![]() These drugs may decrease serum TBG concentration. These drugs may increase serum thyroxine-binding globulin (TBG) concentration. Without Affecting Free Thyroxine (FT4) Concentration (Euthyroidism) Monitor patients appropriately.ĭrugs That May Alter T4 and Triiodothyronine (T3) Serum Transport Sucralfate, antacids, and proton pump inhibitors may cause hypochlorhydria, affect intragastric pH, and reduce levothyroxine absorption. Gastric acidity is an essential requirement for adequate absorption of levothyroxine. (e.g., aluminum & magnesium hydroxides, simethicone) ![]() Administer SYNTHROID at least 4 hours prior to these drugs or monitor TSH levels. (e.g., colesevelam, cholestyramine, colestipol)īile acid sequestrants and ion exchange resins are known to decrease levothyroxine absorption. Monitor patients treated concomitantly with orlistat and SYNTHROID for changes in thyroid function. Administer SYNTHROID at least 4 hours apart from these agents. Phosphate binders may bind to levothyroxine. (e.g., calcium carbonate, ferrous sulfate, sevelamer, lanthanum) Potential impact: Concurrent use may reduce the efficacy of SYNTHROID by binding and delaying or preventing absorption, potentially resulting in hypothyroidism. 2ĭrugs That May Decrease T4 Absorption (Hypothyroidism) ![]() Use the serum free-T4 level to titrate SYNTHROID dosing until the patient is clinically euthyroid and the serum free-T4 is restored to upper half of normal range. Patients should be given the minimum dose necessary to achieve the desired response 2įor secondary or tertiary hypothyroidism, serum TSH is not a reliable measure of SYNTHROID dosage adequacy and should not be used to monitor therapy.Once optimum replacement dose is attained, monitoring may be performed every 6 to 12 months and whenever there is a change in the patient’s clinical status 2.During dose titration, TSH monitoring is generally recommended at 6- to 8-week intervals until normalization 2.Peak therapeutic effect at a given dose may not be attained for 4 to 6 weeks 2.Evaluate need for SYNTHROID dosage adjustments when regularly administering SYNTHROID within 1 hour of food that may affect absorption (soybean flour, cottonseed meal, walnuts, dietary fibers, grapefruit juice) 2.Exercise caution with administering to patients with underlying cardiovascular disease, the elderly, and those with concomitant adrenal insufficiency 2.Dosing must be individualized and adjusted based on periodic assessment of the patient’s clinical response and laboratory parameters 2.Monitor serum TSH every 4 weeks and adjust SYNTHROID dosage until serum TSH is within normal trimester-specific range. Pregnant patients with new onset hypothyroidism Monitor serum TSH 4 to 8 weeks postpartum. Reduce SYNTHROID dosage to pre-pregnancy levels immediately after delivery. Monitor TSH every 4 weeks until a stable dose is reached and serum TSH is within normal trimester-specific range. Increase SYNTHROID dosage by 12.5 to 25 mcg per day. Pre-pregnancy dosage may increase during pregnancy Pregnant patients with pre-existing primary hypothyroidism with serum TSH above normal trimester-specific range Titrate dosage every 6 to 8 weeks as needed until the patient is euthyroid Titrate dosage every 6 to 8 weeks as needed until the patient is euthyroid. Lower starting dose (less than 1.6 mcg/kg/day) Titrate dosage by 12.5 to 25 mcg increments every 4 to 6 weeks, as needed until the patient is euthyroid.Īdults at risk for atrial fibrillation or with underlying cardiac disease Some patients require a lower starting dose.
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