TM Owner Allergan / AbbVie
Thyrolar Various Tablet
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Indications & Clinical Uses
- Thyrolar (liotrix) tablets contain a fixed 4-to-1 ratio of synthetic levothyroxine (T4) and liothyronine (T3), and are approved in the United States as replacement or supplemental therapy for hypothyroidism of any cause, including congenital hypothyroidism (cretinism), myxedema and primary, secondary or tertiary (pituitary or hypothalamic) hypothyroidism, and as a TSH-suppressant in the management of euthyroid goitre and well-differentiated thyroid cancer.
- Thyrolar is manufactured by Allergan (now part of AbbVie) and is supplied in five tablet strengths, Thyrolar-1/4 through Thyrolar-3, so the exact combined T4/T3 dose varies by tablet and must not be confused between strengths.
- It is not the same as single-ingredient levothyroxine or liothyronine products, and switching between liotrix and those single-hormone products requires dose reassessment by your healthcare provider.
- It is taken by mouth, usually once daily.
Side Effects
- Signs of excess thyroid hormone are the main things to watch for and include palpitations, tremor, increased sweating, headache, nervousness, anxiety, insomnia, weight change, diarrhoea, menstrual changes, and in some patients hair loss during the first few months of treatment.
- Increased blood pressure and chest pain can occur, especially in patients with underlying heart disease, and Thyrolar can aggravate angina or precipitate an arrhythmia at excessive doses.
- Overtreatment can also worsen bone loss with long-term use.
- Seek urgent medical attention for chest pain, a fast or irregular heartbeat, severe shortness of breath, or signs of an allergic reaction.
- Report any of these symptoms so your dose can be adjusted, since finding the right dose is done gradually with blood testing.
Precautions & Warnings
- Do not use Thyrolar for weight loss in people with normal thyroid function; doses used for weight reduction are ineffective and can cause serious or life-threatening toxicity, especially when combined with sympathomimetic amines.
- Use with caution and a lower starting dose in patients with cardiovascular disease, angina, or long-standing hypothyroidism, and in the elderly, because of the risk of precipitating cardiac symptoms; also use caution in diabetes, adrenal insufficiency, or diabetes insipidus, since thyroid hormone can worsen these conditions and correct thyroid dosing may unmask undiagnosed adrenal insufficiency.
- Thyrolar should not be used to treat male or female infertility unless due to hypothyroidism.
- Thyroid hormone requirements may change during pregnancy and require closer monitoring.
- Untreated adrenal insufficiency should be corrected before starting Thyrolar.
Avoid Interactions
- Hypothyroidism decreases and hyperthyroidism increases sensitivity to oral anticoagulants such as warfarin, so clotting tests need closer monitoring when Thyrolar is started, stopped or changed.
- Cholestyramine and colestipol bind thyroid hormone in the gut; separate dosing by four to five hours.
- Antacids, calcium and iron supplements, sucralfate and proton pump inhibitors can reduce absorption of the T4/T3 in Thyrolar; take Thyrolar on an empty stomach, apart from these products.
- Oestrogens and oral contraceptives can increase thyroid hormone requirements, while androgens can decrease them.
- Diabetic and insulin doses often need adjustment once thyroid hormone treatment starts.
- Tell your healthcare provider about all other medicines, including tyrosine-kinase inhibitors and other drugs that affect thyroid hormone metabolism.
References
Frequently Asked Questions
Thyrolar (liotrix) replaces thyroid hormone in people with an underactive thyroid, from any cause, including after thyroid surgery. It combines synthetic T4 and T3 in a fixed ratio. It is also used to suppress TSH in euthyroid goitre and some thyroid cancers. It is taken by mouth once daily.
Thyrolar is taken once daily by mouth, usually on an empty stomach in the morning, at least 30 to 60 minutes before food. It comes in five strengths, Thyrolar-1/4 to Thyrolar-3; do not switch strengths or brands without your doctor confirming the new dose.
Too much Thyrolar causes symptoms of an overactive thyroid: fast heartbeat, tremor, sweating, anxiety, insomnia and weight loss. Too little causes ongoing hypothyroid symptoms. Get urgent help for chest pain, a very fast or irregular heartbeat, or severe shortness of breath.
Take Thyrolar apart from calcium, iron, antacids, sucralfate and cholestyramine, which reduce absorption; separate these by four hours or more. It changes warfarin sensitivity and can raise insulin or diabetes drug requirements. Tell your provider about every medicine you take.
If you miss a Thyrolar dose, take it as soon as you remember that day; if you forget completely, skip it and take your next dose as usual the following day. Do not double up. Missing occasional doses of this long-acting hormone rarely causes symptoms.
Thyrolar (liotrix) contains both T4 and T3 hormones together in a fixed 4-to-1 ratio, unlike levothyroxine (T4 only) or liothyronine (T3 only) products. Switching between these is not a simple substitution; your doctor must recheck your dose and thyroid blood tests afterward.
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