Levoxyl (Levothyroxine Sodium)

(lee voe thye rox' een)

Thyroid hormone should not be used to treat obesity in patients with normal thyroid function. Levothyroxine is ineffective for weight reduction in normal thyroid patients and may cause serious or life-threatening toxicity, especially when taken with amphetamines. Talk to your doctor about the potential risks associated with this medication.

Levothyroxine, a thyroid hormone, is used to treat hypothyroidism, a condition where the thyroid gland does not produce enough thyroid hormone.Levothyroxine is also used to treat congenital hypothyroidism (cretinism) and goiter (enlarged thyroid gland). Levothyroxine 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 a capsule to take by mouth. It usually is taken once a day on an empty stomach, one half to one hour before breakfast. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take levothyroxine exactly as directed. 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. The tablets may get stuck in your throat or cause choking or gagging; therefore, the tablet should be taken with a full glass of water. If you are giving levothyroxine to an infant, child, or adult who cannot swallow the tablet, crush the tablet and mix it in 1 to 2 teaspoons of plain water. Give this mixture by spoon or dropper right away. Do not store this mixture. Only mix the crushed tablets with water. Do not mix with food or soybean infant formula. 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.

Before taking levothyroxine,
• tell your doctor and pharmacist if you are allergic to levothyroxine, thyroid hormone, any other medications, or any of the ingredients in levothyroxine. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); amphetamines; anticoagulants ('blood thinners') such as warfarin (Coumadin); aspirin or aspirin-containing products and other nonsteroidal anti-inflammatory drugs; beta-blockers such as metoprolol (Lopressor), propranolol (Inderal) or timolol (Timoptic); carbamazepine (Equetro, Tegretol); corticosteroids such as dexamethasone; digoxin (Lanoxin); estrogens; furosemide (Lasix); imatinib (Gleevac); insulin or other medications to treat diabetes; lithium (Lithobid); maprotiline; oral contraceptives; phenobarbital; phenytoin (Dilantin, Phenytek); rifampin (Rifater, Rifamate, Rifadin); selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft); theophylline (TheoDur); and tricyclic antidepressants such as amitriptyline (Elavil). Many other medications may also interact with levothyroxine, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• if you take an antacid, calcium carbonate (Tums), cholestyramine (Questran), colesevelam (Welchol), colestipol (Colestid), iron, orlistat (Alli, Xenical), simethicone (Phazyme, Gas X), sevelamer (Renvela, Renagel), sodium polystyrene sulfonate (Kayexalate), or sucralfate (Carafate), take it at least 4 hours before or 4 hours after you take levothyroxine.
• tell your doctor if you have or have ever had diabetes; hardening of the arteries (atherosclerosis); kidney disease; liver disease or hepatitis; bleeding problems; porphyria (condition in which abnormal substances build up in the blood and cause problems with the skin or nervous system); cardiovascular disease such as high blood pressure, chest pain (angina), arrhythmias, or heart attack; an underactive adrenal or pituitary gland, or any condition that makes it difficult for you to swallow.
• tell your doctor if you are pregnant, plan to become pregnant or are breast-feeding. If you become pregnant while taking levothyroxine, call your doctor.
• if you have surgery, including dental surgery, tell the doctor or dentist that you are taking levothyroxine.

Eat a normal, healthy diet. Some foods and beverages, particularly those that contain soybeans, walnuts, and dietary fiber, may affect how levothyroxine works for you, so take levothyroxine one half to one hour before breakfast.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Levothyroxine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• weight loss
• tremor
• headache
• nausea
• vomiting
• diarrhea
• stomach cramps
• nervousness
• irritability
• insomnia
• excessive sweating
• increased appetite
• fever
• changes in menstrual cycle
• sensitivity to heat
• temporary hair loss, particularly in children during the first month of therapy

If you experience either of the following symptoms, call your doctor immediately or get emergency medical treatment:

• chest pain (angina)
• rapid or irregular heartbeat or pulse

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to levothyroxine. Learn the brand name and generic name of your medication. Do not switch brands without talking to your doctor or pharmacist, as each brand of levothyroxine contains a slightly different amount of medication. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.