Australian Prescriber Vol. 27 No. 3 2004. Taking care of thyroxine Thyroid hormones help to control the body's metabolism. If the thyroid gland is not working, or is removed surgically, the patient needs to take a substitute thyroid hormone (thyroxine).
2. Food increases the absorption of thyroxine tablets. Answers to self-test questions 1. False 1. False First published online).
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In the USA, the Food and Drug Administration has determined that stability and potency problems with oral thyroxine preparations could potentially have adverse effects on health. It is therefore very important that thyroxine tablets should be kept in their original container and stored out of sunlight in a cool dry place.
This formulation will require refrigeration at all times. Absorption Thyroxine is variably absorbed from the gut following oral administration. It has a bioavailability of 4080. Absorption may decrease with age. 1, 2.
Concurrent administration with iron salts, antacids, calcium carbonate (including milk sucralfate, cholestyramine and soy-based formulas may therefore decrease absorption of thyroxine. Administration Patients should be instructed to take thyroxine 3060 minutes before breakfast in order to maximise absorption.
The extent of thyroxine absorption is increased in the fasting state and is influenced by the content of the gastrointestinal tract. Some substances bind the thyroxine, making it unavailable for diffusion across the gut wall.
3 For patients, particularly children, who cannot swallow tablets, the tablets may be crushed in 1020 mL of water, breast milk or non-soybean formula. The resulting mixture should be used immediately and any remainder discarded.
Thyroxine tablets usually come in bottles of 200. Sometimes, patients do not use all their tablets before the expiry date. As thyroxine may not work, if it is past its use by date marked on the bottle, the patient should not take old tablets.
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2 Breast milk contains only 2030 of the calcium concentration of cows milk, making the likelihood of decreased thyroxine bioavailability less likely. Nonetheless, if breast milk is used to deliver the thyroxine, it should be used consistently, in order to minimise any variation in absorption.
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The long half-life of thyroxine enables longer dosing intervals of up to a week if required. The two Australian brands of thyroxine are identical and patients can swap brands safely, but this should not be assumed for overseas brands.
The two Australian brands are marketed by Sigma and one of its subsidiaries. They are identical products so patients can swap them safely, but this assumption should not be extended to overseas brands.
Aust Prescr 2004; Gregory W. Roberts, Clinical Pharmacist, Repatriation General Hospital, Daw Park, South Australia. Summary Some of the pharmaceutical properties of thyroxine have important implications for the quality use of medicines.