levothyroxine sodium, Synthroid, Levoxyl, Levothroid, Unithroid, Tirosint, Levo-T

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

What is the dosage for levothyroxine sodium?

For adult hypothyroidism, levothyroxine is started at 12.5-125 mcg/day administered orally. Starting doses and dose changes may differ with individual patients based upon age, the presence of cardiovascular disease, the development of tolerance (reduced effectiveness with continued use), side effects to the medication, and blood levels of thyroid hormone. It may take one to three weeks after initiating therapy with levothyroxine or changing the dose before effects are seen. The goal of replacement therapy is to maintain a normal blood thyroxine level.

Which drugs or supplements interact with levothyroxine sodium?

Initiation or discontinuation of therapy with levothyroxine in diabetic patients may create a need for an increase or decrease in the required dose of insulin and/or antidiabetic drug, (for example, glyburide [Micronase]).

Levothyroxine may increase the effect of blood thinners such as warfarin (Coumadin). Therefore, monitoring of blood clotting is necessary, and a decrease in the dose of warfarin may be necessary.

Intravenous administration of epinephrine to patients with coronary artery disease may lead to complications ranging from difficulty in breathing to a heart attack. These complications may occur more frequently among patients also taking levothyroxine. Therefore, careful observation is needed when intravenous epinephrine is given to patients receiving levothyroxine who also have coronary artery disease.

Converting a state of hypothyroidism (under activity) to a normal state (euthyroid state) with levothyroxine may decrease the actions of certain beta-blocking drugs, (for example, metoprolol [Lopressor] or propranolol [Inderal]). It may be necessary, therefore, to change the dose of beta-blocker. For the same reason, the dose of digoxin (Lanoxin), a drug used to manage heart failure or an irregular heart rhythm (for example, atrial fibrillation), also may need to be changed.

Converting hypothyroidism to the euthyroid state with levothyroxine may increase the blood level of theophylline (Slo-Bid), and it may be necessary to change the dose of theophylline.

Taking levothyroxine at the same time as calcium carbonate, ferrous sulphate, cholestyramine (Questran) or colestipol (Colestid) may decrease the effect of levothyroxine and lead to hypothyroidism. This occurs because the levothyroxine binds to these drugs and is not absorbed. Taking the levothyroxine one hour before or four hours after these drugs is necessary to prevent binding.

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