weight gain. However, if youre taking Synthroid, your thyroid hormone level should be within normal range. So, with Synthroid treatment, your metabolism rate may increase, and you may lose weight. It is important to note that even though Synthroids may cause weight loss, drugs shouldnt be used specifically to aid in weight loss. In fact, Synthroid has a box warning advising against using Drug for weight loss. A Boxed warning is the strongest warning required by the Food and Drug Administration. Boxed warnings alert doctors and patients about drug effects that may be dangerous. The Synthroid box warning states that it shouldnt be used to treat obesity or to help with weight loss. If your thyroid function is normal, synthroid will help you lose weight. In fact, using drugs at typical dosages in people without certain Thyroid problems wo lead to weight loss. And using doses larger than those recommended by manufacturer may cause serious side effects. These side effects can include confusion, seizures, coma, and even death. In addition, taking Synthroid along with drugs used for weight loss may cause very serious or even life - threatening side effects. If you have concerns or questions about weight loss while youre taking Synthroid, talk with your doctor. They can recommend ways to help you manage body weight that healthy for you. There isnt any clinical study information that shows how many people lose weight while taking Synthroid.S However, small studies look at how many people lose weight while taking levothyroxine. This study shows that 52% of people taking levothyroxine lose weight after taking the drug for up to 24 months. And peoples average weight loss was 3.


Uses

Read Patient Information Leaflet if available from your pharmacist before you start taking levothyroxine and each time you get a refill. If you have any questions, ask your doctor or pharmacist. Take this medication by mouth as directed by your doctor, usually once daily on an empty stomach, 30 minutes to 1 hour before breakfast. Take this medication with a full glass of water unless your doctor directs you otherwise. If you are taking capsule form of this medication, swallow it whole. Do not split, crush, or chew. People who cannot swallow capsules whole should use tablet form of medication. For infants or children who cannot swallow whole tablets, crush the tablet and mix in 1 to 2 teaspoons of water, and give using a spoon or dropper right away. Do not prepare supply in advance or mix tablets in soy infant formula. Consult your pharmacist for more information. Dosage is based on your age, weight, medical condition, laboratory test results, and response to treatment. Use this medication regularly in order to get most benefit from it. To help you remember, take it at same time each day. Do not stop taking this medication without first consulting with your doctor. Thyroid replacement treatment is usually taken for life. There are different brands of levothyroxine available. Do not change brands without first consulting your doctor or pharmacist. Certain medications can decrease the amount of thyroid hormone that is absorbed by your body. If you are taking any of these drugs, separate them from this medication for at least 4 hours. Symptoms of low thyroid hormone levels include tiredness, muscle aches, constipation, dry skin, weight gain, slow heartbeat, or sensitivity to cold. Tell your doctor if your condition worsens or persists after several weeks of taking this medication.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

DESCRIPTION

Table

Strength (mcg)Color additive(s)
25FDC Yellow No. 6 Aluminum Lake a
50None
75FDC Red No. 40 Aluminum Lake, FDC Blue No. 2 Aluminum Lake
88FDC Blue No. 1 Aluminum Lake, FDC Yellow No. 6 Aluminum Lake a , DC Yellow No. 10 Aluminum Lake
100DC Yellow No. 10 Aluminum Lake, FDC Yellow No. 6 Aluminum Lake a
112DC Red No. 27 30 Aluminum Lake
125FDC Yellow No. 6 Aluminum Lake a , FDC Red No. 40 Aluminum Lake, FDC Blue No. 1 Aluminum Lake
137FDC Blue No. 1 Aluminum Lake
150FDC Blue No. 2 Aluminum Lake
175FDC Blue No. 1 Aluminum Lake, DC Red No. 27 30 Aluminum Lake
200FDC Red No. 40 Aluminum Lake
300DC Yellow No. 10 Aluminum Lake, FDC Yellow No. 6 Aluminum Lake a , FDC Blue No. 1 Aluminum Lake

Levothyroxine should not be used alone or along with other treatments to treat obesity or cause weight loss. Levothyroxine may cause serious or life - threatening problems when given in large doses, especially when taken with amphetamines such as amphetamine, dextroamphetamine, and methamphetamine. Tell your doctor if you have any of the following symptoms while you are taking Levothyroxine: chest pain, rapid or irregular heartbeat or pulse, uncontrollable shaking of part of your body, nervousness, anxiety, irritability, difficulty falling asleep or staying asleep, shortness of breath, or excessive sweating. Talk to your doctor about potential risks associated with this medication. Levothyroxine is used to treat hypothyroidism. It is also used with surgery and radioactive iodine therapy to treat thyroid cancer. Levothyroxine is in a class of medications called hormones. It works by replacing thyroid hormone that is normally produced by the body. Without thyroid hormone, your body cannot function properly, which may result in poor growth, slow speech, lack of energy, excessive tiredness, constipation, weight gain, hair loss, dry, thick skin, increased sensitivity to cold, joint and muscle pain, heavy or irregular menstrual periods, and depression. When taken correctly, Levothyroxine reverses these symptoms. Levothyroxine comes as a tablet and capsule to take by mouth. It usually takes once a day on an empty stomach, 30 minutes to 1 hour before breakfast. Follow directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take Levothyroxine exactly as direct. Do not take more or less of it or take it more often than prescribed by your doctor. Swallow capsules whole; do not chew or crush them. Do not remove the capsule from the package until you are ready to take it. Take tablets with a full glass of water as they may get stuck in your throat or cause choking or gagging. If you are giving Levothyroxine to an infant, child, or adult who cannot swallow tablet, crush and mix it with 1 to 2 teaspoons of water. Only mix crush tablets with water; do not mix them with food or soybean infant formula. Give this mixture by spoon or dropper right away. Do not store it for later use. Your doctor will probably start you on a low dose of Levothyroxine and gradually increase your dose. Levothyroxine controls hypothyroidism but does not cure it. It may take several weeks before you notice a change in your symptoms. Continue to take Levothyroxine even if you feel well. Do not stop taking Levothyroxine without talking to your doctor.


What is levothyroxine?

Many other medicines can affect your thyroid hormone levels. Certain other medicines may also increase or decrease the effects of levothyroxine. Certain medicines can make this medicine less effective if taken at the same time. If you use any of the following drugs, avoid taking them within 4 hours before or 4 hours after you take levothyroxine: Calcium carbonate; cholestyramine, colesevelam, colestipol; ferrous sulfate iron supplement; sucralfate; sodium polystyrene sulfonate; stomach acid reducers - esomeprazole, lansoprazole, omeprazole, rabeprazole, Nexium, Prilosec, Prevacid, Protonix, Zegerid, and others; or antacids that contain aluminum or magnesium - Gaviscon, Maalox, Milk of Magnesia, Mintox, Mylanta, Pepcid Complete, and others. Many drugs can interact with levothyroxine. This includes prescription and over - counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Levothyroxine Dosage

Background It is well - known that Thyroid hormone is required for normal brain function and many other aspects of health. In individuals with underactive Thyroid, Thyroid hormone replacement, usually as Levothyroxine, is needed to maintain normal Thyroid hormone levels. Blood tests ARE traditionally used to make sure that the DOSE OF Levothyroxine is correct. However, it is unclear if small changes in TSH blood test results affect quality of life, mood, and cognition. This study was done in adults with Hypothyroidism who were taking Levothyroxine. Without knowing the type of change make, patients had their DOSE OF Levothyroxine either slightly increase, slightly decrease, or unchanged FOR six months. Patients complete questionnaires designed to assess quality of life, mood, and cognition before and at the end of the STUDY period. Full ARTICLE TITLE: Samuels MH ey al Effects OF altering Levothyroxine DOSES on quality OF life, mood, and cognition in L - T 4 treated subjects. J Clin Endocrinol Metab SUMMARY OF STUDY There were 138 patients who completed STUDY. Patients were 91% women, ranged in age from 27 - 70 years, and on average had taken Levothyroxine FOR 12 years. Regardless OF change in their Levothyroxine DOSE, there were no substantial differences in scores relating to quality OF life, mood, and cognition. Although patients were not able to correctly guess whether their Levothyroxine DOSE had been change, they tended to prefer DOSES that they thought were higher. What ARE the IMPLICATIONS OF this STUDY? In patients with Hypothyroidism, small changes in the DOSE OF Levothyroxine do not seem to affect quality of life, mood, or cognition. However, it remains unclear why some patients with Hypothyroidism continue to have symptoms, even if their Thyroid blood tests become normal after starting Levothyroxine. Further research is needed to better understand this and potentially develop other TREATMENT options.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Limitation of Use 2

Generally, hypothyroidism may be effectively treated via constant daily dose of Levothyroxine, and, for the majority of confirmed aetiologies, this needs to be lifelong. However, in this setting, there appear to be many cases of both Levothyroxine over - and under - dosing and it may be that frequent adjustments of dose are necessary. These adjustments need to be handled with caution and take into account many contributing factors, as multiple Levothyroxine dose adjustments evidently result in greater burden on healthcare resources. This means that it is necessary for clinicians to determine which patients are truly in need of dose adjustment. Even more importantly, accumulating evidence suggests that many patients, for whom indication for Levothyroxine initiation is not adequately established and diagnosis is not well document, are remaining on Levothyroxine therapy for longer than necessary. A prospective clinical cohort follow - up study illustrates this by showing that, among 291 patients on Levothyroxine replacement therapy without solid diagnosis of hypothyroidism and in whom treatment was pause, 114 developed hypothyroidism, while 177 participants remain euthyroid. The latter results clearly point to significant overuse of Levothyroxine therapy. Overtreatment should particularly be avoided in elderly. Study seeking to determine whether Levothyroxine pharmacokinetics are affected by age and weight do not identify any influence of age on Levothyroxine dose requirement, though it was determined that weight may mediate age - related changes in Levothyroxine pharmacokinetics. In addition, transient changes, inter - and intra - individual differences in Thyroid parameters, or ethnic variations may modify treatment target, thus rendering advisable tailored assessment of Thyroid function. Use of Thyroid extract, rather than Levothyroxine, may be associated with overtreatment. In a study of 174 reports of adverse events occurring in patients taking Thyroid hormone extract, 91 of these reports were accompanied by changes in TSH values and, of these, 62 patients had developed new symptoms associated with TSH changes, with most having symptoms consistent with thyrotoxicosis. In a recent case report, authors describe two female patients with Takotsubo cardiomyopathy associated with Levothyroxine over - replacement, clearly underlining the necessity to adjust dose of Levothyroxine, particularly in patients with cardiovascular risks, so as to avoid deleterious effects of iatrogenic hyperthyroidism. Another point to be considered in overzealously treated patients is the high risk of accelerated bone loss, predominantly in postmenopausal women, as well as the risk of osteoporosis and vertebral fractures. Concerning under - dosage, while overtreatment was not associated with impairment of health - related quality of life, patients who were undertreated had worse HRQoL than overtreated patients, especially regarding physical and emotional aspects, independently of the degree of hypothyroidism. Give that hypothyroidism undertreatment is associated with poor patient HRQoL, it is clear that Levothyroxine therapy must be sufficient to maintain serum TSH within reference range. Age - dependent interpretation of TSH values, with appropriate consideration of circadian fluctuations, body weight, gastrointestinal diseases and malabsorption, comorbidity, and possibly pituitary insufficiency or Thyroid hormone resistance, is thus crucial for optimal Levothyroxine dosage.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Proper Use

Levothyroxine exhibits all actions of endogenous thyroid hormone. Liothyronine is the principal hormone that exhibits these actions, whereas Levothyroxine is a major hormone secreted by the thyroid gland and is metabolically deiodinated to T3 in peripheral tissues. Approximately 80% of Levothyroxine dose is deiodinated to T3 and reverse T3, and virtually all of the activity of Levothyroxine can be ascribed to conversion of the drug to T3. Serum concentrations of T4 and TSH are typically used as primary monitoring parameters for determining thyroid function. In general, thyroid hormones influence growth and maturation of tissues, increase energy expenditure, and affect turnover of essentially all substrates. These effects are mediated through control of DNA transcription and, ultimately, protein synthesis. Thyroid hormones play an integral role in both anabolic and catabolic processes and are particularly important to the development of the central nervous system in newborns. They regulate cell differentiation and proliferation and aid in myelination of nerves and development of axonal and dendritic processes in the nervous system. Thyroid hormones, along with somatotropin, are responsible for regulating growth, particularly of bones and teeth. Thyroid hormones also decrease cholesterol concentrations in the liver and bloodstream and have direct cardiostimulatory action. Cardiac consumption is increased by administration of thyroid hormone, resulting in increased cardiac output. Administration of exogenous thyroid hormone to patients with hypothyroidism increases metabolic rate by enhancing protein and carbohydrate metabolism, increasing gluconeogenesis, facilitating mobilization of glycogen stores, and increasing protein synthesis. In response to reestablishing physiologic levels of thyroid hormone, thyroid - stimulating hormone concentrations correct if the primary disorder is at level of thyroid. Release of endogenous T3 and T4 from the thyroid gland into systemic circulation is regulated by TSH, which is secreted by the anterior Pituitary gland. Thyrotropin release is controlled by secretion of thyroid - releasing hormone from the hypothalamus and by feedback mechanism dependent on concentrations of circulating thyroid hormones. When circulating T3 and T4 levels increase, activities of TRH and TSH decrease. Because of this feedback mechanism, administration of pharmacologic doses of exogenous thyroid hormone to patients with normal thyroid suppresses endogenous thyroid hormone secretion.


Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or directions on the label. The following information includes only average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of medicine. Also, number of doses you take each day, time allowed between doses, and length of time you take medicine depend on the medical problem for which you are using medicine. For oral dosage form: for hypothyroidism: Adults and children older than 12 years of age, dose is based on body weight and must be determined by your doctor. The dose is usually 1. 7 micrograms per kilogram of body weight per day but may be less in older adults. Children older than 12 years of age dose is based on body weight and must be determined by your doctor. The dose is usually 2 to 3 mcg per kg of body weight per day. Children 6 to 12 years of ageDose is based on body weight and must be determined by your doctor. The dose is usually 4 to 5 mcg per kg of body weight per day. Children younger than 6 years of ageUse is not recommended as your child might not be able to swallow capsules. For thyroid cancer: AdultsDo is based on body weight and must be determined by your doctor. The dose is usually more than 2 micrograms per kilogram of body weight per day. Childrenuse's and dose must be determined by your doctor. For oral dosage form: for hypothyroidism: Adults and children older than 12 years of age, dose is based on body weight and must be determined by your doctor. The starting dose is usually 1. 7 micrograms per kilogram of body weight per day. Your doctor may adjust your dose as needed. Children older than 12 years of age dose is based on body weight and must be determined by your doctor. The dose is usually 2 to 3 mcg per kg of body weight per day. Children 6 to 12 years of ageDose is based on body weight and must be determined by your doctor. The dose is usually 4 to 5 mcg per kg of body weight per day. Children 1 to 5 years of ageDose is based on body weight and must be determined by your doctor. The dose is usually 5 to 6 mcg per kg of body weight per day. Children 6 to 12 months of ageDose is based on body weight and must be determined by your doctor. The dose is usually 6 to 8 mcg per kg of body weight per day. Children 3 to 6 months of ageDose is based on body weight and must be determined by your doctor. The dose is usually 8 to 10 mcg per kg of body weight per day.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Warnings

Thyroid hormones, either alone or with other therapeutic agents, should not be used for treatment of obesity or for weight loss. In euthyroid patients, doses within the range of daily hormonal requirements are ineffective for weight reduction; larger doses may produce serious or even life - threatening manifestations of toxicity, particularly when given in association with sympathomimetic amines such as those used for their anorectic effects. This medication contains Levothyroxine. Do not take SYNTHROID, Levoxyl, L Thyroxine, Levo T, Levothroid, Levothyroxine T4, Levoxine, Tirosint, or Unithroid if you are allergic to Levothyroxine or any ingredients containing this drug. Keep out of reach of children. In case of overdose, get medical help or contact the Poison Control Center immediately.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Take as directed

Levothyroxine should not be used to treat obesity or weight problems. Dangerous side effects or death can occur from misuse of levothyroxine, especially if you are taking any other weight - loss medications or appetite suppressants. Since thyroid hormones occur naturally in the body, almost anyone can take levothyroxine. However, you may not be able to take this medicine if you have certain medical conditions. Tell your doctor if you have: untreated or uncontrolled adrenal gland disorder; thyroid disorder called thyrotoxicosis; or symptoms of heart attack. Thyroid nodule;s heart disease, blood clot, or blood - clotting disorder; diabetes; kidney disease; anemia; osteoporosis, or low bone mineral density; problems with your pituitary gland; or any food or drug allergies. Tell your doctor if you have recently received radiation therapy with iodine. If you become pregnant while taking levothyroxine, do not stop taking medicine without your doctor's advice. Having low Thyroid hormone levels during pregnancy could harm both mother and baby. Your dose needs may be different during pregnancy. Tell your doctor if you are breast - feeding. Your dose needs may be different while you are nursing. Do not give this medicine to child without medical advice. Tirosint is not approved for use by anyone younger than 6 years old.


Uses

Read Patient Information Leaflet and Instructions for Use if available from your pharmacist before you start taking levothyroxine and each time you get a refill. If you have any questions, ask your doctor or pharmacist. Take this medication by mouth as directed by your doctor, usually once daily on an empty stomach, 30 minutes to 1 hour before breakfast. This medication may be taken by first mixing it in water, or it may be taken directly. To take it by mixing in water, open ampule as direct. Then turn the ampule upside down and slowly squeeze the soft part of the ampule to empty contents into glass or cup of water. Release pressure and wait a few seconds. Repeat squeezing and releasing the ampule at least 5 times, until no more liquid comes out of the ampule. Stir solution and drink all of the liquid right away. Rinse a glass or cup with more water and drink to make sure you have taken all the medicine. Do not prepare supplies ahead of time. To take this medication directly, slowly squeeze soft part of open ampule to empty contents into mouth or onto a spoon. Release pressure and wait a few seconds. Repeat squeezing and releasing the ampule at least 5 times, until no more liquid comes out of the ampule. Take all of the liquid right away. Dosage is based on your age, weight, medical condition, and response to treatment. Use this medication regularly to get the most benefit from it. To help you remember, take it at same time each day. Do not stop taking this medication without consulting your doctor. Thyroid replacement treatment is usually taken for life. There are different brands of levothyroxine available. Do not change brands without first consulting your doctor or pharmacist. Certain medications can decrease the amount of thyroid hormone that is absorbed by your body. If you are taking any of these drugs, separate them from this medication for at least 4 hours. Symptoms of low thyroid hormone levels include tiredness, muscle aches, constipation, dry skin, weight gain, slow heartbeat, or sensitivity to cold. Tell your doctor if your condition is not getting better or if it gets worse after several weeks of taking this medication.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

8. Cautions with other medicines

Some medicines can interfere with thyroid hormones, so the dose of Levothyroxine may need to be change. They include: medicines for fits or seizures - such as carbamazepine and Phenytoin rifampicin amiodarone oestrogens - such as in combined contraceptive pills or hormone replacement therapy. Levothyroxine can change how other medicines work, so their doses may need to be alter. These medicines include: medicines for Diabetes - either insulin or tablets, Blood thinning medicine, warfarin. Some medicines should not be taken at the same time of day as Levothyroxine as they can reduce the amount of Levothyroxine your body takes in, including: antacids, Calcium salts, Iron salts orlistat, medicine used for weight loss sucralfate, medicine used to treat stomach ulcers, some cholesterol - lowering medicines such as colestyramine, colestipol or colesevelem read Information Leaflet supply with these medicines or speak to your pharmacist for advice on how much time to leave between taking these medicines and taking Levothyroxine.


Side Effects

Get emergency medical help if you have signs of allergic reaction to levothyroxine: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Fast or irregular heartbeats; chest pain, pain spreading to your jaw or shoulder; shortness of breath; fever, hot flashes, sweating; tremors, or if you feel unusually cold; weakness, tiredness, sleep problems; memory problems, feeling depressed or irritable; headache, leg cramps, muscle aches; feeling nervous or irritable; dryness of your skin or hair, hair loss; irregular menstrual periods; or vomiting, diarrhea, appetite changes, weight changes. Certain side effects may be more likely in older adults. Chest pain, irregular heartbeats; shortness of breath; tremors, muscle pain or weakness; headache, leg cramps; feeling nervous or irritable, trouble sleeping; increased appetite; feeling hot; weight loss; changes in your menstrual periods; diarrhea; or skin rash, partial hair loss. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1 - 800 - FDA - 1088.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

2.3 Dosing in Specific Populations

Table 1. SYNTHROID Dosing Guidelines for Pediatric Hypothyroidism

AGEDaily Dose Per Kg Body Weight a
0-3 months10-15 mcg/kg/day
3-6 months8-10 mcg/kg/day
6-12 months6-8 mcg/kg/day
1-5 years5-6 mcg/kg/day
6-12 years4-5 mcg/kg/day
Greater than 12 years but growth and puberty incomplete2-3 mcg/kg/day
Growth and puberty complete1.6 mcg/kg/day

Administer TIROSINT as single daily oral dose, on an empty stomach, one - half to one hour before breakfast. Administer TIROSINT at least 4 hours before or after drugs known to interfere with TIROSINT absorption evaluate the need for dose adjustments when regularly administering within hour of certain foods that may affect TIROSINT absorption. Swallow TIROSINT capsules whole, do not cut or crush capsules. The dose of TIROSINT for Hypothyroidism or pituitary TSH suppression depends on a variety of factors including patient's age, body weight, cardiovascular status, concomitant medical conditions, concomitant medications, co - administer food, and specific nature of the condition being treat. Dosing must be individualized to account for these factors and dose adjustments made based on periodic assessment of patient's clinical response and laboratory parameters. The peak therapeutic effect of giving a dose of TIROSINT may not be attained for 4 to 6 weeks. Primary Hypothyroidism in Adults and in Adolescents in Whom Growth and Puberty Are Complete start TIROSINT at full replacement dose in otherwise healthy, non - elderly individuals who have been hypothyroid for only a short time. The average full replacement dose of TIROSINT is approximately 1. 6 mcg per kg per day. Adjust dose by 12. 5 to 25 mcg increments every 4 to 6 weeks until the patient is clinically euthyroid and serum TSH returns to normal. Doses greater than 200 mcg per day are seldom require. Inadequate response to daily doses greater than 300 mcg per day is rare and may indicate poor compliance, malabsorption, drug interactions, or a combination of these factors. For elderly patients or patients with underlying cardiovascular disease, start with a dose of 12. 5 To 25 mcg per day. Increase dose every 6 to 8 weeks, as needed, until the patient is clinically euthyroid and serum TSH returns to normal. The full replacement dose of TIROSINT may be less than 1 mcg per kg per day in elderly patients. In patients with severe longstanding hypothyroidism, start with a dose of 12. 5 To 25 mcg per day. Adjust dose to 12. 5 to 25 mcg increments every 2 to 4 weeks until the patient is clinically euthyroid and serum TSH level is Normalize. Start TIROSINT at full replacement dose in otherwise healthy, non - elderly individuals. Start with a lower dose in elderly patients with underlying cardiovascular disease or patients with severe longstanding Hypothyroidism as described above. Serum TSH is not a reliable measure of TIROSINT dose adequacy in patients with secondary or tertiary Hypothyroidism, and should not be used to monitor therapy. Use serum free - T4 level to monitor adequacy of therapy in this patient population. Titrate TIROSINT dosing per above instructions until patient is clinically euthyroid and serum free - T4 level is restored to the upper half of normal range. Only administer TIROSINT to pediatric patients 6 years and older who are able to swallow intact capsule.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

Table 1: LEVOXYL Dosing Guidelines for Pediatric Hypothyroidism

AgeDaily Dose Per Kg Body Weight
0 to 3 months10 mcg/kg daily to 15 mcg/kg daily
3 to 6 months8 mcg/kg daily to 10 mcg/kg daily
6 to 12 months6 mcg/kg daily to 8 mcg/kg daily
1 to 5 years5 mcg/kg daily to 6 mcg/kg daily
6 to 12 years4 mcg/kg daily to 5 mcg/kg daily
Greater than 12 years but growth and puberty incomplete2 mcg/kg daily to 3 mcg/kg daily
Growth and puberty complete1.6 mcg/kg daily
* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Drug Class: Thyroid products

Levothyroxine is administered orally or intravenously. Over 99% of Levothyroxine is bind to proteins, primarily thyroxine - binding globulin, prealbumin, and albumin. These proteins have a higher affinity for T4 than for liothyronine. Many medications and concurrent clinical conditions may affect T4 protein - binding, resulting in clinically significant changes in thyroid hormone activity since free drug is metabolically active. Thyroid hormones do not readily cross the placental barrier, and only minimal amounts are distributed into breast milk. Levothyroxine exhibits slow metabolic clearance. The major pathway of thyroid hormone metabolism is through sequential deiodination. Approximately 80% of circulating T3 is derived from peripheral T4 by monodeiodination. The liver is a major site of degradation for both T4 and T3, with T4 deiodination also occurring at a number of additional sites, including kidney and other tissues. Approximately 80% of the daily dose of T4 is deiodinated to yield equal amounts of T3 and reverse T3. T3 and rT3 are further deiodinated to diiodothyronine. Thyroid hormones are also metabolized via conjugation with glucuronides and sulfates and excreted directly into bile and gut where they undergo enterohepatic recirculation. Thyroid hormones are primarily eliminated by the kidneys. Portion of conjugate hormone reach colon unchanged and is eliminated in feces. Approximately 20% of T4 is eliminated in feces. Urinary excretion of T4 decreases with age. Elimination half - life of Levothyroxine is 6 to 7 days in euthyroid patients, 9 to 10 days in hypothyroid patients, and 3 to 4 days in hyperthyroid patients. Elimination half - life of T3 is 2 days or less. Levothyroxine has a slower onset of action and longer duration than liothyronine. Full therapeutic effects of Levothyroxine may not be evident for 1 to 3 weeks following oral administration and persist for the same amount of time following cessation of therapy. As hypothyroid patients become euthyroid, TSH secretion decreases. Affect cytochrome P450 are and drug transporters: uridine 5 - diphospho - glucuronosyltransferase, and possibly intestinal P - glycoprotein induction of uridine 5 - diphospho - glucuronosyltransferase by other medications increase L - thyroxine hepatic metabolism and lead to lower T4 serum levels. Literature has reported that Levothyroxine might inhibit P - gp, and lower cyclosporine concentrations; however, this action of Levothyroxine requires further study. Absorption of orally administered Levothyroxine from gastrointestinal tract ranges from 40% to 80%. Base on medical practice, relative bioavailability of oral Levothyroxine is 48 to 74% that of injectable Levothyroxine Sodium. The majority of Levothyroxine dose is absorbed from the jejunum and upper ileum. Relative bioavailability of oral tablets, compared to equal nominal dose of oral Levothyroxine Sodium solution, is approximately 93%. T4 absorption is increased by fasting, and decrease in malabsorption syndromes and by certain foods such as soybeans. Dietary fiber decreases bioavailability of T4. Absorption may also decrease with age. In addition, many drugs and foods affect T4 absorption. Certain foods, like soybean infant formula, enteral feedings, and dietary fiber, decrease T4 absorption. Consistent tablet potency was issued with oral Levothyroxine products prior to 1984.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Dosing Considerations

Avoid under - treatment or over - treatment with this drug. This may result in adverse effects. Initiate lower dose of medicine in the elderly, those with angina pectoris, cardiovascular disease, or in those with severe hypothyroidism. Long - term therapy decreases bone mineral density; use lowest dose in postmenopausal women and women using suppressive doses. Lower dose of Tirosint capsules may be required compared with standard T4 tablets for hypothyroidism in patients with impaired gastric acid secretion to reach their target TSH levels; Tirosint has shown improved absorption compared with conventional T4 tablets. Check for bioequivalence if switching brands / generics, or every week after switching from one levothyroxine sodium preparation to another.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Sources

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

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