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Background Levothyroxine sodium is widely prescribed to treat primary HYPOTHYROIDISM. There is consensus that Levothyroxine should be taken IN morning on empty stomach. Pilot STUDY shows that Levothyroxine intake at bedtime significantly decreases thyrotropin levels and increases free thyroxine and total triiodothyronine levels. To date, no large randomized trial investigating best time for Levothyroxine intake, including quality - OF - life evaluation, has been perform. Methods To ascertain if Levothyroxine intake at bedtime instead OF IN morning improves Thyroid hormone levels, randomized double - blind crossover trial was performed between April 1, 2007, and November 30, 2008, among 105 consecutive PATIENTS with primary HYPOTHYROIDISM At Maasstad Hospital Rotterdam IN Netherlands. Patients were instructed for 6 months to take 1 capsule IN morning and 1 capsule at bedtime, with switch after 3 months. Primary outcome measures were Thyroid hormone levels; secondary outcome measures were creatinine and lipid levels, body mass index, heart rate, and quality OF life. Results Ninety PATIENTS completed trial and were available FOR analysis. Compared with morning intake, direct treatment effects when Levothyroxine was taken at bedtime were decreased IN thyrotropin level OF 1. 25 mIU / L, increase IN free thyroxine level OF 0. 07 ng / dL, and increase IN total triiodothyronine level OF 6. 5 ng / dL. Secondary outcomes, including quality - OF - life questionnaires, show no significant changes between morning and bedtime intake OF Levothyroxine. Conclusions Levothyroxine taken at bedtime significantly improves Thyroid hormone levels. Quality - OF - life variables and plasma lipid levels show no significant changes with bedtime vs morning intake. Clinicians should consider prescribing Levothyroxine intake at bedtime. Because the prevalence OF primary HYPOTHYROIDISM is high among general population, 1, 2 Levothyroxine sodium is one OF most prescribed medications. Absorption OF Levothyroxine is approximately 70 % To 80 % and occurs IN small bowel. 3 There is consensus that Levothyroxine should be taken before breakfast to prevent interference with its intestinal uptake by food or other medications. 4 - 10 IN our clinics, we observe several PATIENTS whose Thyroid hormone levels improve markedly after changing their scheduled intake OF Levothyroxine To bedtime. Pilot STUDY 11 confirmed THIS observation among 11 PATIENTS. Mean plasma thyrotropin level significantly decrease from 5. 1 To 1. 2 mIU / L, and free thyroxine and triiodothyronine levels increase when Levothyroxine is taken at bedtime. The circadian pattern OF thyrotropin rhythm remain intact, which was important regarding time OF blood sampling FOR thyrotropin levels to monitor Levothyroxine therapy. Accordingly, we conducted a randomized double - blind crossover trial to confirm whether Levothyroxine taken at bedtime leads to lower thyrotropin and higher FT 4 and T 3 levels. Hypothyroidism can have major effects on health and quality OF life, as it is associated with fatigue, weight gain, cold intolerance, Depression, neuromuscular symptoms, diastolic dysfunction, and impairment OF renal function. 12 - 15 It is also associated with risk factors FOR cardiovascular disease, such as hyperlipidemia, hyperhomocystinemia, and arterial hypertension, notably IN case OF insufficient Thyroid hormone supplementation.
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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 contained in this drug. Keep out of reach of children. In case of overdose, get medical help OR contact the Poison Control Center immediately. Taking iron and calcium supplements OR antacids can decrease amount of Levothyroxine your body absorbs. Do NOT Take Levothyroxine within 4 hours of taking these supplements OR antacids. Levothyroxine can cause severe allergic reaction.ss Symptoms can include: skin rash OR hives, flushing swelling of your face, lips, throat, OR tongue trouble breathing, wheezing stomach pain, nausea, vomiting, diarrhea, fever. If you develop these symptoms, call 911 OR go to the nearest emergency room. Dont take this drug again if youve ever had an allergic reaction to it. Taking it again could be fatal. Certain foods, such as soybean flour, cotton seed meal, walnuts, and other dietary fibers, may affect how well your body absorbs Levothyroxine. For people with heart problems: Levothyroxine can increase your risk of serious heart problems, such as heart attack, abnormal heart rhythm, and heart failure. This risk is increased if youve already had these problems. Tell your doctor if you have heart problems OR history of heart problems. Your doctor may decide to start you on a lower dosage of Levothyroxine. For people with diabetes: Let your doctor know if you have diabetes. Taking Levothyroxine can make your diabetes worse. Your doctor may monitor your blood sugar level more closely while you take this drug and adjust your diabetes drugs if needed For people with osteoporosis: Using Levothyroxine for long time can cause decreases in your bone mineral density and put you at higher risk of bone fractures. For people with adrenal OR pituitary gland problems: Let your doctor know if you have any adrenal OR pituitary gland problems. Using Levothyroxine can cause changes to your levels of thyroid hormone that could make these problems worse. For people with blood clotting disorders: Let your doctor know if you have any blood clotting disorders. Taking Levothyroxine may make it more difficult for your blood to clot and make bleeding more likely. For pregnant women: Studies of Levothyroxine in pregnant women havent shown risk to fetus. Talk to your doctor if youre pregnant OR planning to become pregnant. It appears unlikely that this drug will harm pregnancy. Not treating hypothyroidism could cause problems for both you and your pregnancy. You should NOT stop taking this drug during pregnancy.
Taking levothyroxine with certain drugs may result in an increase in adverse effects. Examples of these drugs include: antidepressants such as amitriptyline and maprotiline. Side effects of both of these antidepressants and levothyroxine may increase when you take these drugs together. This may put you at risk for irregular heart rhythms. Sympathomimetic drugs such as pseudoephedrine and albuterol. The effects of both sympathomimetic drugs and levothyroxine may increase when you take these drugs together. This may put you at risk of serious heart problems. Blood thinners such as warfarin. Taking these drugs with levothyroxine may increase your risk of bleeding. Your doctor may need to decrease dosage of your blood thinner if you also taking levothyroxine. Ketamine. Taking this drug with levothyroxine may increase your risk of high blood pressure and fast heart rate.
In deciding to use medicine, risks of taking medicine must be weighed against good it will do. This is decision you and your doctor will make. For this medicine, following should be consider: tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also, tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non - prescription products, read label or package ingredients carefully. Appropriate studies performed to date have not demonstrated pediatric - specific problems that would limit the usefulness of levothyroxine in children. Appropriate studies performed to date have not demonstrated geriatric - specific problems that would limit usefulness of levothyroxine in the elderly. However, elderly patients are more likely to have age - related heart or blood vessel problems, which may require caution and adjustment in dose for patients receiving levothyroxine. Studies in women suggest that this medication poses minimal risk to infants when used during breastfeeding. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. Following interactions have been selected on basis of their potential significance and are not necessarily all - inclusive. Using this medicine with any of following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change dose or how often you use one or both of medicines. Midodrine Using this medicine with any of the following medicines may cause increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of medicines. Aluminum Carbonate, Basic Aluminum Hydroxide Aluminum Phosphate Calcium Acetate Calcium Carbonate Calcium Citrate Chlorotrianisene Cholestyramine Chromium Ciprofloxacin Colesevelam conjugate Estrogens conjugate Estrogens Synthetic conjugate Estrogens Synthetic B Dexlansoprazole Dienestrol Diethylstilbestrol Dihydroxyaluminum Aminoacetate Dihydroxyaluminum Sodium Carbonate Eltrombopag Esomeprazole esterify Estrogens Estradiol Estramustine Estriol Estropipate Ethinyl Estradiol Fosphenytoin Imatinib Iron Kelp Lansoprazole Lanthanum Carbonate Lopinavir Magaldrate Magnesium Carbonate Magnesium Hydroxide Magnesium Oxide Magnesium Trisilicate Mestranol Omeprazole Pantoprazole Patiromer Phenytoin Polyestradiol Phosphate Promestriene Quinestrol Rabeprazole Rifampin Ritonavir Semaglutide Sevelamer Simvastatin Tibolone certain medicines should not be use at or around time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Following interactions have been selected on basis of their potential significance and are not necessarily all - inclusive.
If you will be taking THIS medicine FOR long time, it is very important that your doctor check the progress OF you or your child at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. Blood tests will be needed to check FOR unwanted effects. Levothyroxine should not be used FOR treatment OF obesity or FOR purpose OF losing weight. This medicine is not effective FOR weight reduction. If taken in large amounts, Levothyroxine may cause serious unwanted effects. Hypothyroidism can sometimes cause infertility in men and women. Levothyroxine should not be used FOR treatment OF infertility unless it is caused by hypothyroidism. For PATIENTS with diabetes: It is very important that you keep track OF your blood or urine sugar levels as instructed by your doctor. Check with your doctor right away if you notice any changes in your sugar levels. If you think you have become pregnant while using THIS medicine, tell your doctor right away. You may need larger dose OF Levothyroxine while you ARE pregnant. Women who ARE post - menopausal or who use THIS medicine FOR long time may have some bone loss, which could lead to osteoporosis. Talk with your doctor if you have questions or concerns about THIS. Call your doctor right away if you or your child start to have rapid or irregular heartbeats, chest pain, leg cramps, headaches, nervousness, irritability, sleeplessness, tremors, change in appetite, weight gain or loss, vomiting, diarrhea, excessive sweating, heat intolerance, fever, changes in menstrual periods, hives, or skin rash. These could be symptoms OF too much medicine in your body. Do not suddenly stop taking THIS medicine without first checking with your doctor. Your doctor may want you or your child to gradually reduce the amount you ARE using before stopping completely. Make sure any doctor or dentist who treats you knows that you or your child ARE using THIS medicine. You or your child may need to stop using THIS medicine several days before having surgery or medical tests. Temporary loss OF hair may occur during first few months OF Levothyroxine THERAPY. Ask your doctor about THIS if you have any concerns. Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription medicines and herbal or vitamin supplements.
Thyroid gland in your neck makes hormone called thyroxine. Thyroxine controls how much energy your body Use. It's also involve in digestion, how your heart and muscles work, brain development and bone health. When the thyroid gland does not make enough thyroxine, many OF body's functions slow down. Some OF the most common symptoms OF underactive Thyroid gland ARE: tiredness, feeling cold, difficulty concentrating, weight gain feeling depressed. Levothyroxine is synthetic version OF thyroxine. You take Levothyroxine tablets to replace thyroxine that your Thyroid gland cannot produce and prevent symptoms OF HYPOTHYROIDISM. One OF symptoms OF underactive Thyroid gland is weight gain. So, once you start taking Levothyroxine, you may lose weight as your body's hormones rebalance. Losing weight can also be sign that your dose of Levothyroxine is too high. Once your Thyroid hormone levels have returned to normal, your tendency to gain or lose weight is the same as FOR people who do not have Thyroid problems. If you have underactive Thyroid, you re entitled to free prescriptions FOR all OF your medicines. To claim your free prescriptions you ll need to have medical exemption certificate. The application form for medical exemption certificate is called FP92A. You can get THIS from your doctor's surgery. You will need to fill in form, then your doctor will sign it and send it off. It's having underactive Thyroid that causes hair loss - not treatment with Levothyroxine. Because natural hair growth cycle takes several months, hair loss related to Thyroid disease might only be seen months after illness has begin. If treatment with Levothyroxine has already start, it may seem like medicine - rather than the underlying illness - is causing hair loss. Hair usually regrow after treatment with Levothyroxine, but it may take many months.
Read the 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 empty stomach, 30 minutes to 1 hour before breakfast. Take this medication with 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 the tablet form of medication. For infants or children who cannot swallow whole tablets, crush 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 the 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.
Signs and symptoms of Overdosage are those of hyperthyroidism. In addition, confusion and disorientation may occur. Cerebral embolism, shock, coma, and death have been report. Seizures have occurred in children ingesting 18 mg of Levothyroxine. Symptoms may NOT necessarily be evident or may NOT appear until several days after ingestion of Levothyroxine Sodium. Levothyroxine Sodium should be reduced in dose or temporarily discontinued if signs or symptoms of Overdosage occur. Acute Massive Overdosage - This may be life - threatening emergency,. Therefore, symptomatic and supportive therapy should be instituted immediately. If NOT contraindicate, stomach should be empty by emesis or gastric lavage to decrease gastrointestinal absorption. Activated charcoal or cholestyramine may also be used to decrease absorption. Central and peripheral increased sympathetic activity may be treated by administering - receptor antagonists, eg, propranolol, provide there are no medical CONTRAINDICATIONS to their use. Provide respiratory support as needed control congestive heart failure and arrhythmia; control fever, hypoglycemia, and fluid loss as necessary. Large doses of antithyroid drugs followed in one to two hours by large doses of iodine may be given to inhibit synthesis and release of thyroid hormones. Glucocorticoids may be give to inhibit conversion of T4 to T3. Plasmapheresis, charcoal hemoperfusion and exchange transfusion have been reserved for cases in which continue clinical deterioration occurs despite conventional therapy. Because T4 is highly protein bound, very little drug will be removed by dialysis.
Levothyroxine is contraindicate in any patient with known hypersensitivity to Levothyroxine or any OF its excipients; however, there is no well - document evidence in literature OF true allergic or idiosyncratic reactions to thyroid hormone. Hypersensitivity reactions to inactive ingredients have occurred in patients treated with thyroid hormone products. Levothyroxine injection AND Tablets are synthetically derived AND may be used in patients allergic to desiccated thyroid or thyroid extract derived from pork or beef. Levothyroxine is contraindicated for use in patients with diagnosed but untreated adrenal insufficiency. Initiation OF thyroid hormone therapy prior to initiating glucocorticoid therapy may precipitate acute adrenal crisis in patients with adrenal insufficiency due to increase in body's demand for adrenal hormones. Treat patients with adrenal insufficiency with replacement glucocorticoids prior to initiating treatment with Levothyroxine. Serum TSH is not a reliable measure OF Levothyroxine dose adequacy in patients with secondary Hypothyroidism or tertiary Hypothyroidism AND should not be used to monitor therapy. Inappropriate TSH may be seen if Hypothyroidism is caused by TSH deficiency, AND TSH will not normalize with thyroid treatment. Use serum free - T4 level to monitor for adequacy OF therapy in this patient population. Many authorities recommend lower initial dosages AND slower titration of thyroid hormones in patients with cardiac disease AND coronary artery disease. Thyroid hormones such as Levothyroxine should be used with great caution in patients whose integrity OF cardiovascular system is suspect. All Levothyroxine DOSAGE formulations are cardiostimulatory AND should be used with great caution in patients with angina pectoris, uncontrolled hypertension, cardiac arrhythmias, CAD, previous history OF acute myocardial infarction, or current acute myocardial infarction. If adverse cardiac symptoms develop or worsen during treatment, reduce or withhold Levothyroxine AND cautiously restart at lower dose. Over - treatment with thyroid hormones may cause cardiac stimulation AND lead to increased heart rate, cardiac wall thickening, AND increased cardiac contractility, which may precipitate angina or cardiac arrhythmias. Concomitant ADMINISTRATION OF Levothyroxine with vasopressors or sympathomimetic agents may precipitate coronary insufficiency AND associate symptoms, particularly in myxedematous patients or those with CAD. Fluid therapy should be administered with great care to prevent cardiac decompensation. In patients with compromised cardiac function, use thyroid hormones in conjunction with careful cardiac monitoring. Lower starting dose is recommended in adult AND pediatric patients at risk for heart failure or sensitive to thyroid stimulation. Careful monitoring is also recommended during surgery, as some anesthetic agents may induce changes in heart rate or blood pressure when administered with thyroid hormones. Levothyroxine therapy can worsen glycemic control in patients with diabetes mellitus, AND result in increased antidiabetic agent or insulin requirements. Effects see are poorly understood AND depend upon a variety OF factors such as dose AND type OF thyroid preparations AND endocrine status OF patient. Blood glucose should be monitored closely during concomitant therapy, particularly during initiation, dose adjustments, or discontinuation OF therapy. Levothyroxine should not be used for obesity treatment or weight loss.
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