Dr. Izabella Wentz, PharmD

Thyroid Pharmacist

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Shortages, Discontinuations & Switching Medications

Levoxyl Shortage, Levothroid Discontinuation & Switching Medications

Medically reviewed and written by Izabella Wentz, PharmD, FASCP

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Levothroid discontinued by Forest Pharmaceuticals

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Thyroid Medication Shortage Got You Freaking Out?

Levoxyl is on long term manufacturer back order until mid-year in 2014… An unusual smell noticed by patients and pharmacists who opened medication bottles prompted the manufacturer to recall all strengths of Levoxyl.

Update: Levothroid, another T4 medication was discontinued by Forest Pharmaceuticals in July 2013 because the manufacturer could no longer supply the product.

This can be extremely stressful for those of us that rely on thyroid medications.

Thyroid hormones are known to have a very narrow therapeutic index, they are “Goldilocks” medications, in that have to be dosed just right to ensure effectiveness and prevent adverse drug events. Thyroid hormones are dosed in micrograms; that is just 1/1000th of a milligram! When the dose is a teensy bit too high, we may have symptoms of hyperthyroidism, and when the dose is a teensy bit too low, we have symptoms of hypothyroidism!

This is why switching back and forth between different brands of thyroid medications is not recommended. Even a teensy bit difference in the formulation can make a profound impact on our well-being!

But when there is a shortage of the medication you have been stable on, you have no choice but to switch! So what are your options for switching?

Helpful Hints

After switching medications, be sure to have your TSH, Free T4, and Free T3 checked in 4-6 weeks (that’s how long it usually takes the medication to stabilize in your body). Watch out for any symptoms of hypo- or hyperthyroidism.

If you are feeling unwell after switching your medication, call your physician. Per FDA guidelines, generic medications can have as much as 80%-125% of the same effect as the brand versions. That can make a huge difference! Although dose conversions between different brand are 1:1, you may still need to have the dose adjusted.

To learn more about optimizing your thyroid medications, download my free eBook below!

As Tirosint is a new, brand name medication, it may not be covered by many insurances, but you can check the Tirosint website for ongoing coupons or promotions. http://www.tirosint.com/

You can also enroll in the manufacturer’s loyalty program. The manufacturers of new drugs realize that cost can be a deterrent and will provide coupons to give patients a discount on their copays on a monthly basis.

Another great website for discounts and manufacturer programs is www.rxassist.org

On medications but not feeling 100%? You may be interested in my other posts:

What’s Really Going on In Hashimoto’s? 

Diet for Hashimoto’s Hypothyroidism

Which Thyroid Medication Is Best?

PS. You can also download a free Thyroid Diet Guide, 10 Thyroid friendly recipes, and the Nutrient Depletions and Digestion chapter for free by going to my thyroid gifts page. You will also receive occasional updates about new research, resources, giveaways and helpful information.

For future updates, make sure to follow us on Facebook!

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Disclaimer: The information contained herein is for informational purposes only and should not be construed as medical advice. Please consult your physician for any health problems and before making any medical or lifestyle changes.

Lifestyle changes can result in improved thyroid function and/or an increased absorption of thyroid hormone medications, leading to a lower required dose and possible symptoms of hyperthyroidism at a dose that was previously stable. Please discuss lifestyle changes with your physician and ensure that your thyroid function is monitored every 6-8 weeks while making lifestyle changes. Symptoms of overmedication include, but are not limited to: rapid or irregular heartbeat, nervousness, irritability or mood swings, muscle weakness or tremors, diarrhea, menstrual irregularities, hair loss, weight loss, insomnia, chest pain, and excessive sweating. Do not start, change, increase, decrease or discontinue your medications without consulting with your physician.

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Comments

  1. Yes. Freaking out. Just found out today. I can’t understand why it’s going to take Pfizer until 2014 to replenish their stock. Not that I know the first thing about the pharmaceutical industry, but come on, there’s got to be a way! Obviously they care about their customers. That’s why I found out today from the pharmacy and not from some other source. I think I’ll be taking generic. Here’s hoping it’s not horrible.
    Reply

  2. Good luck Nevena! Watch out for subtle symptoms of hypothyroidism like tangled hair, sleeping more and cold intolerance in 4-6 weeks after switching…(It takes that one for your current medication to wash out).You may need to tweak the dose of thyroid medication after switching to get back to feeling good. Be sure to have your thyroid function tested as well.
    Reply

  4. Suzette, I’m sorry to hear about your experience! Generic medications need to show 80-125% of the same effect of branded medication. Thyroid hormones have a very narrow therapeutic index, so that small difference may be making you feel hyperthyroid. Have you checked your pulse? Some people may need to have their physician adjust the dose after switching from brand/generic thyroid hormones. You may want to give your physician a call.
    Reply

  5. I have been on Levoxyl since the endocrinologist put me on it a long time ago. I could not tolerate synthroid. It made me shaky,blurry eyed and just felt awful. Now I was told that it has been pulled along with levathroid,levothroxine. The Dr. Put back on synthroid and dizzy and whobily again.. WHAT CAN I TAKE???? This is terrible.
    Reply

  6. Hi Ramona,
    I’m sorry for the way you are feeling! We all respond to different medications in a different way.
    I would start by having your doctor test your TSH, free T3 and free T4. Feeling shaky and having blurry vision and a general awful feeling could be symptoms of hyperthyroid-ie the dosage may be too high and your doc may need to take it down a bit.
    Brand and generic medications are allowed to have a 5% difference in amount of active hormone. With thyroid hormones, they are dosed in 1/1000th of a milligram, 5% too much (or too little) can be a huge deal!
    If dosage is not the issue, perhaps you are reacting to an inactive filler in the Synthroid such as the dye or binding chemicals. You can see if your Dr. will prescribe the new thyroid med for you. It’s called Tirosint and has the same active ingredients as Levoxyl and Synthroid, but none of the inactive fillers that sometimes cause issues. It is pricey but the drug company offers discounts on copays http://www.offtoasmoothstart.com/
    Then there is also the oldie but goodie, Armour thyroid that has the active ingredient of Levoxyl as well as T3, the active thyroid hormone.
    Good luck to you, let me know of your progress!
    Reply

  7. Very helpful information. Also freaking out here as I try to decide what to do. Thanks for your useful blog.
    Reply

  8. Hi, You have a wonderful website here. I could have used it when I needed help! I am curious as to why Acella’s NP Thyroid is NOT listed above?? Here is a link for info: http://www.npthyroid.com/ It is natural desiccated thyroid the inactive ingredients are calcium stearate, dextrose monohydrate, maltodextrin and mineral oil. The drawback for some could be it only comes in 1/2, 1, and 1 1/2 grain tablets.
    Reply

    • Rosetta- Not everyone will need every single supplement! In fact, I believe that most nutrients should come from the diet, this is why I always list food sources for most of the nutrients, vitamins, minerals and probiotics that are depleted in Hashimoto’s in the book and on the blog. However, some may require/prefer supplements and the supplements on the website are a resource for those that do. I recommend getting tested for deficiencies to determine your need for a supplement as instructed in the book and blog. I also don’t recommend starting multiple supplements all at once. I recommend starting one at a time and then adding another a week or so later once it has been confirmed that the first supplement is not causing any harm.

      I do have a full supplements chapter in my book. Have you checked it out? Not everyone should be taking every supplement and the book will help uncover your root cause. This will help you figure out your supplementation.

      http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20

      Reply

  12. hi Dr. Wentz,
    I have just switched a week ago to a combo t4t3 called Novothyral by Merck (in Germany) foggy brain is getting much! better but I am having a bit of some stinging pain in my thyroid occasionally since i switched from my t4 only med (L-thyrox). Should I be worried?
    Reply

  13. I am 10 years post thy. cancer. I’ve been taking the generic version of levythyroxine. For the last year my levels are really high, indicating poor absorption. I am taking it correctly without any meds that can decrease absorption. The Dr thought to switch me to name brand only as she thinks that may be a factor of non absorption, either that or the possible recurrence of disease. We are finding a nationwide shortage.. My scans and labs a year ago indicated no presence of disease. My dosage is at maximum for my body weight, any suggestions?

    Reply

  14. MY NAME IS DARLENE IVE BEEN ON LEVOTHROXINE 112MCG FOR YEARS NOW BUT JUST SINCE DEC I HAVE PUT ON 42 POUNDS.I WEIGHT 241 POUNDS , IS MY MEDS OFF

    Reply

  15. I am switching from synthoid to wp thoid do i just stop taking the synthroid and bebin the wp or should it be gradual?

    Reply

  16. I was doing well on generic t3 and Armour and both of these stopped working so I had to get on Cytomel and this has also stopped working. My gut is clean, and I mean it. After switching to compound I felt better than ever and now I am having hyper like symptoms. I’m noticing it isn’t me however it’ looks like some batches of the compounding pharmacy have been good or working to much. I’m even getting a gland flare when taking the ones that are making my body over react. Usually, if something stopped working for me i tank, not get hyper symptoms…… I tested and it looks like I’m being over medicated and despite me not taking meds and trying just one of the bad batches as soon as I take it my blood pressure goes up, chest pain, anxiety and hyper like symptoms… I’ve had 4 different pharmacies tell me it looks like they aren’t mixing their Product well and according to the Pharmacy everything is working and being made fine… idk what to do anymore…. what is this it isn’t me my cortisol is fine I can literally feel it over run my body and the more I take of my regular dosage the worse I become and I ended up at the hospital twice with thyroid storm. I don’t have TSI antibodies and I do have TPO antibodies since 2015 so I’m hashis and hypo. Naturally I’ve never been hyper.

    Reply

    • Ivy – thank you so much for sharing your journey. ❤️ Please understand, I am unable to answer specific medical questions, without a comprehensive health assessment. I recommend that you discuss your concerns and symptoms with your personal doctor who’s familiar with your health history.

      Reply

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