Posts Tagged ‘levothyroxine’

How To Take Your Thyroid Medicine

Q: My husband takes a thyroid medicine called levothyroxine. He went to his doctor last week because he’d been feeling tired and the doctor told him it’s because he’s taking his thyroid pills wrong. All these years he’s taken it with his other morning pills at breakfast, but now he’s supposed to take it 30 minutes BEFORE his breakfast instead. He’s tried to make the switch but it’s really hard for him to remember to take it first thing in the morning. Is there anything we can do?

Levothyroxine is a very potent medicine; even small changes in the dose can create big differences in how much energy you have. How much levothyroxine you need can depend not only on how much medicine is prescribed by your doctor, but also on HOW you take those pills. Your husband may not be getting the entire dose of his thyroid medicine because food can interfere with the ability of levothyroxine to get into your body.

Like most medicines, in order to do its job levothyroxine must first get into your body. It needs to jump from a pill sitting in an amber prescription bottle all the way into your thyroid gland, where it works to support your metabolism and give you energy.

When you swallow a pill it doesn’t magically dissolve in your stomach and do its thing right then and there. Most medicines need to get into your bloodstream first before they can get to where they need to go and do what they are supposed to do. Although your pills dissolve in your stomach they can’t jump into your body from there. Instead, medicines and nutrients have to leave your stomach and move into your small intestine before they can be launched into your body.

Your small intestine is a busy place. Its walls are covered with blood vessels and specialized cells designed to transport nutrients and medicines into your bloodstream, where they get carried on throughout your body and delivered to where they need to be, like levothyroxine going to your thyroid gland.

The process of medicine going from a pill you swallow to entering your bloodstream is called absorption. Some medicines are better at being absorbed than others. While many medicines are completely absorbed after you take them, other medicines like levothyroxine can run into trouble along the way, resulting in less of it getting into your body and doing its job.

Your husband will get more consistent results from taking his levothyroxine on an empty stomach because food and certain minerals can attach themselves to it and prevent it from making the trip through the wall of his small intestine into his bloodstream and on to his thyroid gland.

But the most important thing of all is taking it consistently, every day, the same way. His doctor will use blood tests to adjust his levothyroxine dose if he needs more.

Here Are 5 Tips For Best Results When Taking Levothyroxine:

  1. Levothyroxine is absorbed best on an empty stomach, either AT LEAST 30 minutes before a meal OR 3-4 hours after you’ve finished eating.
  2. If you have trouble remembering to take your levothyroxine first thing in the morning, try taking it at bedtime instead, as long as it’s been at least 3 hours since your evening meal. Taking it at bedtime may be easier to remember than taking it all by itself in the morning, especially if you take other medicines at the same time.
  3. If you forget to take your levothyroxine before breakfast, go ahead and take it anyway. Don’t worry, your stomach is not going to blow up, your intestines are not going to fall apart and your thyroid is not going to die. If you take levothyroxine with your meal you may not absorb the whole dose but if you skip entirely it you won’t get ANY of it absorbed! And that’s worse.
  4. If trying to take levothyroxine on an empty stomach is too complicated to do, don’t panic. It’s perfectly okay to take levothyroxine with your breakfast or other meal, as long as you take it that way all the time. Many patients are perfectly successful taking levothyroxine because they ALWAYS take it with their breakfast and don’t skip any doses.
  5. If you take calcium or iron supplements, don’t take them at the same time as levothyroxine. These minerals can significantly reduce the amount of levothyroxine that you absorb, so it’s best to separate them by at least 3-4 hours.

 

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Taking Medicines On Time

As Jenny stepped on the bathroom scale she held her breath. If the glowing red numbers at her feet weren’t lying, she’d gained another pound!

Ten months ago the cramps and diarrhea of her Crohn’s disease were out of control so her rheumatologist at the Virginia Mason clinic in Seattle started her on a new medicine called prednisone. Taking it every day had solved her intestinal problems, but at a price: a raging appetite along with ballooning hips, puffy cheeks and sinking self-confidence.

They’d tried to cut her prednisone dose back several times but each time the cramps and bloody diarrhea came roaring back. Finally she’d had enough and went back to Virginia Mason to insist they take her off the prednisone no matter what before she turned into the Incredible Hulk.

Her doctor agreed. “But this time, before we try to taper it let’s move half of your prednisone dose to the evening first.”
“But I’m already taking the prednisone in the evening.”
“What? When did you start taking it in the evening?”
“I started taking it in the morning but it really upset my stomach so I ended up switching it to dinnertime instead.”
“No wonder we couldn’t get your prednisone dose down!”

Who knew taking a medicine at a certain time could be so important?

How about you? Are you taking your medicine at the “right” time? With some medicines it can make a big difference in how effective the medicine is or how much you are bothered with side effects. Some medicines should be taken on an empty stomach to help you absorb each dose, while others are best taken with food to avoid stomach upset. And a few medicines are more potent if taken at a particular time of day.

When instructed to take a medicine on an empty stomach you should take it at least 30 minutes before eating or 2-3 hours afterward. The thyroid replacement medicine levothyroxine and the stomach acid blocking medicine omeprazole work best if you take them first thing in the morning, about 30 minutes before breakfast.  With the bone building medicines alendronate (Fosamax®) or risendronate (Actonel®) even plain coffee can interfere with getting it into your body.

Most medicines should be taken with food. Stomach upset is the most common side effect reported by people taking medicine in clinical trials, where they keep track of every possible side effect. Unless told otherwise, it’s much easier on your stomach to take medicines with food, especially antibiotics, vitamins and minerals. Many antibiotics can cause nausea, cramps and vomiting if they’re all alone in your stomach. A common diabetes drug called metformin (Glucophage®) is notorious for causing nausea and diarrhea. The popular pain medicines naproxen (Aleve®) and ibuprofen (Motrin®) are very irritating to the stomach, causing cause stomach pain and even bleeding if taken without food or a full glass of water to dilute their irritating effect.

Some cholesterol medicines are more potent if you take them late in the day. Medicines like atorvastatin (Lipitor®) or simvastatin (Zocor®) called “statins” are examples of this. Statin medicines work by blocking the last step needed to make cholesterol, and because your body makes cholesterol at night, statin medicines drop your cholesterol better if you take them in the evening or at bedtime.

Why did Jenny have trouble tapering her prednisone when she took it in the evening? Your body makes an important hormone called cortisol. Cortisol helps you respond to stress, and you make more of it or less of it depending on how much is needed and how much is already in your body. If you take prednisone your body “sees” it as having extra cortisol around so it decreases the amount it makes the next day. As you continue on prednisone over time your body makes less and less cortisol, which can leave you vulnerable when you need large amounts of cortisol quickly to response to stress like a serious infection. When stopping prednisone it can take weeks to months for your body to recover from its lowered cortisol production.

Taking prednisone in the morning minimizes the impact it has on your own cortisol production, making it easier to taper the dose. After moving her prednisone dose from dinnertime to breakfast Jenny was finally able to get off it completely. And now she smiles when she sees the red glowing numbers on her scale each week.

What time is the best time for you to take your medicine?

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How To Take Thyroid Medicine

Q: On the bottle of my thyroid medicine it says to take it in the morning on an empty stomach. But sometimes I forget and don’t realize it’s still there until after I’ve eaten my breakfast. Is it safe to take it then?

My mother took the thyroid medicine levothyroxine, and her prescription bottle said to take it 30 minutes before breakfast. Every day she worried about what might happen if she didn’t take it “correctly”. If she took her first bite of breakfast and noticed that her yellow levothyroxine tablet was still sitting on the counter, she’d skip her dose for that day rather than risk getting an upset stomach or worse.

“Louise, what if it CAN’T be safely mixed with food? What if taking thyroid medicine with food in my stomach starts a deadly chain reaction and my stomach ruptures?”

“It’s okay, Mom. Your stomach won’t rupture if you accidently take your thyroid medicine at the same time as your breakfast. If you take it with breakfast what happens is your body might not get all of the medicine in that pill. That’s because food can change how much of the levothyroxine your body absorbs.”

“But the label on the bottle says to take it BEFORE breakfast. Are you SURE it’s safe if I take it later than that? I don’t want to get into trouble.”

“You might get less of your thyroid medicine if you take it with your breakfast, but skipping it completely guarantees you’ll get NONE of the dose. ZERO medicine. That can affect you even more than if you messed up and took it with breakfast.”

Levothyroxine is one of the most commonly prescribed medicines in the United States, and it can be hard to remember to take it first thing in the morning.

Kate struggled to take her pills every day according to the directions on the labels. She’d even set her alarm for 6am just so she could take her levothyroxine in the morning before breakfast. Otherwise she’d forget it completely. She took her regular morning pills right after she finished breakfast, then took her blood thinner warfarin at 5pm and her cholesterol medicine simvastatin at bedtime. She had to remember to take her medicines 4 times a day every day and it felt overwhelming.

“I want to take my medicines like the doctor wants me to, but it’s so hard to remember to take all of them every day.”

I suggested she move her thyroid medicine and her blood thinner to bedtime, the same time she was taking her simvastatin. That way she only had to take her pills twice a day, which would be easier than 4 times a day.

When she started taking her thyroid medicine more consistently she felt more energetic and no longer worries about taking her medicine correctly. “It’s such a relief to have less to remember, and I love having more energy!”

Here are some tips on how to take this common medicine:

  1. There’s nothing that says you must take levothyroxine in the morning. It won’t hurt you if you take it at a different time, like at breakfast or bedtime.
  2. Although levothyroxine is absorbed better if you take it on an empty stomach (30 minutes to an hour before a meal or 4 hours afterward), as long as you take it the same way every time, you’ll get a consistent dose.
  3. Don’t just skip your dose if you forget to take it before you eat. Even some of your thyroid medicine is better than none.
  4. There are some medicines that should be taken 4 hours from levothyroxine: calcium pills, iron pills, or multivitamins with minerals containing calcium or iron. An easy way to do this is to take any multivitamins or supplements with calcium or iron at your lunch or dinner meal.
  5. If you take thyroid medicine, then if you also take medicine for building bones like alendronate (Fosamax®) take the alendronate FIRST, on an empty stomach and your thyroid medicine at least 30 minutes later.

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