L-thyroxin - instructions for use, reviews, analogs and formulations (tablets 50 μg, 75 μg, 100 μg and 150 μg) of the synthetic thyroid hormone drug for the treatment of hypothyroidism and goitre in adults, children and in pregnancy
In this article, you can read the instructions for using the drug L-thyroxine. Presented are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of L-thyroxine in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of L-thyroxine in the presence of existing structural analogues.Use for the treatment of hypothyroidism and goiter in adults, children, as well as during pregnancy and lactation. Composition of the preparation.
L-thyroxine - synthetic drug of the thyroid hormone, levorotatory isomer of thyroxine. After partial conversion into triiodothyronine (in the liver and kidneys) and transition into the cells of the body, it affects the development and growth of tissues, metabolism.
In small doses, it has an anabolic effect on protein and fat metabolism. In medium doses stimulates growth and development, raises the need for tissues in oxygen, stimulates the metabolism of proteins, fats and carbohydrates, increases the functional activity of the cardiovascular system and the central nervous system. In high doses inhibits the production of TTRG of the hypothalamus and TTG of the pituitary gland.
Therapeutic effect is observed after 7-12 days, during the same time the action remains after drug discontinuation. The clinical effect with hypothyroidism manifests itself in 3-5 days. Diffuse goiter decreases or disappears within 3-6 months.
Composition
Levotiroksin sodium + auxiliary substances.
Pharmacokinetics
After ingestion, L-thyroxine is absorbed almost exclusively from the upper part of the small intestine. Absorbs up to 80% of the dose.Simultaneous food intake reduces the absorption of levothyroxine. It binds to serum proteins (thyroxin-binding globulin, thyroxin-binding prealbumin and albumin) by more than 99%. In different tissues, approximately 80% of levothyroxine is monodegraded to form triiodothyronine (T3) and inactive products. Thyroid hormones are metabolized mainly in the liver, kidneys, brain and muscles. A small amount of the drug is subjected to deamination and decarboxylation, as well as conjugation with sulfuric and glucuronic acids (in the liver). Metabolites are excreted in the urine and with bile.
Indications
- hypothyroidism;
- euthyroid goiter;
- as a replacement therapy and for the prevention of recurrence of goiter after resection of the thyroid gland;
- thyroid cancer (after surgical treatment);
- diffuse toxic goiter: after reaching the euthyroid status with thyreostatics (in the form of combined or monotherapy);
- as a diagnostic tool in the test of thyroid suppression.
Forms of release
Tablets 50 μg, 75 μg, 100 μg and 150 μg.
Instructions for use and dosage
The daily dose is determined individually depending on the indications.
L-thyroxine in a daily dose is taken orally in the morning on an empty stomach, at least 30 minutes before a meal, with a small amount of liquid (half a cup of water) and without chewing.
When performing substitution therapy for hypothyroidism, patients under the age of 55 without cardiovascular disease are prescribed a daily dose of 1.6-1.8 μg / kg of body weight; patients older than 55 years or with cardiovascular disease - 0.9 mcg / kg body weight. With significant obesity, the calculation should be made on "ideal body mass".
Recommended doses of thyroxine for the treatment of congenital hypothyroidism:
- 0-6 months - daily dose of 25-50 μg;
- 6-24 months - daily dose of 50-75 mcg;
- from 2 to 10 years - a daily dose of 75-125 mcg;
- from 10 to 16 years - a daily dose of 100-200 mcg;
- over 16 years - a daily dose of 100-200 mcg.
Recommended doses of L-thyroxine:
- Treatment of euthyroid goiter - 75-200 mcg per day;
- Preventive maintenance of relapse after surgical treatment of euthyroid goiter - 75-200 mkg per day;
- In the complex therapy of thyrotoxicosis - 50-100 mcg per day;
- Suppressive thyroid cancer is 150-300 mcg per day.
For the exact dosing of the drug, the most appropriate dosage of the L-thyroxine preparation (50, 75, 100, 125 or 150 μg) should be used.
In severe long-term hypothyroidism, treatment should be started with extreme caution, from small doses from 25 μg per day, the dose is increased to maintenance at longer intervals - by 25 μg per day every 2 weeks and more often the level of TSH in the blood is determined. With hypothyroidism, L-thyroxine is taken, as a rule, throughout life.
In thyrotoxicosis, L-thyroxine is used in complex therapy with thyreostatics after reaching the euthyroid state. In all cases, the duration of treatment with the drug is determined by the doctor.
Breast children and children under 3 years of age, the daily dose of the drug L-thyroxin is given at one time 30 minutes before the first feeding. The tablet is dissolved in water to a fine suspension, which is prepared immediately before taking the drug.
Side effect
- allergic reactions.
Contraindications
- untreated thyrotoxicosis;
- acute myocardial infarction, acute myocarditis;
- untreated insufficiency of adrenal function;
- increased individual sensitivity to the components of the drug.
Application in pregnancy and lactation
During pregnancy and lactation (breastfeeding), therapy with a drug prescribed for hypothyroidism should continue.In pregnancy, an increase in the dose of the drug is required due to an increase in the level of thyroxine-binding globulin. The amount of thyroid hormone, secreted in breast milk during lactation (even during treatment with high doses of the drug), not enough to cause any disturbances in the child.
The use of the drug in combination with thyreostatic drugs in pregnancy is contraindicated, because taking levothyroxine may require an increase in thyroid doses. Since thyreostatics, in contrast to levothyroxine, can penetrate the placental barrier, the fetus may develop hypothyroidism.
During breastfeeding, the drug should be taken with caution, strictly at recommended doses under the supervision of a doctor.
Use in children
In children, the initial daily dose is 12.5-50 μg. With a long course of treatment, the dose of the drug is determined from an approximate calculation of 100-150 μg / m2 of body surface area.
special instructions
When hypothyroidism, due to the pituitary lesion, it is necessary to find out whether there is a simultaneous insufficiency of the adrenal cortex.In this case, glucocorticosteroid replacement therapy (GCS) should be started before the beginning of hypothyroidism treatment with thyroid hormones in order to avoid the development of acute adrenal insufficiency.
Impact on the ability to drive vehicles and manage mechanisms
The drug does not affect the ability to professional activities associated with driving vehicles and controlling mechanisms.
Drug Interactions
L-thyroxin enhances the effect of indirect anticoagulants, which may require a reduction in their dose.
The use of tricyclic antidepressants with levothyroxine may lead to an increase in the action of antidepressants.
Thyroid hormones can increase the need for insulin and oral hypoglycemic drugs. More frequent monitoring of blood glucose levels is recommended during the start of treatment with levothyroxine, as well as when changing the dose of the drug.
Levothyroxine reduces the action of cardiac glycosides. With simultaneous application of colestramine, colestipol and aluminum hydroxide reduce the plasma concentration of levothyroxine due to inhibition of its absorption in the intestine.
When used simultaneously with anabolic steroids, asparaginase, tamoxifen, pharmacokinetic interaction at the level of binding to the protein is possible.
In an application with phenytoin, salicylates, clofibrate, Furosemide in high doses increases the content of unbound with plasma proteins levothyroxine and T4.
Somatotropin with simultaneous application with L-thyroxine can accelerate the closure of epiphyseal growth zones.
The intake of phenobarbital, Carbamazepine and rifampicin may increase the clearance of levothyroxine and require an increase in the dose.
Estrogens increase the concentration of thyreoglobulin-associated fraction, which may lead to a decrease in the effectiveness of the drug.
Amiodarone, aminoglutethimide, PASK, ethionamide, antithyroid drugs, beta-blockers, carbamazepine, chloral hydrate, diazepam, levodopa, dopamine, metoclopramide, lovastatin, somatostatin affect the synthesis, secretion, distribution and metabolism of the drug.
Analogues of the drug L-thyroxine
Structural analogs for the active substance:
- L-thyroxine 100 Berlin-Chemie;
- L-thyroxine 125 Berlin-Chemie;
- L-thyroxine 150 Berlin-Chemie;
- L-thyroxine 50 Berlin-Chemie;
- L-thyroxine 75 Berlin-Chemie;
- L-thyroxine Hexal;
- L-thyroxine Acry;
- L-thyroxine Farmak;
- Bagotiroks;
- L-Tirok;
- Levotiroksin sodium;
- Tiro-4;
- Eutiroks.
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