#colestyramine posts

[running-in-the-dark]

I've got another colestyramin update.

so I've been taking the chewable tablets for a while, but I feel like maybe they don't work quite as well? either way, I don't like them that much - they're convenient for when I'm not at home, but they're still really annoying (and gross and it takes me forever to chew them)

I found a different version of the powder that comes in a big jar instead of individual packets. I asked my GP if I could try that (she was really weird about me taking this medication at all - asked if I want to take it forever and about how fast I eat and all that. which we already went over several times. and which... kind of... won't fix the issue which is caused by my non-existent gallbladder?! I could not possibly eat any slower, and changing what I eat didn't help at all. I guess I could just stop eating altogether, that would certainly fix this one issue :))) ).

anyway. she prescribed it to me, and I just had my first dose. oh my god it is so fucking bad. it's much more disgusting than the one in the packets, and the texture is horrible. there's two versions of this, one with more sugar and one with more of something else (can't remember the name). I asked for the one with more sugar, she prescribed the other one (and I noticed too late). maybe that's why it's so incredibly disgusting?

but. what's way worse than that. is that it.. had the absolute opposite effect of what it's supposed to do 🙃 tmi, but, it instantly gave me very bad diarrhea (which happens when I don't have this medication and eat for the first time in the day, and after most other meals too). that.. did not happen with the other ones. to be clear - I didn't eat anything yet. soo. I'm not sure what to do now. I guess I'll keep taking it for a few days, and if it doesn't get better I might ask if I can get the other version? but I don't know if she'll do that. so far she's always said I have to use up the previous medication first 🙃

what I really, realllly want. is the one that is just regular pills that you swallow. I don't care that they're apparently huge. I hate the texture of every version I've tried so far (the taste is horrible too, yeah, but the way it feels is the real issue). but that is apparently not officially approved for bile acid stuff in Germany, and I don't think my GP will try to help me get it.

she recommended I see a gastroenterologist (only because she thinks I shouldn't be on this medication long term), I just have to make an appointment. it'll probably be months until I get one, though.

ugh this is so frustrating! if I get the other version of this medication, I think I'll have tried all the ones that are available here.

my GP has zero interest in helping me figure this out. she said that it's bad if I keep taking this medication because it makes it so some vitamins can't be absorbed (as if having constant diarrhea after eating anything is better somehow?!), and when I asked if it would make sense to do a blood test to see if I have any deficiencies, she just asked if I had lost weight, I said not really, maybe a few kgs, and she said I should look into which ones can't be absorbed and that was that. cool. I get that she doesn't have time to look into everything for every one of her patients, but, I've been the one who informed her about everything related to this so far, and she won't even do a fucking blood test?!

I feel completely alone with this and I do not have the time or energy to figure this out right now!! I need to finish my thesis somehow, how am I supposed to research this at the same time?! and how am I supposed to do ANYTHING if I have to spend hours every day in the bathroom again, and be in pain the rest of the day?!

[farmsonpharma]

8 Paracetamol Guidelines for Patients

Paracetamol is such a common drug that we often tend to take it even without consulting a doctor. However, this practice is not safe until you have an in-depth understanding about Paracetamol medicine.

Thus, to help, in this blog post, Farmson as Paracetamol Bulk Drug Manufacturers and Paracetamol Suppliers sums a basic guideline about Paracetamol medicine for improved understanding of patients.

a)       Forms of Paracetamol

Paracetamol can be taken in different forms such as capsule, tablet, suppository, effervescent injection, granule, and soluble tablet. Choose your form of Paracetamol medicine only after consulting a doctor and based on the condition of your body.

b)      Doctor consultation for Paracetamol

Breastfeeding women, pregnant women and patients with kidney problems must particularly discuss with doctor before beginning any Paracetamol medicine course.

Patients taking medicines like Colestyramine, Metoclopramide or Warfarin must consult doctors before taking Paracetamol in any form.

Farmson as one of the well-known pharmaceutical companies of India recommends every patient to do a Paracetamol medicine dosage before beginning to take it. Farmson has their own Paracetamol manufacturing plant.

c)       Time gap between Paracetamol medications

A 4-hour gap should be maintained between any two Paracetamol dosage.

d)      Maximum Paracetamol dosage for patients

Any patient can take maximum 4 doses of Paracetamol medicine in a span of 24-hours.

e)       Paracetamol for children

Children must be given Paracetamol only upon doctor’s recommendation. Children under the age of 10 must not be given Paracetamol 500mg.

Farmson has been manufacturing Paracetamol bulk drugs for years now.

f)        Paracetamol and antibiotic combination

In case you combine Paracetamol with an antibiotic, ensure you complete the entire course of the both the medicines.

g)       Paracetamol for Covid-19 positive patients

Paracetamol can be taken by Covid-19 positive patients. However, doctor consultancy is must for planning the Paracetamol medicine course for Covid-19 patients.

h)      Storing and using Paracetamol

Store Paracetamol in normal temperature and in a closed box. Keep it out of children’s reach. Do not take Paracetamol medicine that has crossed its expiry date.

This blog post about ‘8 Paracetamol Guidelines for Patients’ is compiled by Farmson who has been manufacturing Paracetamol for years now.  Farmson is also a Paracetamol Powder Manufacturer who offers Paracetamol Powder Product.

[greatestlcve]

levothyroxine Uses, Dosage, Side Effects, Precautions & Warnings

Drug Online

Generic drug of the Therapeutic class: Endocrinology active ingredients: Levothyroxine sodium

what is levothyroxine used for and  indication?

Hypothyroidism.

Circumstances, associated or not with hypothyroidism, where it is necessary to curb the TSH.

levothyroxine dosage

Dosage

The doses administered vary according to the degree of hypothyroidism, the age of the patient and individual tolerance. Hypothyroidism being in the majority of cases, a definitive disease, treatment should be continued indefinitely.

levothyroxine dosage adults

In general the dosage should be established gradually starting for example, at 25 or 50 μg per day; the daily dose will then be increased in increments of 25 to 50 μg approximately 2 to 4 weeks apart;

In general, hormone replacement therapy requires an average of 100 to 150 μg once a day in the morning on an empty stomach;

 More gradual dosing regimens may also be proposed in particular, in cases of heart failure or coronary heart failure, rhythm disorders, in patients with severe or persistent hypothyroidism and in the elderly, for whom it is appropriate to start treatment at lower doses and to respect more progressive levels. A maintenance dose below the dose required to normalize the TSH level may be considered.

 In acute post-surgical hypothyroidism in the absence of underlying cardiac pathology, treatment can be initiated from the outset at 1 μg / kg / day as a single substitution and at 2 μg / kg / day as a treatment with a cold target. (by adjusting the dose later).

The average doses are 1.7 μg / kg / day for replacement therapy and 2.1 to 2.5 μg / kg / day for treatment with freezing;

 In combination with synthetic antithyroid drugs for the treatment of Graves’ disease, the dosage is 25 to 125 μg to be adapted to the biological results;

The dosage should be adjusted according to TSH results, after approximately 6 to 8 weeks of constant dosing. An additional free T4 assay is required for the treatment of patients with thyroid cancer for the purpose of treatment. In other cases (suspected non-adherence, prescription amiodarone or unexplained hypothyroidism), other free T4 determinations may be appropriate. Patient monitoring will focus on the clinic with signs of overdose (nervousness, tachycardia, insomnia) and biological tests. In equilibrium, if the clinical state is stable, a dosage once or twice a year is sufficient.

Particular case of patients with central hypothyroidism (pituitary insufficiency): the TSH assay is non-contributory and should be replaced by the assay of free T4.

levothyroxine dose in child

The maintenance dose is usually 100 to 150 μg / m2 body surface area per day.

For neonates and infants with congenital hypothyroidism for whom it is important to initiate replacement therapy quickly, the recommended starting dose is 10 to 15 μg / kg body weight per day for the first 3 months. Thereafter, the dose should be adjusted according to clinical outcomes and thyroid hormone and TSH levels.

For children with acquired hypothyroidism, the recommended starting dose is 12.5 to 50 μg / day. The dose should be increased gradually every 2 to 4 weeks depending on the clinical results and thyroid hormone and TSH levels until the dose for complete substitution is reached.

Administration mode

In children:

This treatment should be given only to children who can swallow tablets.

For infants, the total daily dose should be given if possible at least 1/2 hour before the first meal of the day.

how levothyroxine works in the body?

Pharmacotherapeutic group: thyroid medications, ATC code: H03AA01

Thyroid hormone, chemically defined in its natural form L more active than form D.

Levothyroxine essentially increases tissue oxygen consumption, basic metabolism, heart rate.

 What are the side effects of levothyroxine?

Aggravation of any cardiopathy (heart failure, angina, rhythm disorders …).

 Signs of hyperthyroidism, such as tachycardia, tremors, cardiac arrhythmias, insomnia, excitability, elevated temperature, sweating, rapid weight loss, diarrhea, should be used for hormonal dosing, decrease or discontinue treatment for several days. will then be resumed at lower doses.

In children, possibility of hypercalciuria.

 Hypersensitivity reactions to excipients and / or the active substance have been reported. The most common signs and symptoms are: urticaria, pruritus, angioedema, dyspnea, erythema.

Reporting of suspected adverse reactions

levothyroxine Interactions

Association subject to precautions for use

 Ion exchange resins (colestyramine, cholestipol, kayexalate, …) sevelamer, sucralfate,gastrointestinal topical agents , antacids (aluminum salts …) and adsorbents

Decreased activity of thyroid hormones (reduction of intestinal absorption).

Take them away from thyroid hormones (more than 2 hours if possible).

Enzyme inducers

Anticonvulsants (carbamazepine, phenobarbital, phenytoin, primidone, barbiturates); griseofulvin; rifampicin, rifabutin. Described for phenytoin, rifampicin and carbamazepine.

Risk of clinical hypothyroidism in hypothyroid patients when using combinations due to increased metabolism of T3 and T4.

Monitoring of serum T3 and T4 levels and adjustment of thyroid hormone dosage if necessary during enzyme inducer treatment and after discontinuation.

Drugs containing iron salts, oral calcium

Decreased digestive absorption of levothyroxine.

Take Levothyroxine away from these products (more than 2 hours, if possible).

Chloroquine / proguanil

Risk of clinical hypothyroidism in patients substituted by thyroid hormones.

Monitoring of TSH and serum T3 and T4 concentrations and adaptation, if necessary, of thyroid hormone dosage during antimalarial treatment and after discontinuation.

Protease inhibitors boosted by ritonavir (indinavir, lopinavir …)

Protease inhibitors can decrease the effectiveness of thyroid hormones by increasing their hepatic metabolism. It is recommended to closely monitor thyroid hormone levels (clinical and laboratory monitoring) and if necessary adjust the dose of levothyroxine.

Non-contraceptive estrogens

Risk of clinical hypothyroidism in estrogen replacement therapy. In this case, clinical and biological monitoring is necessary; the dose of levothyroxine should be adjusted in postmenopausal women taking estrogens.

Associations to consider

Imatinib, sunitinib

Imatinib and sunitinib may decrease the effectiveness of levothyroxine. It is therefore recommended to monitor any changes in the thyroid function of patients, at the initiation or at the end of the concomitant treatment. The dose of levothyroxine will be adjusted if necessary.

Orlistat

Orlistat may interact with thyroid hormone replacement therapy by decreasing the absorption of thyroid hormones.

levothyroxine Warnings and Precautions

levothyroxine warnings

Obesity is not an indication of thyroid hormones used alone or in combination unless this obesity is associated with true hypothyroidism. Their administration at high doses or in combination with amphetamine substances can be dangerous.

The effectiveness of the treatment and the possible signs of intolerance can appear only after a latency period of the order of 15 days to a month.

Precautions for use

The quality of the therapeutic balance must be controlled by an adequate endocrinological evaluation.

In case of cardiac pathology balanced by the treatment (coronary disorders, rhythm disorders), the indication is to be discussed on a case by case basis. If the treatment is instituted, the substitution is limited to obtaining a TSH in the high normal values. The surveillance of the subjects must be particularly attentive. Persistent or aggravated hypertension with levothyroxine should lead immediately to appropriate management.

If there is a risk of adrenocortical insufficiency (in particular, hypothyroidism of pituitary origin), treatment with hydrocortisone should be instituted beforehand.

Soy can decrease intestinal absorption of levothyroxine. Therefore, a reassessment of the Levothyrox dosage may be necessary especially at the beginning or end of a soy supplementation.

When switching from one levothyroxine sodium medication to another, it is important to monitor the therapeutic balance in certain at-risk patients in the following categories: patients who are receiving treatment for thyroid cancer but who have also cardiovascular disease (heart or coronary heart failure, and rhythm disorders), pregnant women, children and the elderly; and in some situations where the therapeutic balance has been particularly difficult to achieve.

In these patients, the maintenance of the therapeutic balance must be confirmed by a clinical evaluation, or even biological if necessary (by a control of the TSH carried out between 6 and 8 weeks after the substitution, except for the pregnant women where the modalities of surveillance to be adapted according to the evolution of the thyroid pathology and the term of the pregnancy).

In postmenopausal women with hypothyroidism and a high risk of osteoporosis, supra-physiologic levels of levothyroxine should be avoided. This is why close monitoring of thyroid function is recommended.

Drive and use machines

Not applicable.

levothyroxine and PREGNANCY / BREAST FEEDING / FERTILITY:

levothyroxine and pregnancy

Levothyroxine passes very little through the placenta and its administration at appropriate doses is devoid of fetal consequences. Treatment with thyroid hormones must be continued throughout pregnancy. It is recommended to strengthen the clinical and biological surveillance especially in early pregnancy and to adapt the treatment if necessary.

Normal maternal thyroid function or even mild hyperthyroidism is required during pregnancy to reduce the risk of fetal hypothyroidism.

During pregnancy, Levothyrox should not be used with anti-thyroid medications for hyperthyroidism. Indeed, only very small amounts of Levothyrox cross the placenta, while large amounts of anti-thyroid drugs pass from mother to child. This can result in fetal hypothyroidism.

levothyroxine and feeding

Breastfeeding is possible in case of treatment with thyroid hormones.

levothyroxine and Fertility

Hypothyroidism or hyperthyroidism can affect fertility. Treatment of hypothyroidism with Levothyrox should therefore be adapted on the basis of biological monitoring since under-dosing may not improve hypothyroidism and overdose may lead to hyperthyroidism.

What should I do if I miss a dose?

Pharmacotherapeutic group: thyroid medications, ATC code: H03AA01

Thyroid hormone, chemically defined in its natural form L more active than form D.

Levothyroxine essentially increases tissue oxygen consumption, basic metabolism, heart rate.

What happens if I overdose from LEVOTHYROX ?

Acute intoxications are generally of moderate severity in the absence of cardiac history, including during accidental ingestions in children. In symptomatic cases, clinical effects may occur within a few hours or be delayed by a few days in the case of a single dose and may include one or more signs of thyrotoxicosis (see below). In the case of repeated doses of supratherapeutic doses, the following signs of hyperthyroidism have been observed and, in the most severe cases, define a state of thyrotoxicosis:

Digestive disorders: vomiting, abdominal pain, diarrhea, increased appetite, weight loss.

Cardiovascular disorders: tachycardia, atrial fibrillation arrhythmia or extrasystoles, hypertension, chest pain, angina, congestive heart failure, cardiogenic collapse.

General disorders: fever, redness of the skin, sweating.

Neurological disorders: irritability, insomnia, headache, agitation, confusion, mydriasis, convulsions in predisposed patients, disturbances of consciousness, coma, acute psychosis.

The severity of the clinical manifestations is neither correlated with the dose ingested nor with the serum T4 and T3 determination. Beta-sympathomimetic effects, such as tachycardia, anxiety, agitation, or hyperkinesia, may be relieved by a beta-blocker. Exceptionally, after ingestion of a massive, life-threatening dose, plasmapheresis or haemoperfusion on charcoal may be considered. In case of excessive doses, especially at the time of initiation of treatment, rare cases of seizures have been reported in epileptic patients.

What is Composition?

 p cpLevothyroxine Sodium (INN)25 μgor50 μgor75 μgor100 μgor125 μgor150 μgor175 μgor200 μg

Excipients (common): mannitol, corn starch, gelatin, croscarmellose sodium, magnesium stearate, anhydrous citric acid.

What is forms? 

The tablet can be divided into two equal half-doses.

NOT’s

Edrug-online contains comprehensive and detailed information about drugs available in the medical field, and is divided into four sections:

general information:

Includes a general description of the drug, its use, brand names, FAQs, and relevant news and articles

Additional information:

General explanation about dealing with the medicine: how to take the medicine, the doses and times of it, the start and duration of its effectiveness, the recommended diet during the period of taking the medicine, the method of storage and storage, recommendations in cases for forgetting the dose and instructions to stop taking the drug and take additional doses.

Special warnings:

For pregnant and breastfeeding women, the elderly, boys and drivers, and use before surgery.

Side effects:

It treats possible side effects and drug interactions that require attention and its effect on continuous use.

The information contained in this medicine is based on medical literature, but it is not a substitute for consulting a doctor.

The post levothyroxine Uses, Dosage, Side Effects, Precautions & Warnings appeared first on Drug Online.

from Drug Online https://bit.ly/30biQdV via Edrug Online from Faculty of Medicine https://bit.ly/3120ZoV via Internal Medicine

[thesittingduck]

levothyroxine Uses, Dosage, Side Effects, Precautions & Warnings

Drug Online

Generic drug of the Therapeutic class: Endocrinology active ingredients: Levothyroxine sodium

what is levothyroxine used for and  indication?

Hypothyroidism.

Circumstances, associated or not with hypothyroidism, where it is necessary to curb the TSH.

levothyroxine dosage

Dosage

The doses administered vary according to the degree of hypothyroidism, the age of the patient and individual tolerance. Hypothyroidism being in the majority of cases, a definitive disease, treatment should be continued indefinitely.

levothyroxine dosage adults

In general the dosage should be established gradually starting for example, at 25 or 50 μg per day; the daily dose will then be increased in increments of 25 to 50 μg approximately 2 to 4 weeks apart;

In general, hormone replacement therapy requires an average of 100 to 150 μg once a day in the morning on an empty stomach;

 More gradual dosing regimens may also be proposed in particular, in cases of heart failure or coronary heart failure, rhythm disorders, in patients with severe or persistent hypothyroidism and in the elderly, for whom it is appropriate to start treatment at lower doses and to respect more progressive levels. A maintenance dose below the dose required to normalize the TSH level may be considered.

 In acute post-surgical hypothyroidism in the absence of underlying cardiac pathology, treatment can be initiated from the outset at 1 μg / kg / day as a single substitution and at 2 μg / kg / day as a treatment with a cold target. (by adjusting the dose later).

The average doses are 1.7 μg / kg / day for replacement therapy and 2.1 to 2.5 μg / kg / day for treatment with freezing;

 In combination with synthetic antithyroid drugs for the treatment of Graves’ disease, the dosage is 25 to 125 μg to be adapted to the biological results;

The dosage should be adjusted according to TSH results, after approximately 6 to 8 weeks of constant dosing. An additional free T4 assay is required for the treatment of patients with thyroid cancer for the purpose of treatment. In other cases (suspected non-adherence, prescription amiodarone or unexplained hypothyroidism), other free T4 determinations may be appropriate. Patient monitoring will focus on the clinic with signs of overdose (nervousness, tachycardia, insomnia) and biological tests. In equilibrium, if the clinical state is stable, a dosage once or twice a year is sufficient.

Particular case of patients with central hypothyroidism (pituitary insufficiency): the TSH assay is non-contributory and should be replaced by the assay of free T4.

levothyroxine dose in child

The maintenance dose is usually 100 to 150 μg / m2 body surface area per day.

For neonates and infants with congenital hypothyroidism for whom it is important to initiate replacement therapy quickly, the recommended starting dose is 10 to 15 μg / kg body weight per day for the first 3 months. Thereafter, the dose should be adjusted according to clinical outcomes and thyroid hormone and TSH levels.

For children with acquired hypothyroidism, the recommended starting dose is 12.5 to 50 μg / day. The dose should be increased gradually every 2 to 4 weeks depending on the clinical results and thyroid hormone and TSH levels until the dose for complete substitution is reached.

Administration mode

In children:

This treatment should be given only to children who can swallow tablets.

For infants, the total daily dose should be given if possible at least ½ hour before the first meal of the day.

how levothyroxine works in the body?

Pharmacotherapeutic group: thyroid medications, ATC code: H03AA01

Thyroid hormone, chemically defined in its natural form L more active than form D.

Levothyroxine essentially increases tissue oxygen consumption, basic metabolism, heart rate.

What are the side effects of levothyroxine?

Aggravation of any cardiopathy (heart failure, angina, rhythm disorders …).

 Signs of hyperthyroidism, such as tachycardia, tremors, cardiac arrhythmias, insomnia, excitability, elevated temperature, sweating, rapid weight loss, diarrhea, should be used for hormonal dosing, decrease or discontinue treatment for several days. will then be resumed at lower doses.

In children, possibility of hypercalciuria.

 Hypersensitivity reactions to excipients and / or the active substance have been reported. The most common signs and symptoms are: urticaria, pruritus, angioedema, dyspnea, erythema.

Reporting of suspected adverse reactions

levothyroxine Interactions

Association subject to precautions for use

 Ion exchange resins (colestyramine, cholestipol, kayexalate, …) sevelamer, sucralfate,gastrointestinal topical agents , antacids (aluminum salts …) and adsorbents

Decreased activity of thyroid hormones (reduction of intestinal absorption).

Take them away from thyroid hormones (more than 2 hours if possible).

Enzyme inducers

Anticonvulsants (carbamazepine, phenobarbital, phenytoin, primidone, barbiturates); griseofulvin; rifampicin, rifabutin. Described for phenytoin, rifampicin and carbamazepine.

Risk of clinical hypothyroidism in hypothyroid patients when using combinations due to increased metabolism of T3 and T4.

Monitoring of serum T3 and T4 levels and adjustment of thyroid hormone dosage if necessary during enzyme inducer treatment and after discontinuation.

Drugs containing iron salts, oral calcium

Decreased digestive absorption of levothyroxine.

Take Levothyroxine away from these products (more than 2 hours, if possible).

Chloroquine / proguanil

Risk of clinical hypothyroidism in patients substituted by thyroid hormones.

Monitoring of TSH and serum T3 and T4 concentrations and adaptation, if necessary, of thyroid hormone dosage during antimalarial treatment and after discontinuation.

Protease inhibitors boosted by ritonavir (indinavir, lopinavir …)

Protease inhibitors can decrease the effectiveness of thyroid hormones by increasing their hepatic metabolism. It is recommended to closely monitor thyroid hormone levels (clinical and laboratory monitoring) and if necessary adjust the dose of levothyroxine.

Non-contraceptive estrogens

Risk of clinical hypothyroidism in estrogen replacement therapy. In this case, clinical and biological monitoring is necessary; the dose of levothyroxine should be adjusted in postmenopausal women taking estrogens.

Associations to consider

Imatinib, sunitinib

Imatinib and sunitinib may decrease the effectiveness of levothyroxine. It is therefore recommended to monitor any changes in the thyroid function of patients, at the initiation or at the end of the concomitant treatment. The dose of levothyroxine will be adjusted if necessary.

Orlistat

Orlistat may interact with thyroid hormone replacement therapy by decreasing the absorption of thyroid hormones.

levothyroxine Warnings and Precautions

levothyroxine warnings

Obesity is not an indication of thyroid hormones used alone or in combination unless this obesity is associated with true hypothyroidism. Their administration at high doses or in combination with amphetamine substances can be dangerous.

The effectiveness of the treatment and the possible signs of intolerance can appear only after a latency period of the order of 15 days to a month.

Precautions for use

The quality of the therapeutic balance must be controlled by an adequate endocrinological evaluation.

In case of cardiac pathology balanced by the treatment (coronary disorders, rhythm disorders), the indication is to be discussed on a case by case basis. If the treatment is instituted, the substitution is limited to obtaining a TSH in the high normal values. The surveillance of the subjects must be particularly attentive. Persistent or aggravated hypertension with levothyroxine should lead immediately to appropriate management.

If there is a risk of adrenocortical insufficiency (in particular, hypothyroidism of pituitary origin), treatment with hydrocortisone should be instituted beforehand.

Soy can decrease intestinal absorption of levothyroxine. Therefore, a reassessment of the Levothyrox dosage may be necessary especially at the beginning or end of a soy supplementation.

When switching from one levothyroxine sodium medication to another, it is important to monitor the therapeutic balance in certain at-risk patients in the following categories: patients who are receiving treatment for thyroid cancer but who have also cardiovascular disease (heart or coronary heart failure, and rhythm disorders), pregnant women, children and the elderly; and in some situations where the therapeutic balance has been particularly difficult to achieve.

In these patients, the maintenance of the therapeutic balance must be confirmed by a clinical evaluation, or even biological if necessary (by a control of the TSH carried out between 6 and 8 weeks after the substitution, except for the pregnant women where the modalities of surveillance to be adapted according to the evolution of the thyroid pathology and the term of the pregnancy).

In postmenopausal women with hypothyroidism and a high risk of osteoporosis, supra-physiologic levels of levothyroxine should be avoided. This is why close monitoring of thyroid function is recommended.

Drive and use machines

Not applicable.

levothyroxine and PREGNANCY / BREAST FEEDING / FERTILITY:

levothyroxine and pregnancy

Levothyroxine passes very little through the placenta and its administration at appropriate doses is devoid of fetal consequences. Treatment with thyroid hormones must be continued throughout pregnancy. It is recommended to strengthen the clinical and biological surveillance especially in early pregnancy and to adapt the treatment if necessary.

Normal maternal thyroid function or even mild hyperthyroidism is required during pregnancy to reduce the risk of fetal hypothyroidism.

During pregnancy, Levothyrox should not be used with anti-thyroid medications for hyperthyroidism. Indeed, only very small amounts of Levothyrox cross the placenta, while large amounts of anti-thyroid drugs pass from mother to child. This can result in fetal hypothyroidism.

levothyroxine and feeding

Breastfeeding is possible in case of treatment with thyroid hormones.

levothyroxine and Fertility

Hypothyroidism or hyperthyroidism can affect fertility. Treatment of hypothyroidism with Levothyrox should therefore be adapted on the basis of biological monitoring since under-dosing may not improve hypothyroidism and overdose may lead to hyperthyroidism.

What should I do if I miss a dose?

Pharmacotherapeutic group: thyroid medications, ATC code: H03AA01

Thyroid hormone, chemically defined in its natural form L more active than form D.

Levothyroxine essentially increases tissue oxygen consumption, basic metabolism, heart rate.

What happens if I overdose from LEVOTHYROX ?

Acute intoxications are generally of moderate severity in the absence of cardiac history, including during accidental ingestions in children. In symptomatic cases, clinical effects may occur within a few hours or be delayed by a few days in the case of a single dose and may include one or more signs of thyrotoxicosis (see below). In the case of repeated doses of supratherapeutic doses, the following signs of hyperthyroidism have been observed and, in the most severe cases, define a state of thyrotoxicosis:

Digestive disorders: vomiting, abdominal pain, diarrhea, increased appetite, weight loss.

Cardiovascular disorders: tachycardia, atrial fibrillation arrhythmia or extrasystoles, hypertension, chest pain, angina, congestive heart failure, cardiogenic collapse.

General disorders: fever, redness of the skin, sweating.

Neurological disorders: irritability, insomnia, headache, agitation, confusion, mydriasis, convulsions in predisposed patients, disturbances of consciousness, coma, acute psychosis.

The severity of the clinical manifestations is neither correlated with the dose ingested nor with the serum T4 and T3 determination. Beta-sympathomimetic effects, such as tachycardia, anxiety, agitation, or hyperkinesia, may be relieved by a beta-blocker. Exceptionally, after ingestion of a massive, life-threatening dose, plasmapheresis or haemoperfusion on charcoal may be considered. In case of excessive doses, especially at the time of initiation of treatment, rare cases of seizures have been reported in epileptic patients.

What is Composition?

  p cp Levothyroxine Sodium (INN) 25 μg or 50 μg or 75 μg or 100 μg or 125 μg or 150 μg or 175 μg or 200 μg

Excipients (common): mannitol, corn starch, gelatin, croscarmellose sodium, magnesium stearate, anhydrous citric acid.

What is forms? 

The tablet can be divided into two equal half-doses.

NOT’s

Edrug-online contains comprehensive and detailed information about drugs available in the medical field, and is divided into four sections:

general information:

Includes a general description of the drug, its use, brand names, FAQs, and relevant news and articles

Additional information:

General explanation about dealing with the medicine: how to take the medicine, the doses and times of it, the start and duration of its effectiveness, the recommended diet during the period of taking the medicine, the method of storage and storage, recommendations in cases for forgetting the dose and instructions to stop taking the drug and take additional doses.

Special warnings:

For pregnant and breastfeeding women, the elderly, boys and drivers, and use before surgery.

Side effects:

It treats possible side effects and drug interactions that require attention and its effect on continuous use.

The information contained in this medicine is based on medical literature, but it is not a substitute for consulting a doctor.

The post levothyroxine Uses, Dosage, Side Effects, Precautions & Warnings appeared first on Drug Online.

from Drug Online https://bit.ly/30biQdV via Edrug Online from faculty of medicine https://bit.ly/33bFsg4 via Faculty of Medicine

[colinfitzpatrick]

levothyroxine Uses, Dosage, Side Effects, Precautions & Warnings

Drug Online

Generic drug of the Therapeutic class: Endocrinology active ingredients: Levothyroxine sodium

what is levothyroxine used for and  indication?

Hypothyroidism.

Circumstances, associated or not with hypothyroidism, where it is necessary to curb the TSH.

levothyroxine dosage

Dosage

The doses administered vary according to the degree of hypothyroidism, the age of the patient and individual tolerance. Hypothyroidism being in the majority of cases, a definitive disease, treatment should be continued indefinitely.

levothyroxine dosage adults

In general the dosage should be established gradually starting for example, at 25 or 50 μg per day; the daily dose will then be increased in increments of 25 to 50 μg approximately 2 to 4 weeks apart;

In general, hormone replacement therapy requires an average of 100 to 150 μg once a day in the morning on an empty stomach;

 More gradual dosing regimens may also be proposed in particular, in cases of heart failure or coronary heart failure, rhythm disorders, in patients with severe or persistent hypothyroidism and in the elderly, for whom it is appropriate to start treatment at lower doses and to respect more progressive levels. A maintenance dose below the dose required to normalize the TSH level may be considered.

 In acute post-surgical hypothyroidism in the absence of underlying cardiac pathology, treatment can be initiated from the outset at 1 μg / kg / day as a single substitution and at 2 μg / kg / day as a treatment with a cold target. (by adjusting the dose later).

The average doses are 1.7 μg / kg / day for replacement therapy and 2.1 to 2.5 μg / kg / day for treatment with freezing;

 In combination with synthetic antithyroid drugs for the treatment of Graves’ disease, the dosage is 25 to 125 μg to be adapted to the biological results;

The dosage should be adjusted according to TSH results, after approximately 6 to 8 weeks of constant dosing. An additional free T4 assay is required for the treatment of patients with thyroid cancer for the purpose of treatment. In other cases (suspected non-adherence, prescription amiodarone or unexplained hypothyroidism), other free T4 determinations may be appropriate. Patient monitoring will focus on the clinic with signs of overdose (nervousness, tachycardia, insomnia) and biological tests. In equilibrium, if the clinical state is stable, a dosage once or twice a year is sufficient.

Particular case of patients with central hypothyroidism (pituitary insufficiency): the TSH assay is non-contributory and should be replaced by the assay of free T4.

levothyroxine dose in child

The maintenance dose is usually 100 to 150 μg / m2 body surface area per day.

For neonates and infants with congenital hypothyroidism for whom it is important to initiate replacement therapy quickly, the recommended starting dose is 10 to 15 μg / kg body weight per day for the first 3 months. Thereafter, the dose should be adjusted according to clinical outcomes and thyroid hormone and TSH levels.

For children with acquired hypothyroidism, the recommended starting dose is 12.5 to 50 μg / day. The dose should be increased gradually every 2 to 4 weeks depending on the clinical results and thyroid hormone and TSH levels until the dose for complete substitution is reached.

Administration mode

In children:

This treatment should be given only to children who can swallow tablets.

For infants, the total daily dose should be given if possible at least 1/2 hour before the first meal of the day.

how levothyroxine works in the body?

Pharmacotherapeutic group: thyroid medications, ATC code: H03AA01

Thyroid hormone, chemically defined in its natural form L more active than form D.

Levothyroxine essentially increases tissue oxygen consumption, basic metabolism, heart rate.

  What are the side effects of levothyroxine?

Aggravation of any cardiopathy (heart failure, angina, rhythm disorders …).

 Signs of hyperthyroidism, such as tachycardia, tremors, cardiac arrhythmias, insomnia, excitability, elevated temperature, sweating, rapid weight loss, diarrhea, should be used for hormonal dosing, decrease or discontinue treatment for several days. will then be resumed at lower doses.

In children, possibility of hypercalciuria.

 Hypersensitivity reactions to excipients and / or the active substance have been reported. The most common signs and symptoms are: urticaria, pruritus, angioedema, dyspnea, erythema.

Reporting of suspected adverse reactions

levothyroxine Interactions

Association subject to precautions for use

 Ion exchange resins (colestyramine, cholestipol, kayexalate, …) sevelamer, sucralfate,gastrointestinal topical agents , antacids (aluminum salts …) and adsorbents

Decreased activity of thyroid hormones (reduction of intestinal absorption).

Take them away from thyroid hormones (more than 2 hours if possible).

Enzyme inducers

Anticonvulsants (carbamazepine, phenobarbital, phenytoin, primidone, barbiturates); griseofulvin; rifampicin, rifabutin. Described for phenytoin, rifampicin and carbamazepine.

Risk of clinical hypothyroidism in hypothyroid patients when using combinations due to increased metabolism of T3 and T4.

Monitoring of serum T3 and T4 levels and adjustment of thyroid hormone dosage if necessary during enzyme inducer treatment and after discontinuation.

Drugs containing iron salts, oral calcium

Decreased digestive absorption of levothyroxine.

Take Levothyroxine away from these products (more than 2 hours, if possible).

Chloroquine / proguanil

Risk of clinical hypothyroidism in patients substituted by thyroid hormones.

Monitoring of TSH and serum T3 and T4 concentrations and adaptation, if necessary, of thyroid hormone dosage during antimalarial treatment and after discontinuation.

Protease inhibitors boosted by ritonavir (indinavir, lopinavir …)

Protease inhibitors can decrease the effectiveness of thyroid hormones by increasing their hepatic metabolism. It is recommended to closely monitor thyroid hormone levels (clinical and laboratory monitoring) and if necessary adjust the dose of levothyroxine.

Non-contraceptive estrogens

Risk of clinical hypothyroidism in estrogen replacement therapy. In this case, clinical and biological monitoring is necessary; the dose of levothyroxine should be adjusted in postmenopausal women taking estrogens.

Associations to consider

Imatinib, sunitinib

Imatinib and sunitinib may decrease the effectiveness of levothyroxine. It is therefore recommended to monitor any changes in the thyroid function of patients, at the initiation or at the end of the concomitant treatment. The dose of levothyroxine will be adjusted if necessary.

Orlistat

Orlistat may interact with thyroid hormone replacement therapy by decreasing the absorption of thyroid hormones.

levothyroxine Warnings and Precautions

levothyroxine warnings

Obesity is not an indication of thyroid hormones used alone or in combination unless this obesity is associated with true hypothyroidism. Their administration at high doses or in combination with amphetamine substances can be dangerous.

The effectiveness of the treatment and the possible signs of intolerance can appear only after a latency period of the order of 15 days to a month.

Precautions for use

The quality of the therapeutic balance must be controlled by an adequate endocrinological evaluation.

In case of cardiac pathology balanced by the treatment (coronary disorders, rhythm disorders), the indication is to be discussed on a case by case basis. If the treatment is instituted, the substitution is limited to obtaining a TSH in the high normal values. The surveillance of the subjects must be particularly attentive. Persistent or aggravated hypertension with levothyroxine should lead immediately to appropriate management.

If there is a risk of adrenocortical insufficiency (in particular, hypothyroidism of pituitary origin), treatment with hydrocortisone should be instituted beforehand.

Soy can decrease intestinal absorption of levothyroxine. Therefore, a reassessment of the Levothyrox dosage may be necessary especially at the beginning or end of a soy supplementation.

When switching from one levothyroxine sodium medication to another, it is important to monitor the therapeutic balance in certain at-risk patients in the following categories: patients who are receiving treatment for thyroid cancer but who have also cardiovascular disease (heart or coronary heart failure, and rhythm disorders), pregnant women, children and the elderly; and in some situations where the therapeutic balance has been particularly difficult to achieve.

In these patients, the maintenance of the therapeutic balance must be confirmed by a clinical evaluation, or even biological if necessary (by a control of the TSH carried out between 6 and 8 weeks after the substitution, except for the pregnant women where the modalities of surveillance to be adapted according to the evolution of the thyroid pathology and the term of the pregnancy).

In postmenopausal women with hypothyroidism and a high risk of osteoporosis, supra-physiologic levels of levothyroxine should be avoided. This is why close monitoring of thyroid function is recommended.

Drive and use machines

Not applicable.

levothyroxine and PREGNANCY / BREAST FEEDING / FERTILITY:

levothyroxine and pregnancy

Levothyroxine passes very little through the placenta and its administration at appropriate doses is devoid of fetal consequences. Treatment with thyroid hormones must be continued throughout pregnancy. It is recommended to strengthen the clinical and biological surveillance especially in early pregnancy and to adapt the treatment if necessary.

Normal maternal thyroid function or even mild hyperthyroidism is required during pregnancy to reduce the risk of fetal hypothyroidism.

During pregnancy, Levothyrox should not be used with anti-thyroid medications for hyperthyroidism. Indeed, only very small amounts of Levothyrox cross the placenta, while large amounts of anti-thyroid drugs pass from mother to child. This can result in fetal hypothyroidism.

levothyroxine and feeding

Breastfeeding is possible in case of treatment with thyroid hormones.

levothyroxine and Fertility

Hypothyroidism or hyperthyroidism can affect fertility. Treatment of hypothyroidism with Levothyrox should therefore be adapted on the basis of biological monitoring since under-dosing may not improve hypothyroidism and overdose may lead to hyperthyroidism.

What should I do if I miss a dose?

Pharmacotherapeutic group: thyroid medications, ATC code: H03AA01

Thyroid hormone, chemically defined in its natural form L more active than form D.

Levothyroxine essentially increases tissue oxygen consumption, basic metabolism, heart rate.

What happens if I overdose from LEVOTHYROX ?

Acute intoxications are generally of moderate severity in the absence of cardiac history, including during accidental ingestions in children. In symptomatic cases, clinical effects may occur within a few hours or be delayed by a few days in the case of a single dose and may include one or more signs of thyrotoxicosis (see below). In the case of repeated doses of supratherapeutic doses, the following signs of hyperthyroidism have been observed and, in the most severe cases, define a state of thyrotoxicosis:

Digestive disorders: vomiting, abdominal pain, diarrhea, increased appetite, weight loss.

Cardiovascular disorders: tachycardia, atrial fibrillation arrhythmia or extrasystoles, hypertension, chest pain, angina, congestive heart failure, cardiogenic collapse.

General disorders: fever, redness of the skin, sweating.

Neurological disorders: irritability, insomnia, headache, agitation, confusion, mydriasis, convulsions in predisposed patients, disturbances of consciousness, coma, acute psychosis.

The severity of the clinical manifestations is neither correlated with the dose ingested nor with the serum T4 and T3 determination. Beta-sympathomimetic effects, such as tachycardia, anxiety, agitation, or hyperkinesia, may be relieved by a beta-blocker. Exceptionally, after ingestion of a massive, life-threatening dose, plasmapheresis or haemoperfusion on charcoal may be considered. In case of excessive doses, especially at the time of initiation of treatment, rare cases of seizures have been reported in epileptic patients.

What is Composition?

  p cp Levothyroxine Sodium (INN) 25 μg or 50 μg or 75 μg or 100 μg or 125 μg or 150 μg or 175 μg or 200 μg

Excipients (common): mannitol, corn starch, gelatin, croscarmellose sodium, magnesium stearate, anhydrous citric acid.

What is forms? 

The tablet can be divided into two equal half-doses.

NOT’s

Edrug-online contains comprehensive and detailed information about drugs available in the medical field, and is divided into four sections:

general information:

Includes a general description of the drug, its use, brand names, FAQs, and relevant news and articles

Additional information:

General explanation about dealing with the medicine: how to take the medicine, the doses and times of it, the start and duration of its effectiveness, the recommended diet during the period of taking the medicine, the method of storage and storage, recommendations in cases for forgetting the dose and instructions to stop taking the drug and take additional doses.

Special warnings:

For pregnant and breastfeeding women, the elderly, boys and drivers, and use before surgery.

Side effects:

It treats possible side effects and drug interactions that require attention and its effect on continuous use.

The information contained in this medicine is based on medical literature, but it is not a substitute for consulting a doctor.

The post levothyroxine Uses, Dosage, Side Effects, Precautions & Warnings appeared first on Drug Online.

from Drug Online https://bit.ly/30biQdV via Edrug Online

[running-in-the-dark]

I don't know how many doses of cholestyramine you're taking a day. I was at 3 doses a day at one point and my gastroenterologist did tell me to try to get it down to 2 if I could because if I ever had to take another medication it could be hard to intersperse them (cholestyramine will interfere with any other meds you take) but other than that nobody's told me I can't take it forever (actually, when I asked my GP about it, he specifically said, "You found a miracle. Why would you want to stop taking it?") I dunno doctors are weird.

yeah, I do take a bunch of other medications and it's complicated trying to figure out when I can take what now. I've been trying to take three doses but honestly, sometimes I just forgot one.

and yeah it seems very weird to me that my GP feels that way. I've read lots of posts about people's experiences with it and many of them have been taking it for years and aren't planning to stop, and their doctors don't tell them to. I'm likely also going to take thyroid medication forever. sure I'd rather not, I don't enjoy taking medication or anything! but it is what it is.

and especially with this one - it felt very weird when she asked if I WANT to take it forever. no?! it's fucking gross, I hate it! but it helps. so while I'd rather go back in time and have a functioning gallbladder, sadly that's not an option. taking this medication is the second best thing right now, so yeah, if I have to I'll take it forever!

I'm hoping it's just due to her general incompetence. I guess I'll find out when I see a gastroenterologist.

[running-in-the-dark]

okaaaay. there's definitely something in this version of Colestyramine that my body doesn't like.

I just took it for the second time - the first was yesterday, and I had to take Loperamide after that because it was so bad. I wanted to give my body some time to recover before I tried again.

so, I just took half the recommended dose to see what that would do. and it's almost as bad as it was yesterday 😭 which is... impressive. normally if I take Loperamide it's fine for a couple days, no matter what I eat. so. yeah. something in this is not good for me. 😭

I'm so conflicted on what to do about it. I'll keep taking it for a few more days. I guess then I'll have to talk to my GP again. I don't want to ask to try another version again (I can tell she finds that annoying) but it's.. kind of pointless to keep taking this one if it makes the diarrhea worse.

I tried taking it with juice for the first time (I've tried water, tea and iced tea with the other version, and all of those were bad) and was really happy that it wasn't as awful. annnd then my stomach started rumbling immediately.

I guess if she doesn't want me to switch again before I've used up this stuff (which would be kind of cruel? but it sounds like something she would do 🤷) I'll have to wait about a month (since that's how long it'd last if I took the recommended dose 3 times a day). I don't think that's a good idea. 🙃

[running-in-the-dark]

and also. about that last paragraph.

I'm still angry that no doctor told me at any point that this was something that could happen after gallbladder removal. it might have been in the info material that I was 'told' about and had to sign - but if it was, it was definitely not mentioned (as in, said out loud by anyone). all I can remember being told is the risks of having surgery. not anything that could happen after.

obviously I would have had the surgery anyway, the pain was unbearable, but that's not the point. it would just have been helpful to be told 'hey so this happens to a percentage of people who have this surgery, and if it does it's a good idea to see a gastroenterologist because they can help you find the right medication'

but no, all I was told, again and again, was that there's no risks, no side effects, because you really don't need a gallbladder, so there's nothing to worry about.

if someone on here hadn't mentioned it and told me about the medication, I don't know how long it would have taken to figure out that 1. it's directly related to not having a gallbladder anymore and 2. there's medication for it. because I had similar (but less severe) problems for a few years before surgery too (probably because my gallbladder already wasn't doing its job?), and I was told over and over again that it won't kill me so it's fine and I just have to live with it.

I've got another colestyramin update.

so I've been taking the chewable tablets for a while, but I feel like maybe they don't work quite as well? either way, I don't like them that much - they're convenient for when I'm not at home, but they're still really annoying (and gross and it takes me forever to chew them)

I found a different version of the powder that comes in a big jar instead of individual packets. I asked my GP if I could try that (she was really weird about me taking this medication at all - asked if I want to take it forever and about how fast I eat and all that. which we already went over several times. and which... kind of... won't fix the issue which is caused by my non-existent gallbladder?! I could not possibly eat any slower, and changing what I eat didn't help at all. I guess I could just stop eating altogether, that would certainly fix this one issue :))) ).

anyway. she prescribed it to me, and I just had my first dose. oh my god it is so fucking bad. it's much more disgusting than the one in the packets, and the texture is horrible. there's two versions of this, one with more sugar and one with more of something else (can't remember the name). I asked for the one with more sugar, she prescribed the other one (and I noticed too late). maybe that's why it's so incredibly disgusting?

but. what's way worse than that. is that it.. had the absolute opposite effect of what it's supposed to do 🙃 tmi, but, it instantly gave me very bad diarrhea (which happens when I don't have this medication and eat for the first time in the day, and after most other meals too). that.. did not happen with the other ones. to be clear - I didn't eat anything yet. soo. I'm not sure what to do now. I guess I'll keep taking it for a few days, and if it doesn't get better I might ask if I can get the other version? but I don't know if she'll do that. so far she's always said I have to use up the previous medication first 🙃

what I really, realllly want. is the one that is just regular pills that you swallow. I don't care that they're apparently huge. I hate the texture of every version I've tried so far (the taste is horrible too, yeah, but the way it feels is the real issue). but that is apparently not officially approved for bile acid stuff in Germany, and I don't think my GP will try to help me get it.

she recommended I see a gastroenterologist (only because she thinks I shouldn't be on this medication long term), I just have to make an appointment. it'll probably be months until I get one, though.

ugh this is so frustrating! if I get the other version of this medication, I think I'll have tried all the ones that are available here.

my GP has zero interest in helping me figure this out. she said that it's bad if I keep taking this medication because it makes it so some vitamins can't be absorbed (as if having constant diarrhea after eating anything is better somehow?!), and when I asked if it would make sense to do a blood test to see if I have any deficiencies, she just asked if I had lost weight, I said not really, maybe a few kgs, and she said I should look into which ones can't be absorbed and that was that. cool. I get that she doesn't have time to look into everything for every one of her patients, but, I've been the one who informed her about everything related to this so far, and she won't even do a fucking blood test?!

I feel completely alone with this and I do not have the time or energy to figure this out right now!! I need to finish my thesis somehow, how am I supposed to research this at the same time?! and how am I supposed to do ANYTHING if I have to spend hours every day in the bathroom again, and be in pain the rest of the day?!