Administration : Should be taken on an empty stomach: Take ? hr before meals.
Contraindications:
Levothyroxine (Euthyrox) must not be used in patients with: untreated adrenal insufficiency (dysfunction of the adrenal gland); untreated pituitary insufficiency (dysfunction of the pituitary gland); untreated thyrotoxicosis (excessive overproduction of thyroid hormones); acute myocardial infarction (heart disease); acute myocarditis or acute pancarditis (heart inflammation); hypersensitivity to any of the excipients of the product.
Combination therapy of levothyroxine (Euthyrox) and an anti-thyroid agent for hyperthyroidism is not indicated during pregnancy.
Special Precautions : CHD, adrenocortical insufficiency. Pregnancy & lactation. Elderly.
Adverse Reactions
Where the individual tolerance limit for levothyroxine is exceeded or in the case of overdosage, it is possible for the following clinical symptoms typical of hyperthyroidism to occur, especially if the dose is increased too quickly at the start of treatment: irregular or rapid heart rate (tachycardia, palpitations, arrhythmias such as atrial fibrillation and extrasystoles), chest pain (angina pectoris), headache, muscle weakness or cramps, warmth and redness of the face (flushing), fever, vomiting, disorders of menstruation, pseudotumor cerebri (increased pressure in the head with eye swelling), trembling, restlessness, sleep disturbances, sweating (hyperhidrosis), weight loss, diarrhea. In such cases the daily dose should be reduced or the medication withdrawn for several days.
Therapy may carefully be resumed once the adverse effects have disappeared. In case of hypersensitivity to any of the ingredients of levothyroxine (Euthyrox), allergic reactions, particularly of the skin, may occur. Cases of angioedema (swelling of the face or throat) have been reported.
At the first sign of any adverse drug reaction, patient must seek medical attention immediately.
Interactions
May reduce effect of antidiabetics. May intensify anticoagulant effect of coumarin derivatives. May influence effect w/ PIs (eg, ritonavir, indinavir, lopinavir). Elevated fT4 & fT3 fraction & increased hepatic metabolization w/ phenytoin. Elevated fT4 fraction w/ salicylates, dicoumarol, furosemide (in high doses) & clofibrate. Hypothyroidism &/or reduced hypothyroidism control w/ orlistat. May decrease absorption w/ sevelamer. May decrease efficacy w/ tyrosine-kinase inhibitors (eg, imatinib, sunitinib). Inhibit absorption w/ ion exchange resins (eg, cholestyramine, colestipol). Potentially decreased effect w/ Al (eg, antacids, sucralfates) & Fe containing drugs. Propylthiouracil, glucocorticoids, β-sympatholytics, iodine-containing media & amiodarone inhibit peripheral conversion of T4 to T3. Decreased efficacy & increased TSH level w/ sertraline, chloroquine/proguanil. Increased hepatic clearance w/ hepatic enzyme inducers (eg, barbiturates, carbamazepine). Women on estrogen-containing contraceptives or postmenopausal under hormone-replacement therapy may have increased need for levothyroxine. May lower the uptake w/ soy products.