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Drug overview for LIOTHYRONINE SODIUM (liothyronine sodium):
Generic name: LIOTHYRONINE SODIUM
Drug class: Thyroid Hormones
Therapeutic class: Endocrine
Liothyronine sodium, the sodium salt of the l-isomer of 3,3',5-triiodothyronine, is a thyroid agent.
Liothyronine sodium may be used for replacement or substitution of diminished or absent thyroid function resulting from primary causes including functional deficiency, primary atrophy, or partial or complete absence of the gland or the effects of surgery, radiation, or antithyroid agents; however, levothyroxine sodium is generally preferred for long-term therapy in these conditions. Liothyronine sodium also may be used for replacement or supplemental therapy in patients with secondary (pituitary) or tertiary (hypothalamic) hypothyroidism. Therapy must be maintained continuously to control the symptoms of hypothyroidism.
Because liothyronine sodium has a rapid onset and short duration of action, some clinicians prefer its use to levothyroxine sodium when a rapid effect or rapidly reversible effect is desired (e.g., diagnostic procedures requiring short-term thyrotropin suppression, myxedema coma); however, the fact that liothyronine produces wide swings in serum triiodothyronine concentrations and the possibility of more pronounced adverse cardiovascular effects generally make the drug unsatisfactory for long-term use. Liothyronine sodium may be useful when absorption of levothyroxine sodium is questionable or impairment of peripheral conversion of thyroxine to triiodothyronine is suspected. Liothyronine sodium may also be used therapeutically in patients with simple (nontoxic) goiter to reduce the size of the goiter.
Liothyronine sodium is used IV in the treatment of myxedema coma or precoma. Simultaneous administration of corticosteroids is required. Myxedema coma should be considered a medical emergency, and therapy should be directed at the correction of electrolyte disturbances, possible infection, or other intercurrent illness in addition to the administration of IV liothyronine sodium. Liothyronine sodium is used principally in the T3 suppression test to differentiate suspected hyperthyroidism from euthyroidism in patients with I 131 thyroid uptake values in the borderline-high range.
Generic name: LIOTHYRONINE SODIUM
Drug class: Thyroid Hormones
Therapeutic class: Endocrine
Liothyronine sodium, the sodium salt of the l-isomer of 3,3',5-triiodothyronine, is a thyroid agent.
Liothyronine sodium may be used for replacement or substitution of diminished or absent thyroid function resulting from primary causes including functional deficiency, primary atrophy, or partial or complete absence of the gland or the effects of surgery, radiation, or antithyroid agents; however, levothyroxine sodium is generally preferred for long-term therapy in these conditions. Liothyronine sodium also may be used for replacement or supplemental therapy in patients with secondary (pituitary) or tertiary (hypothalamic) hypothyroidism. Therapy must be maintained continuously to control the symptoms of hypothyroidism.
Because liothyronine sodium has a rapid onset and short duration of action, some clinicians prefer its use to levothyroxine sodium when a rapid effect or rapidly reversible effect is desired (e.g., diagnostic procedures requiring short-term thyrotropin suppression, myxedema coma); however, the fact that liothyronine produces wide swings in serum triiodothyronine concentrations and the possibility of more pronounced adverse cardiovascular effects generally make the drug unsatisfactory for long-term use. Liothyronine sodium may be useful when absorption of levothyroxine sodium is questionable or impairment of peripheral conversion of thyroxine to triiodothyronine is suspected. Liothyronine sodium may also be used therapeutically in patients with simple (nontoxic) goiter to reduce the size of the goiter.
Liothyronine sodium is used IV in the treatment of myxedema coma or precoma. Simultaneous administration of corticosteroids is required. Myxedema coma should be considered a medical emergency, and therapy should be directed at the correction of electrolyte disturbances, possible infection, or other intercurrent illness in addition to the administration of IV liothyronine sodium. Liothyronine sodium is used principally in the T3 suppression test to differentiate suspected hyperthyroidism from euthyroidism in patients with I 131 thyroid uptake values in the borderline-high range.
DRUG IMAGES
LIOTHYRONINE SOD 10 MCG/ML VL
The following indications for LIOTHYRONINE SODIUM (liothyronine sodium) have been approved by the FDA:
Indications:
Myxedema coma
Myxedema
Professional Synonyms:
Gull's disease
Indications:
Myxedema coma
Myxedema
Professional Synonyms:
Gull's disease
The following dosing information is available for LIOTHYRONINE SODIUM (liothyronine sodium):
Dosage of liothyronine sodium is expressed in terms of liothyronine. Dosage of liothyronine must be carefully adjusted according to individual requirements and response. The age and general physical condition of the patient and the severity and duration of hypothyroid symptoms determine the initial dosage and the rate at which dosage may be increased to the eventual maintenance dosage.
Dosage should be initiated at a lower level in geriatric patients; in patients with long-standing disease, other endocrinopathies, or functional or ECG evidence of cardiovascular disease; and in patients with severe hypothyroidism. Adjustment of thyroid replacement therapy should be determined mainly by the patient's clinical response and confirmed by appropriate laboratory tests.
Prompt administration of an adequate dose of IV liothyronine sodium is important in determining clinical outcome of myxedema coma. Initial and subsequent doses of liothyronine sodium should be based on continuous monitoring of the patient's clinical status and response to therapy. Myxedematous patients are very sensitive to the effects of thyroid hormones; therefore, dosage in such patients should be initiated at a low level and increased gradually since acute changes may precipitate adverse cardiovascular events.
For the management of mild hypothyroidism in adults, the usual initial oral dosage of liothyronine is 25 mcg daily given as a single dose; dosage is increased by increments of 12.5 or 25 mcg daily at intervals of 1-2 weeks until the desired response is obtained. The usual maintenance dosage is 25-75 mcg daily; some patients may require higher or lower dosages.
For the management of severe hypothyroidism in adults, the usual initial oral dosage is 5 mcg daily given as a single dose; dosage is increased by increments of 5-10 mcg daily at intervals of 1-2 weeks until the desired response is obtained. The usual maintenance dosage is 50-100 mcg daily. For geriatric patients with hypothyroidism, the usual initial oral dosage of liothyronine is 5 mcg daily given as a single dose; dosage is increased by increments of 5 mcg daily at intervals of 1-2 weeks until the desired response is obtained.
In infants and children, it is essential to achieve rapid and complete thyroid replacement because of the critical importance of thyroid hormone in sustaining growth and maturation. In general, despite the smaller body size, the dosage (on a weight basis) required to sustain a full rate of growth, development, and general thriving is higher in children than in adults. Although levothyroxine sodium is considered the drug of choice for the treatment of congenital hypothyroidism (cretinism), liothyronine has been used.
The initial oral dosage of liothyronine recommended by the manufacturer for the treatment of congenital hypothyroidism is 5 mcg daily given as a single dose; dosage is increased by increments of 5 mcg daily at intervals of 3-4 days until the desired response is obtained. For additional information on the use of thyroid agents in the treatment of congenital hypothyroidism, see Cautions: Pediatric Precautions, in the Thyroid Agents General Statement 68:36.04.
For the management of simple (nontoxic) goiter in adults, the usual initial oral dosage of liothyronine is 5 mcg daily; dosage is increased by increments of 5-10 mcg daily at intervals of 1-2 weeks until a dosage of 25 mcg daily is reached. Thereafter, dosage may be increased by increments of 12.5 or 25 mcg daily at intervals of 1-2 weeks until the desired response is obtained.
The usual maintenance dosage is 75 mcg daily.
When a patient is transferred from another thyroid preparation to liothyronine, the other thyroid preparation should be discontinued and liothyronine therapy initiated at a low dosage. Liothyronine dosage may be increased in small increments after residual effects of the previous thyroid preparation have subsided. When a patient is transferred from liothyronine to another thyroid preparation, it must be kept in mind that the onset and dissipation of effects of liothyronine are relatively rapid, and, to avoid relapse, it is necessary to start therapy with the replacement thyroid preparation several days before complete withdrawal of liothyronine.
Although levothyroxine sodium is generally considered the drug of choice in the treatment of myxedema coma, some clinicians prefer liothyronine because of its rapid onset of action. Liothyronine has been given orally via a nasogastric tube, but the IV route of administration is preferred. The usual initial adult IV dose of liothyronine recommended by the manufacturer for the emergency treatment of myxedema coma or precoma is 25-50 mcg.
In patients with known or suspected cardiovascular disease, the manufacturer suggests an initial dose of 10-20 mcg of liothyronine. The manufacturer states that additional doses of liothyronine should be administered at least 4 hours after the initial dose to allow for adequate assessment of therapeutic response, but no more than 12 hours should elapse between doses to avoid fluctuations in hormone levels. However, both the initial and subsequent doses of the drug should be determined based on continuous monitoring of the patient's clinical condition and response to liothyronine sodium therapy.
Administration of at least 65 mcg daily of IV liothyronine in the initial days of therapy reportedly has been associated with lower mortality. However, clinical experience with liothyronine dosages exceeding 100 mcg daily is limited. Oral therapy with thyroid hormones should be resumed as soon as the patient's condition stabilizes and the drug can be given orally.
Oral therapy with liothyronine sodium should be initiated at a low dosage following discontinuance of the IV drug, and dosage should be increased gradually according to the patient's response. If levothyroxine sodium rather than liothyronine sodium is used in initiating oral therapy, the clinician should consider the delay in onset of activity of levothyroxine sodium and IV liothyronine sodium should be discontinued gradually.
When used in the T3 suppression test to differentiate suspected hyperthyroidism from euthyroidism, liothyronine is given in a dosage of 75-100 mcg daily for 7 days. Radioactive I 131 uptake test is performed before and after administration of the 7-day course of liothyronine. In patients with hyperthyroidism, the radioactive iodine thyroid uptake will not be substantially affected, while in the euthyroid patient, it will decrease to less than 20% of the baseline value.
For further information on chemistry, pharmacology, pharmacokinetics, uses, toxicity, cautions, acute toxicity, drug interactions, laboratory test interferences, and dosage and administration of liothyronine sodium, see the Thyroid Agents General Statement 68:36.04.
Dosage should be initiated at a lower level in geriatric patients; in patients with long-standing disease, other endocrinopathies, or functional or ECG evidence of cardiovascular disease; and in patients with severe hypothyroidism. Adjustment of thyroid replacement therapy should be determined mainly by the patient's clinical response and confirmed by appropriate laboratory tests.
Prompt administration of an adequate dose of IV liothyronine sodium is important in determining clinical outcome of myxedema coma. Initial and subsequent doses of liothyronine sodium should be based on continuous monitoring of the patient's clinical status and response to therapy. Myxedematous patients are very sensitive to the effects of thyroid hormones; therefore, dosage in such patients should be initiated at a low level and increased gradually since acute changes may precipitate adverse cardiovascular events.
For the management of mild hypothyroidism in adults, the usual initial oral dosage of liothyronine is 25 mcg daily given as a single dose; dosage is increased by increments of 12.5 or 25 mcg daily at intervals of 1-2 weeks until the desired response is obtained. The usual maintenance dosage is 25-75 mcg daily; some patients may require higher or lower dosages.
For the management of severe hypothyroidism in adults, the usual initial oral dosage is 5 mcg daily given as a single dose; dosage is increased by increments of 5-10 mcg daily at intervals of 1-2 weeks until the desired response is obtained. The usual maintenance dosage is 50-100 mcg daily. For geriatric patients with hypothyroidism, the usual initial oral dosage of liothyronine is 5 mcg daily given as a single dose; dosage is increased by increments of 5 mcg daily at intervals of 1-2 weeks until the desired response is obtained.
In infants and children, it is essential to achieve rapid and complete thyroid replacement because of the critical importance of thyroid hormone in sustaining growth and maturation. In general, despite the smaller body size, the dosage (on a weight basis) required to sustain a full rate of growth, development, and general thriving is higher in children than in adults. Although levothyroxine sodium is considered the drug of choice for the treatment of congenital hypothyroidism (cretinism), liothyronine has been used.
The initial oral dosage of liothyronine recommended by the manufacturer for the treatment of congenital hypothyroidism is 5 mcg daily given as a single dose; dosage is increased by increments of 5 mcg daily at intervals of 3-4 days until the desired response is obtained. For additional information on the use of thyroid agents in the treatment of congenital hypothyroidism, see Cautions: Pediatric Precautions, in the Thyroid Agents General Statement 68:36.04.
For the management of simple (nontoxic) goiter in adults, the usual initial oral dosage of liothyronine is 5 mcg daily; dosage is increased by increments of 5-10 mcg daily at intervals of 1-2 weeks until a dosage of 25 mcg daily is reached. Thereafter, dosage may be increased by increments of 12.5 or 25 mcg daily at intervals of 1-2 weeks until the desired response is obtained.
The usual maintenance dosage is 75 mcg daily.
When a patient is transferred from another thyroid preparation to liothyronine, the other thyroid preparation should be discontinued and liothyronine therapy initiated at a low dosage. Liothyronine dosage may be increased in small increments after residual effects of the previous thyroid preparation have subsided. When a patient is transferred from liothyronine to another thyroid preparation, it must be kept in mind that the onset and dissipation of effects of liothyronine are relatively rapid, and, to avoid relapse, it is necessary to start therapy with the replacement thyroid preparation several days before complete withdrawal of liothyronine.
Although levothyroxine sodium is generally considered the drug of choice in the treatment of myxedema coma, some clinicians prefer liothyronine because of its rapid onset of action. Liothyronine has been given orally via a nasogastric tube, but the IV route of administration is preferred. The usual initial adult IV dose of liothyronine recommended by the manufacturer for the emergency treatment of myxedema coma or precoma is 25-50 mcg.
In patients with known or suspected cardiovascular disease, the manufacturer suggests an initial dose of 10-20 mcg of liothyronine. The manufacturer states that additional doses of liothyronine should be administered at least 4 hours after the initial dose to allow for adequate assessment of therapeutic response, but no more than 12 hours should elapse between doses to avoid fluctuations in hormone levels. However, both the initial and subsequent doses of the drug should be determined based on continuous monitoring of the patient's clinical condition and response to liothyronine sodium therapy.
Administration of at least 65 mcg daily of IV liothyronine in the initial days of therapy reportedly has been associated with lower mortality. However, clinical experience with liothyronine dosages exceeding 100 mcg daily is limited. Oral therapy with thyroid hormones should be resumed as soon as the patient's condition stabilizes and the drug can be given orally.
Oral therapy with liothyronine sodium should be initiated at a low dosage following discontinuance of the IV drug, and dosage should be increased gradually according to the patient's response. If levothyroxine sodium rather than liothyronine sodium is used in initiating oral therapy, the clinician should consider the delay in onset of activity of levothyroxine sodium and IV liothyronine sodium should be discontinued gradually.
When used in the T3 suppression test to differentiate suspected hyperthyroidism from euthyroidism, liothyronine is given in a dosage of 75-100 mcg daily for 7 days. Radioactive I 131 uptake test is performed before and after administration of the 7-day course of liothyronine. In patients with hyperthyroidism, the radioactive iodine thyroid uptake will not be substantially affected, while in the euthyroid patient, it will decrease to less than 20% of the baseline value.
For further information on chemistry, pharmacology, pharmacokinetics, uses, toxicity, cautions, acute toxicity, drug interactions, laboratory test interferences, and dosage and administration of liothyronine sodium, see the Thyroid Agents General Statement 68:36.04.
Liothyronine sodium is administered orally. The drug also is administered by IV injection in the treatment of myxedema coma or precoma. The manufacturer states that liothyronine sodium injection should not be administered IM or subcutaneously.
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| LIOTHYRONINE SOD 10 MCG/ML VL | Maintenance | Adults inject 2.5 milliliters (25 mcg) by intravenous route every 12 hours as needed not to exceed 100 mcg in 24hrs |
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| LIOTHYRONINE SOD 10 MCG/ML VL | Maintenance | Adults inject 2.5 milliliters (25 mcg) by intravenous route every 12 hours as needed not to exceed 100 mcg in 24hrs |
The following drug interaction information is available for LIOTHYRONINE SODIUM (liothyronine sodium):
There are 0 contraindications.
There are 2 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Radioactive Iodide/Agents that Affect Iodide SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Many compounds can affect iodide protein binding and alter iodide pharmacokinetics and pharmacodynamics.(1) CLINICAL EFFECTS: Compounds that affect iodide pharmacokinetics and pharmacodynamics may impact the effectiveness of radioactive iodide.(1) PREDISPOSING FACTORS: Compounds that affect iodide pharmacokinetics and pharmacodynamics are expected to have the most impact during therapy using radioactive iodide. Diagnostic procedures would be expected to be impacted less. PATIENT MANAGEMENT: Discuss the use of agents that affect iodide pharmacokinetics and pharmacodynamics with the patient's oncologist.(1) Because indocyanine green contains sodium iodide, the iodine-binding capacity of thyroid tissue may be reduced for at least one week following administration. Do not perform radioactive iodine uptake studies for at least one week following administration of indocyanine green.(2) The manufacturer of iopamidol states administration may interfere with thyroid uptake of radioactive iodine and decrease therapeutic and diagnostic efficacy. Avoid thyroid therapy or testing for up to 6 weeks post administration of iopamidol.(3) DISCUSSION: Many agents interact with radioactive iodine. The average duration of effect is: anticoagulants - 1 week antihistamines - 1 week anti-thyroid drugs, e.g: carbimazole, methimazole, propylthiouracil - 3-5 days corticosteroids - 1 week iodide-containing medications, e.g: amiodarone - 1-6 months expectorants - 2 weeks Lugol solution - 3 weeks saturated solution of potassium iodine - 3 weeks vitamins - 10-14 days iodide-containing X-ray contrast agents - up to 1 year lithium - 4 weeks phenylbutazone - 1-2 weeks sulfonamides - 1 week thyroid hormones (natural or synthetic), e.g.: thyroxine - 4 weeks tri-iodothyronine - 2 weeks tolbutamide - 1 week topical iodide - 1-9 months (1) |
ADREVIEW, JEANATOPE, MEGATOPE, SODIUM IODIDE I-123 |
| Sodium Iodide I 131/Agents that Affect Iodide SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Many compounds can affect iodide protein binding and alter iodide pharmacokinetics and pharmacodynamics.(1,2) CLINICAL EFFECTS: Compounds that affect iodide pharmacokinetics and pharmacodynamics may impact the effectiveness of radioactive iodide.(1,2) PREDISPOSING FACTORS: Compounds that affect iodide pharmacokinetics and pharmacodynamics are expected to have the most impact during therapy using radioactive iodide. Diagnostic procedures would be expected to be impacted less. PATIENT MANAGEMENT: Discuss the use of agents that affect iodide pharmacokinetics and pharmacodynamics with the patient's oncologist.(1,2) Because indocyanine green contains sodium iodide, the iodine-binding capacity of thyroid tissue may be reduced for at least one week following administration. Do not perform radioactive iodine uptake studies for at least one week following administration of indocyanine green.(3) The manufacturer of iopamidol states administration may interfere with thyroid uptake of radioactive iodine and decrease therapeutic and diagnostic efficacy. Avoid thyroid therapy or testing for up to 6 weeks post administration of iopamidol.(4) DISCUSSION: Many agents interact with radioactive iodine. The average duration of effect is: anticoagulants - 1 week antihistamines - 1 week anti-thyroid drugs, e.g: carbimazole, methimazole, propylthiouracil - 3-5 days corticosteroids - 1 week iodide-containing medications, e.g: amiodarone - 1-6 months expectorants - 2 weeks Lugol solution - 3 weeks saturated solution of potassium iodine - 3 weeks vitamins - 10-14 days iodide-containing X-ray contrast agents - up to 1 year lithium - 4 weeks phenylbutazone - 1-2 weeks sulfonamides - 1 week thyroid hormones (natural or synthetic), e.g.: thyroxine - 4 weeks tri-iodothyronine - 2 weeks tolbutamide - 1 week topical iodide - 1-9 months (1,2) |
HICON, SODIUM IODIDE I-131 |
There are 4 moderate interactions.
The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.
| Drug Interaction | Drug Names |
|---|---|
| Thyroid Preparations/Sertraline SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The mechanism by which sertraline lowers serum thyroid hormone concentrations is uncertain. One reported case in which sertraline caused a low serum total thyroxine concentration is believed to be caused by sertraline increasing the clearance of the thyroxine.(1) CLINICAL EFFECTS: The coadministration of thyroid preparations and sertraline may result in decreased levels and clinical effects of thyroid hormones.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Patients taking thyroid preparations and sertraline should be monitored for changes in thyroid function. The dosage of the thyroid preparation may need to be increased. DISCUSSION: In a case report of 9 levothyroxine treated patients with hypothyroidism, who were treated with sertraline, all were found to have elevated serum thyrotropin concentrations. Elevated thyrotropin levels are indicative of a decrease in the efficacy of levothyroxine. The dose of levothyroxine was increased for all patients. Required dosage adjustments ranged from 11% to 50%.(1) In a study, patients with major depression and hypothyroidism on adequate levothyroxine therapy were treated with either fluoxetine or sertraline. The results of this study showed no change in thyroid levels among hypothyroid patients on levothyroxine therapy who were treated with either fluoxetine or sertraline.(2) |
SERTRALINE HCL, ZOLOFT |
| Thyroid Preparations/Estrogens SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Estrogens increase thyroxine-binding globulin (TBG) levels by increasing its biosynthesis and decreasing its clearance.(1) Hypothyroid patients who start estrogens may be unable to compensate for this increase and may have decreased serum free T4 (FT4) concentrations and increased TSH.(1,2) CLINICAL EFFECTS: The coadministration of thyroid preparations and estrogens may result in decreased levels and clinical effects of thyroid hormones.(1-4) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Patients taking thyroid preparations and who start or stop estrogens should be monitored for changes in thyroid function. The dosage of the thyroid preparation may need to be increased.(1-4) DISCUSSION: In a prospective observational study, 25 post-menopausal women with hypothyroidism on stable levothyroxine therapy for at least 9 months started on estrogen replacement therapy. After 12 weeks, mean serum FT4 levels decreased significantly from 1.7 +/- 0.4 ng/dL to 1.4 +/-0.3 mg/dL and TSH increased significantly from 0.9 +/-1.1 to 3.2 +/- 3.1 milli-units/L.(1) |
2-METHOXYESTRADIOL, ACTIVELLA, AFIRMELLE, ALTAVERA, ALYACEN, AMETHIA, AMETHYST, ANGELIQ, ANNOVERA, APRI, ARANELLE, ASHLYNA, AUBRA, AUBRA EQ, AUROVELA, AUROVELA 24 FE, AUROVELA FE, AVIANE, AYUNA, AZURETTE, BALCOLTRA, BALZIVA, BEYAZ, BIJUVA, BLISOVI 24 FE, BLISOVI FE, BRIELLYN, CAMRESE, CAMRESE LO, CAZIANT, CHARLOTTE 24 FE, CHATEAL EQ, CLIMARA, CLIMARA PRO, COMBIPATCH, COVARYX, COVARYX H.S., CRYSELLE, CYRED, CYRED EQ, DASETTA, DAYSEE, DELESTROGEN, DEPO-ESTRADIOL, DESOGESTR-ETH ESTRAD ETH ESTRA, DIETHYLSTILBESTROL, DIVIGEL, DOLISHALE, DOTTI, DROSPIRENONE-ETH ESTRA-LEVOMEF, DROSPIRENONE-ETHINYL ESTRADIOL, DUAVEE, EEMT, EEMT H.S., ELESTRIN, ELINEST, ELURYNG, ENILLORING, ENPRESSE, ENSKYCE, ESTARYLLA, ESTRACE, ESTRADIOL, ESTRADIOL (ONCE WEEKLY), ESTRADIOL (TWICE WEEKLY), ESTRADIOL BENZOATE, ESTRADIOL CYPIONATE, ESTRADIOL HEMIHYDRATE, ESTRADIOL HEMIHYDRATE MICRO, ESTRADIOL MICRONIZED, ESTRADIOL VALERATE, ESTRADIOL-NORETHINDRONE ACETAT, ESTRATEST F.S., ESTRATEST H.S., ESTRING, ESTRIOL, ESTRIOL MICRONIZED, ESTROGEL, ESTROGEN-METHYLTESTOSTERONE, ESTRONE, ETHINYL ESTRADIOL, ETHYNODIOL-ETHINYL ESTRADIOL, ETONOGESTREL-ETHINYL ESTRADIOL, EVAMIST, FALMINA, FEIRZA, FEMLYV, FEMRING, FINZALA, FYAVOLV, GEMMILY, HAILEY, HAILEY 24 FE, HAILEY FE, HALOETTE, ICLEVIA, IMVEXXY, ISIBLOOM, JAIMIESS, JASMIEL, JINTELI, JOLESSA, JOYEAUX, JULEBER, JUNEL, JUNEL FE, JUNEL FE 24, KAITLIB FE, KALLIGA, KARIVA, KELNOR 1-35, KELNOR 1-50, KURVELO, LARIN, LARIN 24 FE, LARIN FE, LAYOLIS FE, LEENA, LESSINA, LEVONEST, LEVONORG-ETH ESTRAD ETH ESTRAD, LEVONORG-ETH ESTRAD-FE BISGLYC, LEVONORGESTREL-ETH ESTRADIOL, LEVORA-28, LO LOESTRIN FE, LO-ZUMANDIMINE, LOESTRIN, LOESTRIN FE, LOJAIMIESS, LORYNA, LOW-OGESTREL, LUTERA, LYLLANA, MARLISSA, MENEST, MENOSTAR, MERZEE, MIBELAS 24 FE, MICROGESTIN, MICROGESTIN FE, MILI, MIMVEY, MINIVELLE, MINZOYA, MONO-LINYAH, MYFEMBREE, NATAZIA, NECON, NEXTSTELLIS, NIKKI, NORELGESTROMIN-ETH ESTRADIOL, NORETHIN-ETH ESTRA-FERROUS FUM, NORETHINDRON-ETHINYL ESTRADIOL, NORETHINDRONE-E.ESTRADIOL-IRON, NORGESTIMATE-ETHINYL ESTRADIOL, NORTREL, NUVARING, NYLIA, OCELLA, ORIAHNN, ORTHO TRI-CYCLEN, ORTHO-NOVUM, PHILITH, PIMTREA, PORTIA, PREMARIN, PREMPHASE, PREMPRO, RECLIPSEN, RIVELSA, SAFYRAL, SETLAKIN, SIMLIYA, SIMPESSE, SPRINTEC, SRONYX, SYEDA, TARINA 24 FE, TARINA FE, TARINA FE 1-20 EQ, TAYTULLA, TILIA FE, TRI-ESTARYLLA, TRI-LEGEST FE, TRI-LINYAH, TRI-LO-ESTARYLLA, TRI-LO-MARZIA, TRI-LO-MILI, TRI-LO-SPRINTEC, TRI-MILI, TRI-SPRINTEC, TRI-VYLIBRA, TRI-VYLIBRA LO, TRIVORA-28, TURQOZ, TWIRLA, TYBLUME, VAGIFEM, VALTYA, VELIVET, VESTURA, VIENVA, VIORELE, VIVELLE-DOT, VOLNEA, VYFEMLA, VYLIBRA, WERA, WYMZYA FE, XARAH FE, XELRIA FE, XULANE, YASMIN 28, YAZ, YUVAFEM, ZAFEMY, ZARAH, ZOVIA 1-35, ZUMANDIMINE |
| Carbimazole; Methimazole/Thyroid Preparations SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Methimazole can affect the therapeutic response to thyroid hormone therapy. It decreases thyroid hormone secretion. Thyroid hormone therapy can antagonize the pharmacologic effects of methimazole by supplying an exogenous source of thyroid hormone. Carbimazole is a prodrug of methimazole.(1) CLINICAL EFFECTS: Concurrent use of carbimazole or methimazole and thyroid hormones may result in opposing effects. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Concurrent use of carbimazole or methimazole and thyroid hormones should be avoided. DISCUSSION: The 2016 American Thyroid Association guidelines recommended avoiding the concurrent use of methimazole and thyroid preparations for "block and replace" therapy to make a patient euthyroid. Meta-analyses have shown that a higher prevalence of adverse events occurs with block-and-replace regimens than dose titration.(2) The 2018 European Thyroid Association guidelines state that methimazole (30 mg) may be given combined with levothyroxine supplement ion for block-and-replace therapy to avoid drug-induced hypothyroidism but methimazole dose titration is the preferred therapy.(3) |
CARBIMAZOLE, METHIMAZOLE |
| Selected Anticoagulants/Thyroid SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Unknown. However, thyroid hormones may influence concentrations of vitamin K-dependent clotting factors. CLINICAL EFFECTS: Concurrent use of vitamin K antagonists and thyroid hormones may increase the risk for bleeding. Hypothyroidism may increase the oral anticoagulant requirements. Administration of thyroid hormones or hyperthyroidism may decrease oral anticoagulant requirements. PREDISPOSING FACTORS: The risk for bleeding episodes may be greater in patients with disease-associated factors (e.g. thrombocytopenia). Drug associated risk factors include concurrent use of multiple drugs which inhibit anticoagulant/antiplatelet metabolism and/or have an inherent risk for bleeding (e.g. NSAIDs). PATIENT MANAGEMENT: Monitor prothrombin activity and adjust the anticoagulant dosage accordingly during initiation of warfarin therapy in patients receiving thyroid replacement therapy, during the initiation or titration of thyroid replacement therapy in patients receiving warfarin, or if any changes in thyroid function occur. If concurrent therapy is warranted, monitor patients receiving concurrent therapy for signs of blood loss, including decreased hemoglobin, hematocrit, fecal occult blood, and/or decreased blood pressure and promptly evaluate patients with any symptoms. When applicable, perform agent-specific laboratory test (e.g. INR, aPTT) to monitor efficacy and safety of anticoagulation. Discontinue anticoagulation in patients with active pathologic bleeding. Instruct patients to report any signs and symptoms of bleeding, such as unusual bleeding from the gums or nose; unusual bruising; red or black, tarry stools; red, pink or dark brown urine; acute abdominal or joint pain and/or swelling. The time of highest risk for a coumarin-type drug interaction is when the precipitant drug is initiated or discontinued. Contact the prescriber before initiating, altering the dose or discontinuing either drug. DISCUSSION: Any change in thyroid status in patients stabilized on warfarin may necessitate a change in warfarin dosage requirements. Initiation of thyroid replacement therapy in patients stabilized on warfarin may result in increases in the effects of warfarin. A decrease in the dose of warfarin usually becomes necessary within one to four weeks after starting therapy with thyroid compounds. Warfarin therapy should be initiated in low doses in patients who are hyperthyroid. In a 16 year population based nested matched case control study, 10,532 hospitalizations for hemorrhage were evaluated and matched to 40,595 controls. The primary analysis showed no increase in risk of hemorrhage in older patients on warfarin initiated on levothyroxine in previous 30 days (OR 1.11, 95% CI 0.67-1.86). When patients were matched up to 90 days prior to the hemorrhage event, there was no significant association with levothyroxine 31-60 days prior to index date (OR 0.75 95% CI 0.26-2.25) or 61-90 days prior to index date (OR 0.67 95% CI 0.15-3.01). A retrospective, self-controlled study of 102 patients on chronic warfarin therapy were included if the patient had INR results 90 days before and after starting levothyroxine. The mean warfarin dose/INR ratio in the pre-period and post-period had no significant change (p=0.825). In patients who achieved euthyroid during post-period, warfarin dose/INR ratio was numerically lower in the post-period but not statistically significant (13.42 versus 12.7, respectively; p=0.338). In patients initiated on levothyroxine doses greater than 50 mcg, pre-period and post-period warfarin dose/INR ratio also had no significant difference (p>0.2). |
ANISINDIONE, DICUMAROL, JANTOVEN, PHENINDIONE, WARFARIN SODIUM |
The following contraindication information is available for LIOTHYRONINE SODIUM (liothyronine sodium):
Drug contraindication overview.
No enhanced Contraindications information available for this drug.
No enhanced Contraindications information available for this drug.
There are 2 contraindications.
Absolute contraindication.
| Contraindication List |
|---|
| Primary adrenocortical insufficiency |
| Thyrotoxicosis crisis |
There are 2 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| Hyperthyroidism |
| Pituitary insufficiency |
There are 7 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Angina |
| Cardiac arrhythmia |
| Coronary artery disease |
| Diabetes mellitus |
| Hypertension |
| Osteopenia |
| Osteoporosis |
The following adverse reaction information is available for LIOTHYRONINE SODIUM (liothyronine sodium):
Adverse reaction overview.
No enhanced Common Adverse Effects information available for this drug.
No enhanced Common Adverse Effects information available for this drug.
There are 15 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. |
Osteopenia |
| Rare/Very Rare |
|---|
|
Abnormal hepatic function tests Acute myocardial infarction Angina Angioedema Cardiac arrest Cardiac arrhythmia Dyspnea Heart failure Idiopathic intracranial hypertension Mood changes Seizure disorder Skin rash Tachycardia Urticaria |
There are 26 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Female infertility |
Hypertension Weight loss |
| Rare/Very Rare |
|---|
|
Abdominal pain with cramps Alopecia Chest pain Diarrhea Fatigue Fever Flushing Headache disorder Heat intolerance Hyperhidrosis Increased appetite Increased pulse rate Insomnia Irregular menstrual periods Irritability Menstrual disorder Muscle spasm Muscle weakness Nervousness Palpitations Symptoms of anxiety Tremor Vomiting |
The following precautions are available for LIOTHYRONINE SODIUM (liothyronine sodium):
No enhanced Pediatric Use information available for this drug.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
No enhanced Pregnancy information available for this drug.
No enhanced Lactation information available for this drug.
No enhanced Geriatric Use information available for this drug.
The following prioritized warning is available for LIOTHYRONINE SODIUM (liothyronine sodium):
No warning message for this drug.
No warning message for this drug.
The following icd codes are available for LIOTHYRONINE SODIUM (liothyronine sodium)'s list of indications:
| Myxedema | |
| E03.0 | Congenital hypothyroidism with diffuse goiter |
| E03.1 | Congenital hypothyroidism without goiter |
| E03.2 | Hypothyroidism due to medicaments and other exogenous substances |
| E03.4 | Atrophy of thyroid (acquired) |
| E03.8 | Other specified hypothyroidism |
| E03.9 | Hypothyroidism, unspecified |
| E89.0 | Postprocedural hypothyroidism |
| Myxedema coma | |
| E03.5 | Myxedema coma |
Formulary Reference Tool