Levothyroxine sodium

When ATH:
H03AA01

Pharmacological action.
Fill the shortage of thyroid hormones.

Application.

Hypothyroid state of different etiologies (incl. due to surgical or the influence of medication), thyroid suppressive therapy is simple (non-toxic) goiter, autoimmunnogo Hashimoto thyroiditis, mnohouzlovoho goiter, thyrostatic treatment of hyperthyroidism (complex therapy after achieving euthyroid state, tireotropinzavisimye highly differentiated papillary or follicular thyroid carcinoma (combined treatment), prevention of relapse weeks after resection, holding supressionnogo scintigraphic thyroid test.

Contraindications.

Hypersensitivity, Untreated hyperthyroidism, acute myocardial infarction, angina, miokardit, tachysystolic arrhythmias, heart failure, severe hypertension, neskorrigirovannoe dysfunction of the adrenal cortex, advanced age (senior 65 years).

Pregnancy and breast-feeding.

Category actions result in FDA - A. (As a result, adequate and well-controlled studies have found the risk of adverse effects on the fetus in the I trimester of pregnancy and there is no data, evidence of such a risk in subsequent trimesters.)

Side effects.

Tachycardia, arrhythmias, chest pain, tremor, anxiety, insomnia, hyperhidrosis, weight loss, diarrhea, alopecia, dysfunction of the adrenal glands (pituitary or hypothalamic when hypothyroidism), Disorder of renal function in children.

Cooperation.

It reduces the effect of insulin and oral antidiabetic drugs, cardiac glycosides, enhances — indirect anticoagulants, tricyclic antidepressants. Cholestyramine, colestipol, aluminum hydroxide reduces the plasma concentration due to inhibition of intestinal absorption. Phenobarbital and phenytoin accelerate metabolic clearance, without increasing the proportion of free T₃ and T₄ in blood. Estrogens increase the concentration associated with thyroglobulin fraction (effectiveness is reduced). Protein binding change anabolic steroids, asparaginase, clofibrate, furosemid, salicilaty, Tamoxifen. Amiodarone, aminoglutethimide, aminosalicylic acid, ethionamide, antithyroid drugs, beta-blockers, Carbamazepine, khloralgidrat, diazepam, levodopa, dofamin, metoclopramide, lovastatin, somatostatin, etc.. can alter the levels of thyroid and thyroid-stimulating hormone, usually, affecting the synthesis of, secretion, distribution, metabolism, action or elimination of thyroid hormones or altering the secretion of TSH.

Overdose.

Symptoms: thyrotoxic crisis, sometimes delayed for several days after administration.

Treatment: appointment of beta-blockers, / in the administration of corticosteroids, plasmapheresis.

Dosing and Administration.

Inside, morning, fasting, drinking a small amount of liquid. If hypothyroidism is the initial dose of 25-100 µg per day, gradually increasing (on 25-50 mcg every 2-3 weeks) to support — 125-250 mcg per day, after surgery for malignant tumors of the thyroid gland is to 300 mcg per day.

Children initial dose of 12.5-50 mcg, supports 100-150 mcg per day.

In the complex treatment of hyperthyroidism-5-100 micrograms per day.

To conduct test for supressing 14 days 200 micrograms per day or 3 mg 1 time for 7 days before re scintigrams.

Euthyroid goiter and prevention of its recurrence after resection: adults-75-200 micrograms per day, children-12.5-150 mcg per day.

Precautions.

It is recommended to periodically determine the blood content of TSH, elevated level which indicates failure dose. The adequacy of thyroid suppressive therapy is evaluated as to suppress the capture of radioactive iodine. When long-existing multinodular goiter before treatment should be stimulus test with thyrotropin-releasing hormone. In most cases, hypothyroidism, metabolic status should recover gradually, especially in elderly patients and patients with cardiovascular disease. For older patients initial dose should not exceed 50 g. When applied in the II and III trimester of pregnancy tend to increase the dose to 25%. With caution is prescribed for severe long-existing hypothyroidism. Before treatment should eliminate the possibility of pituitary or hypothalamic hypothyroidism.

Cooperation