Levothyrox 100µg Merck treatment of goiter, hypothyroidism, cancer (2 blisters x 15 tablets)

Dosage form Box of 2 blisters x 15 tablets
Specifications Levothyroxine

Ingredient

Composition information	Content
Levothyroxine	100mcg

Uses

indications

levothyrox drugs are indicated in the following cases:

Treatment of benign goiter armor.

ATC code: H03A A01.

Levothyroxine synthesized in levothyrox® has the same effect as natural hormone excreted by the thyroid. It is transformed into T3 at peripheral organs, such as hormones, promoting its specific effects at T3 receptor. The body cannot distinguish external and endogenous levothyroxine.

Dynamic pharmacokinetics

levothyroxine orally absorbed almost completely at the upper part of the small intestine. Depending on the formula of the absorption amount can be up to 80%. Tmax is about 5 to 6 hours.

After oral use, onset the effect is seen after 3-5 days. Levothyroxine shows a very high level of cohesion with specialized shipping protein about 99.97%. This protein hormone connection is not assimilated, so the hormone is connected in plasma quickly and constantly exchanging with the free hormone. Due to high protein cohesion, levothyroxine is not affected by hemolysis or dialysis. The half -life of the average levothyroxine is 7 days.

In hyperthyroidism, this time is shorter (3-4 days) and longer in hypothyroidism (approximately 9 - 10 days). The distribution volume is about 10 - 12i. The liver contains 1/3 of the total levothyroxine on the outside of the thyroid gland that they quickly talk to levothyroxine in serum. The thyroid hormone is metabolized mainly in the liver, kidney, brain and muscle. The metabolites are eliminated through urine and feces. The whole metabolic clearance of levothyroxine is 1.2 plasma/day.

Before taking Levothyrox 100µg Merck treatment of goiter, hypothyroidism, cancer (2 blisters x 15 tablets)

How to use

daily dose can be used once.

Use drugs: Use a single dose in the morning when the abdomen is empty, half an hour before breakfast, should drink with a little water (for example: half a glass of water).

Children take the entire one -time dose at least 30 minutes before the first meal of the day. Dissolve the pill with a little water into a mixture and drink with a little water, just dissolve the pill just before drinking.

The time for treatment is usually a lifetime for replacement in hypothyroidism and after removing thyroid or removal of the thyroid and in the recurrent preventive prophylaxis after removing the goiter.

Coordinate to treat hyperthyroidism after reaching the level of armor is indicated in the period of anti -thyroid drug.

For benign goiter, the necessary treatment time is usually from 6 months to 2 years. If the treatment during this period is not enough, it is advisable to consider surgery or radiation therapy. Dosage

Levothyrox tablets are currently available from 25 to 100 mcg to treat each patient according to the needs of each individual. Therefore, patients usually only need one tablet.

The recommended dose below is only instructed.

Dosage for each individual should be determined based on test results and clinical examination. Because some patients have high T4 and FT4 concentrations, the substrate concentration of serum thyroid hormones is a more reliable standard for the next treatment cycle.

Thyroid hormone treatment should start with low doses and gradually increase every 2 to 4 weeks until the full replacement dose is achieved.

Children: For babies and young children with congenital hypothyroidism, when fast replacement therapy is important, the recommended starting dose is 10 to 15 mcg/kg body weight per day for the first 3 months. After that, the dose should be adjusted for each individual based on clinical signs, thyroid hormone values and TSH.

In the elderly, patients with coronary artery disease, and patients with severe or prolonged hypothyroidism, should be cautious at the beginning of treatment with thyroid hormones, that is, should start with a low dose (for example, 12.5 mcg/day), then increase the dose slowly and the distance from each other (for example: gradually increase the dose of 12.5 mcg/day after every 2 weeks) and regularly monitor thyroid hormones.

It is necessary to consider when using the lower dose than the optimal dose needed for complete replacement treatment due to the failure to achieve the complete adjustment results of TSH.

Experience shows that lower dose is enough for mild weight patients and large goiter patients.

Treatment of benign goiter: 75 - 200 mcg sodium levothyroxin/day.

Preventive treatment relapses after mere goiter surgery: 75 - 200 mcg sodium levothyroxin/day.

Alternative treatment in hypothyroidism in adults:

Initial dose: 25 - 50 mcg sodium levothyroxin/day

Initial dose: 12.5 - 50 mcg sodium levothyroxin/day

Coordinate with anti -thyroid drugs in the treatment of hyperthyroidism: 50 - 100 mcg sodium levothyroxin/day.

Used in diagnosis for thyroid inhibiting tests (only applicable to levothyrox 100mcg):

Week 2 and 1 before testing: 200 mcg sodium levothyroxin/day.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.What to do when overdose? After overdose, symptoms of metabolic increase significantly appear. Depending on the level of overdose, the recommendation to stop treatment and conduct tests.

Symptoms include increased effects like sympathetic beta such as fast heartbeat, anxiety, anxiety and increased exercise can be reduced by beta blockers. Treatment with plasma refined can work in case of very high overdose.

In some patients at risk, there are several cases of epilepsy reported when using an individual's tolerance limit.

Overdose of levothyroxine can lead to hyperthyroidism and can lead to symptoms of acute mental disorders, especially in patients at risk of mental disorders.

Many cases of sudden death are reported in patients with abuse of levothyroxine for many years.

In an emergency, call the 115 emergency center immediately or go to the nearest local health station.

What to do when you forget 1 dose? However, if the time to relax with the next dose is too short, skip the dose and continue the calendar of the drug. Do not use double dose to compensate for missed dose.

Side Effects

When exceeding the limit of personal tolerance or overdose of sodium levothyroxine, typical clinical symptoms of hyperthyroidism can occur, especially in the case of increasing dose too fast when starting treatment such as arrhythmia (such as atrial fibrillation and extra mind), tachycardia, chest pain, chest pain, headache, muscle weakness & mouse, fake nervous, nervous, nervous, nervous, nervous, nervous, fever, fever, fever, fever, fever, fever, fever, fever, nervousness Foul, weight loss, diarrhea.

In such cases, the daily dose should be reduced or stop using the drug for many days. Can start treatment when the adverse reactions are lost.

In case of sensitivity to any component of Levothyrox®, allergic reactions may occur on the skin and respiratory tract. There have been reports on some cases of circuit.

Notice to the doctor or pharmacist the unwanted effects when using the drug.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

contraindicated

Levothyrox drugs contraindicated in the following cases:

Hypersensitivity to the active ingredient or any excipients of the drug. Unexpectedly treated adrenal glands. breastfeeding).

Be cautious when used

Before starting thyroid hormone treatment or before conducting thyroid inhibiting tests, excluding or treating the following health conditions: coronary insension, angina, arteriosclerosis, high blood pressure, pituitary insertion, adrenal insufficiency. Autonomous thyroid disease should also be excluded or treated before starting treatment with thyroid hormones.

When starting to treat levothyroxine in patients at risk of mental disorders, it is recommended to start with low doses of levothyroxine and increase the dose from the beginning of treatment. Need to monitor patients. If the signs of mental disorders occur, the adjustment of the dose of levothyroxine should be considered.

Hyperthespan due to mild drugs should be avoided in patients with coronary heart failure, heart failure or tachycardia. Therefore, it is necessary to regularly check the thyroid hormone indicators in these cases.

In the case of secondary hypothyroidism, the cause must be determined before the replacement treatment and if it is necessary to start the treatment instead of adrenal insufficiency.

When suspected of having autonomous thyroid disease, it is advisable to conduct a test or blink of an inhibitor before treatment.

Avoid levothyroxine serum on the case of physiological level in case of hypothyroidism in menopausal women and increase the risk of osteoporosis, and thus, check the tight thyroid function. Levothyroxine should not be used in hyperthyroidism, unless used with anti -thyroid drugs when treating hyperthyroidism.

thyroid hormone is not used to lose weight. In patients with armor, treatment with levothyroxine does not cause weight loss. High doses can cause serious or even life -threatening reactions. Do not combine high doses of levothyrox® with some drugs to lose weight, for example sympathetic drugs.

Once treated with levothyroxine, in case you want to change to another drug, it is recommended to adjust the dose according to the patient's clinical response and test results.

Hypothyroidism and/or reduced control of hypothyroidism may occur when combined with orlistat and levothyroxine (see interactive section). Patients who use levothyroxine should consult a doctor before starting or stopping or changing treatment with orlistat by Orlistat and Levothyroxine may need to be used at different times and the dose of levothyroxine may need to be adjusted. Moreover, it is recommended to monitor patients by checking serum hormones.

The effect of the drug on driving and operating machinery

No research on the ability to drive and operate any machinery has been conducted. However, because Levothyroxine is like a natural thyroid hormone, Levothyrox® is expected to have no effect on the ability to drive and operate machinery.

Pregnant and lactating women

Treatment with levothyroxine should be guaranteed during pregnancy and lactation. The dose needed can increase during pregnancy. Because serum increases can occur early in the first 4 weeks of pregnancy, pregnant women are using levothyroxine, so they should check TSH every 3 months, to be sure the mother's serum value is in a special reference range of every 3 months of pregnancy. Serum TSH increases should be adjusted by increasing the dose of levothyroxine. Due to the similar level of TSH after birth with the value before pregnancy, the levothyroxine dose should be adjusted before the dose before pregnancy immediately after birth. The serum level should be achieved from 6 - 8 weeks after birth.

Pregnant women

Experience shows that there is no evidence of the likelihood of teratogenic or drug poisoning due to drugs in humans with recommended dose. Very high doses levothyroxine during pregnancy can cause adverse effects on the development of the fetus and postpartum.

Do not specify the treatment of hyperthyroidism in combination with levothyroxine and anti -thyroid drugs during pregnancy. This combination needs high doses of anti -thyroid drugs, the drug can pass through the placenta and cause hypothyroidism in infants.

Do not conduct a diagnosis of thyroid inhibitor during pregnancy, because the use of radioactive iodine in pregnant women is contraindicated.

breastfeeding women

levothyroxine excreted in breast milk during breastfeeding but with recommended dose, the concentration is not enough to cause hyperthyroidism or TSH inhibition in infants.

Interactive drug

Diabetes treatment: Levothyroxine can reduce the effect of diabetes treatment drugs. Therefore, it is advisable to regularly check blood sugar at the beginning of thyroid hormone treatment and must adjust the dose of diabetes if necessary.

Coumarin derivatives: The effect of anticoagulants can increase due to levothyroxine releasing anticoagulant drugs from plasma proteins, thus increasing the risk of bleeding, such as gastrointestinal bleeding or central nerves, especially older patients. Therefore, it is necessary to regularly check the coagulation index at the beginning and during the combined treatment. If necessary, anticoagulant dose must be adjusted.

Protease inhibitors: Protease inhibitors (such as Ritonavir, Indinavir, Lopinavir) may affect the effect of levothyroxine. It is recommended to closely monitor thyroid hormone index. If necessary, adjust the dose of levothyroxine.

Phenytoin: Phenytoin can affect the effect of levothyroxine by solving levothyroxine from serum protein that increases FT4 and FT3. On the other hand, phenytoin increases the metabolism of levothyroxine in the liver. Recommendation should closely monitor thyroid hormones.

Cholestyramine, Colestipol: Using ion exchange resins like Cholestyramine and Colestipol inhibits the absorption of Levothyroxine sodium. So take Levothyroxine sodium 4 - 5 hours before using these substances.

Aluminum, iron, and calcium salts: aluminum -containing drugs (antacids, sucralfate) are reported in the literature as capable of reducing the effect of levothyroxine. Therefore, levothyroxine should be used for at least 2 hours before using aluminum drugs. The same applies to iron and calcium -containing drugs.

salicylate, dicumarol, Furosemid, Clofibrate: salicylate, dicumarol, high -dose Furosemide (250mg), clofibone and other substances can release levothyroxine sodium from plasma proteins, increasing FT4.

Orlistat: Hypertmania and/or reduced control of hypothyroidism may occur when Orlistat and Levothyroxine are used at the same time. This may be due to reducing guise and/or levothyroxine.

SEVELAMER: SEVELAMER can reduce the absorption of levothyroxine. Therefore, it is recommended that patients monitor thyroid function when starting and ending combined treatment. If necessary, adjust the dose of levothyroxine.

Tyrosine Kinase inhibitors: Tyrosine Kinase inhibitors (such as imatinib, Sunitinib) can reduce the effect of levothyroxine. Therefore, it is recommended that patients monitor thyroid function when starting and ending combined treatment. If necessary, adjust the dose of levothyroxine.

propylthiouracil, glucocorticoid, sympathetic neurotransmitter, amiodarone and contrast containing iodine: These substances inhibit peripheral metabolism from T4 to T3. Because of high iodine, Amiodaron can activate hyperthyroidism as well as hypothyroidism. It should be noted especially in the case of thyroid thyroid but may not be identified as a self -control thyroid disease.

Sertraline, Chloroquin/Proguanil: These substances reduce the effectiveness of levothyroxine and increase serum levels.

Enzyme -induced drugs: enzyme -induced drugs such as barbiturat, carbamazepine may increase liver clearance of levothyroxine.

estrogen: Women using birth control pills contain estrogen or menopausal women who are treating hormones instead can increase the demand for levothyroxine.

Soy -containing substances: Soy -containing substances can reduce the absorption of levothyroxine in the intestine. Therefore, the Levothyrox dose may be needed, especially when starting or stopping using soy -containing supplements.

Storage

Store at temperatures not exceeding 30 ° C. Store in the original packaging to avoid light.

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