- Thyroid hormones either alone or with other therapeutic agents should be avoided for the treatment of obesity or for weight loss in euthyroid patients. Doses within the range of daily hormonal requirements are ineffective in euthyroid patients for weight reduction. Serious or even life threatening manifestations of toxicity have occurred at higher doses particularly when given in association with sympathomimetic amines such as those used for their anorectic effects [US Black Box Warning]
- Avoid using in the treatment of male or female infertility unless this condition is associated with hypothyroidism
- Use with great caution in patients with cardiovascular system disorders, particularly disorders of the coronary arteries. Patients with angina pectoris and elderly patients should be initiated with low doses
- Prior to starting therapy, morphologic hypogonadism and nephrosis should be ruled out; if hypopituitarism is present, correct first
- Initiate therapy at a very low dosage and increase gradually in myxedematous patients as they are very sensitive to thyroid
- Carefully monitor for a hyperthyroid state or aggravation of existing hyperthyroidism during therapy
- Therapy may aggravate the intensity of symptoms in patients with concomitant diabetes mellitus or insipidus or adrenal cortical insufficiency
- Closely monitor prothombin time in thyroid-treated patients on oral anticoagulants and adjust dosage on the basis of frequent prothrombin time determinations because hypothyroidism decreases and hyperthyroidism increases the sensitivity to oral anticoagulants
- Craniosynostosis may occur in infants due to excessive doses of thyroid hormone preparations
- Caution should be exercised when administering thyroid hormones with digitalis or vasopressors
- Administer fluid therapy with great care to prevent cardiac decompensation
- Institute oral therapy as soon as the clinical situation has been stabilized and the patient is able to take oral medication
- Prior to starting liothyronine sodium injection, patients with pituitary myxedema should receive adrenocortical hormone replacement therapy
Cautions: Use cautiously in:
- Renal impairment
- Cardiovascular disorders
- CAD
- Diabetes mellitus
- Diabetes insipidus
- Nontoxic diffuse goiter
- Adrenal insufficiency
- Concomitant vasopressor therapy
- Geriatrics
Pregnancy Category:A
Breastfeeding: Safety unknown. It is a normal component of human milk. No need to discontinue breastfeeding when liothyronine is required by the mother. As safety is unknown, an alternate drug may be preferred in nursing mothers. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 27 May 2011). Manufacturer advises caution.
Note: Usually only seen when excessive doses cause iatrogenic hyperthyroidism
- CNS: Insomnia, irritability, headache, nervousness, tremor
- CV: Arrhythmias, tachycardia, angina pectoris, cardiopulmonary arrest, MI, angina, hypotension, HTN, CHF
- GI: Abdominal cramps, diarrhea, vomiting
- DERM: Excessive sweating
- ENDO: Hyperthyroidism, menstrual irregularities
- METABOLIC: Weight loss, heat intolerance
- LOCAL: Phlebitis and twitching at injection site
- MUSC: Accelerated bone maturation in children
