Adult Dosing

Hypothyroidism

• Start: 30 mg PO qd; then increase by 15 mg/day q2-3 wks
• Titrate slowly if elderly, myxedema, or cardiac risk factors present
• Usual range: 60-120 mg/day

Thyroid suppression tests

• 1.56 mcg/kg/day PO for 7-10 days; dose expressed as levothyroxine
• Determine radioactive iodine uptake pre and post therapy; >50% supression indicates normal thyroid pituitary axis

Pediatric Dosing

Congenital hypothyroidism

• 0-6 months: 15-30 mg PO qd; Alt: 4.8-6 mg/kg PO qd
• 6-12 months: 30-45 mg PO qd; Alt: 3.6-4.8 mg/kg PO qd
• 1-5 yrs: 45-60 mg PO qd; Alt: 3-3.6 mg/kg PO qd
• 6-12 yrs: 60-90 mg PO qd; Alt: 2.4-3 mg/kg PO qd
• >12 yrs: >90 mg PO qd; Alt: 1.2-1.8 mg/kg PO qd

• Replacement or supplemental therapy in hypothyroidism
• As TSH suppressants (in thyroid cancer, nodules, goiters, and enlargement in chronic thyroiditis)

• Hypersensitivity to any of the ingredients of the product
• Acute MI
• Thyrotoxicosis uncomplicated by hypothyroidism
• Hypothyroidism and hypoadrenalism (Addison disease) coexist

• Thyroid hormones alone or in combination with other drugs, should not be used for the treatment of obesity or for weight loss. In euthyroid patients, doses within range of daily hormonal requirements are ineffective for weight loss; larger doses may cause serious or life-threatening toxicity, especially in combination with sympathomimetic amines including those used for their anorectic effects

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Do not administer therapy alone or in combination with other drugs for the treatment of obesity or for weight loss [US Black Box Warning]
• Overdosage of drug in combination with sympathomimetic amines may cause serious or life-threatening toxicity. In euthyroid patients, doses within range of daily hormonal requirements are ineffective for weight loss [US Black Box Warning]
• Initiate therapy with lower doses in patients with cardiovascular disorders
• Monitor prothrombin time in patients taking concomitant oral anticoagulants
• Thyroid hormone therapy in patients with diabetes mellitus, diabetes insipidus or adrenal cortical insufficiency, may aggravate the intensity of symptoms. Hence use cautiously in these patients with appropriate adjustments of various therapeutic measures directed at these concomitant endocrine diseases

Cautions: Use cautiously in

• Cardiovascular disease
• Diabetes mellitus
• Hypertension
• Elderly patients

Pregnancy Category:A

Breastfeeding: Safety unknown. No data available on use of exogenous liothyronine during breastfeeding. However no adverse events were seen in breastfed infants when exogenous levothyroxine was administered to mothers. There is no reason to discontinue breastfeeding if thyroid is required by the nursing mother. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 18 May 2011).

• CNS: Insomnia, irritability, headache
• CV: Arrhythmias, tachycardia, angina pectoris
• GI: Abdominal cramps, diarrhea, vomiting
• DERM: Hyperhidrosis
• ENDO: Hyperthyroidism, menstrual irregularities
• METABOLIC: Weight loss, heat intolerance
• MISC: Accelerated bone maturation in children

Levothyroxine

• Thyroid hormone; increases metabolic rate of body tissues
• Levothyroxine (T4) is partially absorbed from the GI tract
• Metabolized in liver, tissues, kidney
• Excreted in urine, feces

Liothyronine

• Thyroid hormone; increases metabolic rate of body tissues
• Liothyronine (T3) is almost totally absorbed (95%) in 4 hrs
• Metbolized at a number of sites, including liver, kidney, and other tissues
• Excreted in urine, feces

US Trade Name(s)

• Armour Thyroid

US Availability

thyroid desiccated (generic)

• TABS: 30, 60, 90, 120, 180 mg
• CAPS: 15, 30, 60, 90, 120, 180, 240 mg

Armour Thyroid

• TABS: 15, 30, 60, 90, 120, 180, 240, 300 mg

Canadian Trade Name(s)

• Only generic available

Canadian Availability

thyroid desiccated (generic)

• TABS: 30, 60, 125 mg

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

Endocrine/Metabolic

Thyroid Drugs

Pricing data from www.DrugStore.com in U.S.A.

• Armour Thyroid 90 MG TABS [Bottle] (FOREST)
  30 mg = $18.99
  60 mg = $25.98
• Armour Thyroid 120 MG TABS [Bottle] (FOREST)
  30 mg = $19.99
  90 mg = $35.97
• Armour Thyroid 180 MG TABS [Bottle] (FOREST)
  30 mg = $23.99
  90 mg = $52.97
• Armour Thyroid 240 MG TABS [Bottle] (FOREST)
  30 mg = $30.99
  90 mg = $69.97
• Armour Thyroid 300 MG TABS [Bottle] (FOREST)
  30 mg = $32.99
  90 mg = $79.97
• Armour Thyroid 60 MG TABS [Bottle] (FOREST)
  30 mg = $14.99
  60 mg = $19.98
• Armour Thyroid 30 MG TABS [Bottle] (FOREST)
  30 mg = $14.99
  90 mg = $22.97
• Armour Thyroid 15 MG TABS [Bottle] (FOREST)
  30 mg = $14.99
  60 mg = $18.97

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.