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This medication is accompanied by important safety information that must be reviewed carefully. If you have any questions or concerns, please consult your healthcare provider.

• Not for Weight Loss: This medication should not be used as a weight-loss aid. Using normal doses for weight loss is ineffective, and larger doses can lead to serious, potentially fatal side effects, particularly when combined with diet pills or other weight-loss medications.

• Heart Health Risks: Excessive use of this medication can lead to heart problems, especially in older adults or individuals with pre-existing heart conditions. Symptoms such as rapid or irregular heartbeat, chest pain, or difficulty breathing require immediate medical attention. Your healthcare provider may need to adjust or discontinue your dosage if heart issues arise.

• Adrenal Crisis Warning: In rare situations, using this medication can exacerbate low adrenal hormone levels, particularly in individuals with Addison's disease. It is crucial to address adrenal insufficiency before starting treatment for thyroid conditions, as untreated adrenal issues can worsen.

• Diabetes Considerations: This medication may elevate blood sugar levels, particularly when initiating treatment or adjusting doses. If you have diabetes, your healthcare provider might need to modify your diabetes medication. It's essential to regularly monitor your blood sugar levels and report any significant changes to your provider.

• Bone Health Concerns: High doses of this medication can contribute to bone weakening. Postmenopausal women are at heightened risk for bone density loss. To minimize this risk, your provider will ensure you are on the lowest effective dose for your thyroid condition. Maintaining a bone-healthy lifestyle through exercise, diet, and limited alcohol consumption is advised.

Contraindications: Do not use this medication if you have uncorrected adrenal insufficiency. Consult your healthcare provider to ensure safe use if this condition applies to you.

Common side effects:

• Headache
• Anxiety or nervousness
• Trouble sleeping
• Tiredness
• Increased hunger
• Diarrhea
• Vomiting
• Stomach cramps
• Weight loss
• Excessive sweating
• Weak muscles
• Trouble breathing

Less common but important to monitor:

• Increased sweating
• Heat sensitivity
• Mood changes such as nervousness or mood swings
• Persistent tiredness
• Diarrhea
• Tremors

Serious side effects:

• Chest pain
• Fast or pounding heartbeat
• Swelling in the hands, ankles, or feet
• Rash
• Itching
• Swelling (particularly of the face, tongue, or throat)
• Severe dizziness
• Difficulty breathing

Levothyroxine, a medication prescribed for hypothyroidism, can interact with various substances, potentially affecting its effectiveness. Understanding these interactions is crucial for optimal treatment.

Medications That May Reduce Levothyroxine Absorption:

• Antacids and Proton Pump Inhibitors (PPIs): Medications like Calcium Carbonate (found in TUMS), aluminum hydroxide/Magnesium Hydroxide (Maalox), and PPIs such as Omeprazole (Prilosec) can decrease stomach acidity, leading to reduced absorption of levothyroxine. It's advisable to take levothyroxine at least 4 hours apart from these medications.

• Iron and Calcium Supplements: Iron supplements (Ferrous Sulfate) and calcium supplements can bind to levothyroxine in the digestive tract, hindering its absorption. To prevent this, take levothyroxine at least 4 hours before or after consuming these supplements.

• Bile Acid Sequestrants and Phosphate Binders: Medications like Cholestyramine (Prevalite), Colesevelam (Welchol), and sevelamer (Renagel) can interfere with levothyroxine absorption. Administer levothyroxine at least 4 hours before these drugs.

Medications That May Alter Levothyroxine Metabolism:

• Enzyme Inducers: Drugs such as Rifampin and Phenobarbital can increase the breakdown of levothyroxine in the liver, potentially necessitating a higher dose of levothyroxine.

• Beta-Blockers and Amiodarone: High doses of beta-blockers like Propranolol and medications like amiodarone can reduce the conversion of levothyroxine (T4) to its active form (T3), possibly affecting thyroid hormone levels.

Other Considerations:

• Diabetes Medications: Levothyroxine may reduce the effectiveness of diabetes medications, requiring careful monitoring of blood sugar levels and potential dosage adjustments.

• Anticoagulants: Levothyroxine can enhance the effects of blood thinners like Warfarin, increasing the risk of bleeding. Regular monitoring of blood clotting parameters is recommended.

Food Interactions:

• Certain Foods: Soy products, walnuts, and high-fiber foods can interfere with levothyroxine absorption. It's best to take levothyroxine on an empty stomach, typically 30 minutes to an hour before breakfast.

Recommendations:

• Timing: Take levothyroxine on an empty stomach, ideally 30 minutes to an hour before eating, to ensure optimal absorption.

• Separation from Other Medications: Maintain a 4-hour gap between levothyroxine and medications or supplements known to interfere with its absorption.

• Regular Monitoring: Inform your healthcare provider about all medications and supplements you're taking. Regular blood tests may be necessary to monitor thyroid hormone levels and adjust dosages accordingly.

By being aware of these interactions and following these guidelines, you can help ensure that your levothyroxine therapy is as effective as possible.