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Interactions between Fluoxymesterone and Tirosint-Sol

1 drug interaction and 29 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

levothyroxine fluoxymesterone

Applies to: Tirosint-Sol (levothyroxine) and fluoxymesterone
Monitor

Concomitant use of androgens and/or anabolic steroids or corticosteroids with thyroid hormone replacement therapy, may cause a transient decrease in thyroid hormone replacement requirements. The proposed mechanism is a decrease in T4 binding globulin resulting in an initial transient increase in free T4. However, continued administration results in a decrease in serum T4 and normal free T4 and TSH concentrations. In addition, the clearance of corticosteroids may be increased in hyperthyroid patients, and decreased in hypothyroid patients, changes in thyroid hormone replacement dosage may affect corticosteroid dosage. Glucocorticoids may also inhibit the peripheral conversion of T4 to its active form T3. In addition, initiation of thyroid hormone replacement prior to initiating glucocorticoid therapy may precipitate an acute adrenal crisis in patients with adrenal insufficiency.

Management

Clinical and laboratory monitoring of thyroid function is recommended for patients receiving thyroid hormone replacement therapy and androgens and/or anabolic steroids, or corticosteroids. Thyroid hormone dosage adjustments may be needed. Patients should be advised to contact their physician if clinical manifestations of hyperthyroidism occur, such as appetite changes, unexplained weight loss, insomnia, and fatigue. In addition, when the dosage of the thyroid medication is changed, the corticosteroid dosage may need to be adjusted. Patients with adrenal insufficiency should be treated with replacement glucocorticoids prior to initiating thyroid hormone replacement.

References (8)
  1. Arafah BM (1994) "Decreased levothyroxine requirement in women with hypothyroidism during androgen therapy for breast cancer." Ann Intern Med, 121, p. 247-51
  2. (2024) "Product Information. Synthroid (levothyroxine)." AbbVie US LLC, FDA 38
  3. (2024) "Product Information. Levothyroxine Sodium (levothyroxine)." Lannett Company Inc
  4. (2023) "Product Information. Levothyroxine Sodium (levothyroxine)." Zentiva Pharma UK Ltd
  5. (2023) "Product Information. Levothyroxine (Sandoz) (levothyroxine sodium)." Sandoz Pty Ltd
  6. (2024) "Product Information. Liothyronine Sodium (liothyronine)." AvKare Inc
  7. (2024) "Product Information. Eltroxin (levothyroxine)." Shire US Inc
  8. (2024) "Product Information. Armour Thyroid (thyroid desiccated)." A-S Medication Solutions

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

levothyroxine Food/Lifestyle

Applies to: Tirosint-Sol (levothyroxine)
Adjust dosing interval

Consumption of certain foods as well as the timing of meals relative to dosing may affect the oral absorption of T4 thyroid hormone (i.e., levothyroxine). T4 oral absorption is increased by fasting and decreased by foods such as soybean flour (e.g., infant formula), cotton seed meal, walnuts, dietary fiber, calcium, and calcium fortified juices. Grapefruit or grapefruit products may delay the absorption of T4 thyroid hormone and reduce its bioavailability. The mechanism of this interaction is not fully understood.

Management

Some manufacturers recommend administering oral T4 as a single daily dose, on an empty stomach, one-half to one hour before breakfast. In general, oral preparations containing T4 thyroid hormone should be administered on a consistent schedule with regard to time of day and relation to meals to avoid large fluctuations in serum levels. Foods that may affect T4 absorption should be avoided within several hours of dosing if possible. Consult local guidelines for the administration of T4 in patients receiving enteral feeding.

References (3)
  1. (2002) "Product Information. Synthroid (levothyroxine)." Abbott Pharmaceutical
  2. (2022) "Product Information. Armour Thyroid (thyroid desiccated)." Forest Pharmaceuticals
  3. Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT (2009) "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm, 66, p. 1438-67
Moderate:

levothyroxine multivitamins with minerals

Applies to: Tirosint-Sol (levothyroxine)
Adjust dosing interval

Concurrent administration of calcium-containing products may decrease the oral bioavailability of levothyroxine by one-third in some patients. Pharmacologic effects of levothyroxine may be reduced. The exact mechanism of interaction is unknown but may involve nonspecific adsorption of levothyroxine to calcium at acidic pH levels, resulting in an insoluble complex that is poorly absorbed from the gastrointestinal tract. In one study, 20 patients with hypothyroidism who were taking a stable long-term regimen of levothyroxine demonstrated modest but significant decreases in mean free and total thyroxine (T4) levels as well as a corresponding increase in mean thyrotropin (thyroid-stimulating hormone, or TSH) level following the addition of calcium carbonate (1200 mg/day of elemental calcium) for 3 months. Four patients had serum TSH levels that were higher than the normal range. Both T4 and TSH levels returned to near-baseline 2 months after discontinuation of calcium, which further supported the likelihood of an interaction. In addition, there have been case reports suggesting decreased efficacy of levothyroxine during calcium coadministration. It is not known whether this interaction occurs with other thyroid hormone preparations.

Management

Some experts recommend separating the times of administration of levothyroxine and calcium-containing preparations by at least 4 hours. Monitoring of serum TSH levels is recommended. Patients with gastrointestinal or malabsorption disorders may be at a greater risk of developing clinical or subclinical hypothyroidism due to this interaction.

References (4)
  1. Schneyer CR (1998) "Calcium carbonate and reduction of levothyroxine efficacy." JAMA, 279, p. 750
  2. Singh N, Singh PN, Hershman JM (2000) "Effect of calcium carbonate on the absorption of levothyroxine." JAMA, 283, p. 2822-5
  3. Csako G, McGriff NJ, Rotman-Pikielny P, Sarlis NJ, Pucino F (2001) "Exaggerated levothyroxine malabsorption due to calcium carbonate supplementation in gastrointestinal disorders." Ann Pharmacother, 35, p. 1578-83
  4. Neafsey PJ (2004) "Levothyroxine and calcium interaction: timing is everything." Home Healthc Nurse, 22, p. 338-9

Disease interactions

27 potential interactions Applies to: 23 conditions, including High Blood Pressure, High Cholesterol, Underactive Thyroid, Heart Failure, and Asthma.

Adrenal Insufficiency

Major:

Tirosint-Sol

The levothyroxine in Tirosint-Sol has a major potential interaction with Adrenal Insufficiency.

The use of thyroid hormones is contraindicated in patients with uncorrected adrenal insufficiency. Thyroid hormones increase tissue demand for adrenocortical hormones and may precipitate acute adrenal crisis. In patients with controlled adrenal insufficiency or other endocrine disorders, therapy for these concomitant disorders may need to be adjusted following thyroid replacement, since hypothyroidism often obscure or diminish the signs and symptoms of these conditions. Clinical monitoring of thyroid and adrenal function as well as any other appropriate endocrine function is recommended during thyroid hormone therapy.

Asthma

Moderate:

fluoxymesterone

Fluoxymesterone has a moderate potential interaction with Asthma.

The brand name product, Halotestin of fluoxymesterone contain FD&C Yellow No. 5 (tartrazine), which can cause allergic-type reactions (including asthma) in certain susceptible individuals. Caution is advised when using this product in patients with hypersensitivity to aspirin, serious allergies, and asthma.

Benign Prostatic Hyperplasia

Major:

fluoxymesterone

Fluoxymesterone has a major potential interaction with Benign Prostatic Hyperplasia.

The use of androgenic anabolic steroids is contraindicated for male patients with carcinoma of the breast or prostate. Circulating androgens can be converted in peripheral tissues to estrogens and dihydrotestosterone, which may act as promoters of tumor growth in the breast and prostate, respectively. Likewise, androgenic agents may cause enlargement of the prostate and should be used cautiously in patients with or predisposed to prostatic hypertrophy.

Bleeding Disorder

Major:

fluoxymesterone

Fluoxymesterone has a major potential interaction with Bleeding Disorder.

Androgenic anabolic steroids may cause suppression of clotting factors II, V, VII, and X, and an increase in prothrombin time. Androgen therapy should be administered cautiously in patients with bleeding disorders.

Breast Cancer

Major:

fluoxymesterone

Fluoxymesterone has a major potential interaction with Breast Cancer.

When treated with androgenic anabolic steroids, patients with metastatic breast cancer may develop hypercalcemia due to osteolysis. Frequent determination of urine and serum calcium levels is recommended during therapy with androgenic agents. If hypercalcemia occurs, therapy should be stopped. The development of hypercalcemia may indicate progression of metastases to the bone.

Breast Cancer, Male

Major:

fluoxymesterone

Fluoxymesterone has a major potential interaction with Breast Cancer, Male.

The use of androgenic anabolic steroids is contraindicated for male patients with carcinoma of the breast or prostate. Circulating androgens can be converted in peripheral tissues to estrogens and dihydrotestosterone, which may act as promoters of tumor growth in the breast and prostate, respectively. Likewise, androgenic agents may cause enlargement of the prostate and should be used cautiously in patients with or predisposed to prostatic hypertrophy.

Diabetes Insipidus

Moderate:

Tirosint-Sol

The levothyroxine in Tirosint-Sol has a moderate potential interaction with Diabetes Insipidus.

Since hypothyroidism often obscure or diminish the signs and symptoms of endocrine disorders such as diabetes mellitus or diabetes insipidus, thyroid replacement therapy may aggravate the intensity of symptoms associated with these conditions. Patients with endocrine disorders should be monitored more closely during thyroid hormone therapy, and their medication regimen adjusted accordingly. If thyroid medication is later discontinued, a downward readjustment of insulin or oral hypoglycemic agent may be necessary in patients with diabetes mellitus to avoid hypoglycemia.

Diabetes Mellitus

Moderate:

fluoxymesterone

Fluoxymesterone has a moderate potential interaction with Diabetes Mellitus.

The metabolic effects of androgenic anabolic steroids may lower blood glucose. Decreased glucose tolerance and increased insulin resistance have also been reported. Patients with diabetes mellitus should be monitored more closely during therapy with androgenic agents, and their antidiabetic regimen adjusted accordingly.

Moderate:

Tirosint-Sol

The levothyroxine in Tirosint-Sol has a moderate potential interaction with Diabetes Mellitus.

Since hypothyroidism often obscure or diminish the signs and symptoms of endocrine disorders such as diabetes mellitus or diabetes insipidus, thyroid replacement therapy may aggravate the intensity of symptoms associated with these conditions. Patients with endocrine disorders should be monitored more closely during thyroid hormone therapy, and their medication regimen adjusted accordingly. If thyroid medication is later discontinued, a downward readjustment of insulin or oral hypoglycemic agent may be necessary in patients with diabetes mellitus to avoid hypoglycemia.

Fluid Retention

Major:

fluoxymesterone

Fluoxymesterone has a major potential interaction with Fluid Retention.

Androgenic anabolic steroids may cause sodium and water retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with fluid overload or are at risk for developing edema. The manufacturers consider the use of androgenic agents to be contraindicated in patients with severe cardiac, renal and/or hepatic dysfunction.

Heart Disease

Major:

Tirosint-Sol

The levothyroxine in Tirosint-Sol has a major potential interaction with Heart Disease.

Thyroid hormones cause increases in myocardial contractility and heart rate as a result of increased metabolic demands and oxygen consumption. Therapy with thyroid hormones should be administered cautiously and initiated at reduced dosages in patients with cardiovascular disorders such as angina, coronary artery disease, and hypertension. Clinical monitoring of cardiovascular function is recommended. If chest pain or exacerbation of cardiovascular disease occurs, the dosage of thyroid hormone should be reduced, even at the expense of achieving euthyroid state. Thyroid hormones should not be administered to patients with an acute myocardial infarction that is not complicated by hypothyroidism.

Heart Failure

Major:

fluoxymesterone

Fluoxymesterone has a major potential interaction with Heart Failure.

Androgenic anabolic steroids may cause sodium and water retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with fluid overload or are at risk for developing edema. The manufacturers consider the use of androgenic agents to be contraindicated in patients with severe cardiac, renal and/or hepatic dysfunction.

High Blood Pressure

Major:

Tirosint-Sol

The levothyroxine in Tirosint-Sol has a major potential interaction with High Blood Pressure.

Thyroid hormones cause increases in myocardial contractility and heart rate as a result of increased metabolic demands and oxygen consumption. Therapy with thyroid hormones should be administered cautiously and initiated at reduced dosages in patients with cardiovascular disorders such as angina, coronary artery disease, and hypertension. Clinical monitoring of cardiovascular function is recommended. If chest pain or exacerbation of cardiovascular disease occurs, the dosage of thyroid hormone should be reduced, even at the expense of achieving euthyroid state. Thyroid hormones should not be administered to patients with an acute myocardial infarction that is not complicated by hypothyroidism.

High Cholesterol

Major:

fluoxymesterone

Fluoxymesterone has a major potential interaction with High Cholesterol.

Androgenic anabolic steroids may adversely affect serum lipids, including lowering HDL and elevating LDL levels. These changes can be marked, particularly with the 17-alpha-alkyl derivatives (i.e., fluoxymesterone, methyltestosterone, oxandrolone, oxymetholone, and stanozolol), and may significantly impact the risk of atherosclerosis and coronary artery disease. Patients with preexisting hyperlipoproteinemia may require closer monitoring during therapy with androgenic agents, and adjustments made accordingly in their lipid-lowering regimen. Androgen therapy should be administered cautiously in patients with coronary artery disease or a history of ischemic heart disease.

Hypercalcemia

Moderate:

fluoxymesterone

Fluoxymesterone has a moderate potential interaction with Hypercalcemia.

Androgenic anabolic steroids decrease urinary excretion of calcium, which may result in hypercalcemia. Therapy with androgenic agents should be administered cautiously in patients with hypercalcemia, disorders of bone metabolism such as hyperparathyroidism, or renal dysfunction. Some manufacturers consider the use of androgenic anabolic steroids to be contraindicated in patients with hypercalcemia.

Hyperparathyroidism

Moderate:

fluoxymesterone

Fluoxymesterone has a moderate potential interaction with Hyperparathyroidism.

Androgenic anabolic steroids decrease urinary excretion of calcium, which may result in hypercalcemia. Therapy with androgenic agents should be administered cautiously in patients with hypercalcemia, disorders of bone metabolism such as hyperparathyroidism, or renal dysfunction. Some manufacturers consider the use of androgenic anabolic steroids to be contraindicated in patients with hypercalcemia.

Hyperthyroidism

Major:

Tirosint-Sol

The levothyroxine in Tirosint-Sol has a major potential interaction with Hyperthyroidism.

The use of thyroid hormones is contraindicated in patients with untreated thyrotoxicosis of any etiology, since thyroid hormones may exacerbate the condition.

Minor:

fluoxymesterone

Fluoxymesterone has a minor potential interaction with Hyperthyroidism.

When androgenic anabolic steroids are used in patients with thyroid disorders, clinicians should be aware that these agents may affect thyroid function tests. Specifically, thyroid-binding globulin levels may be decreased, resulting in lower total T4 serum levels and increased resin uptake of T3 and T4. Free thyroid hormone levels remain unchanged, however.

Ischemic Heart Disease

Major:

fluoxymesterone

Fluoxymesterone has a major potential interaction with Ischemic Heart Disease.

Androgenic anabolic steroids may adversely affect serum lipids, including lowering HDL and elevating LDL levels. These changes can be marked, particularly with the 17-alpha-alkyl derivatives (i.e., fluoxymesterone, methyltestosterone, oxandrolone, oxymetholone, and stanozolol), and may significantly impact the risk of atherosclerosis and coronary artery disease. Patients with preexisting hyperlipoproteinemia may require closer monitoring during therapy with androgenic agents, and adjustments made accordingly in their lipid-lowering regimen. Androgen therapy should be administered cautiously in patients with coronary artery disease or a history of ischemic heart disease.

Liver Disease

Major:

fluoxymesterone

Fluoxymesterone has a major potential interaction with Liver Disease.

Androgenic anabolic steroids may cause sodium and water retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with fluid overload or are at risk for developing edema. The manufacturers consider the use of androgenic agents to be contraindicated in patients with severe cardiac, renal and/or hepatic dysfunction.

Major:

fluoxymesterone

Fluoxymesterone has a major potential interaction with Liver Disease.

The use of androgenic anabolic steroids may be associated with development of cholestatic hepatitis and jaundice. Other, more serious hepatotoxicities such as peliosis hepatis and hepatocellular neoplasms are rare but may occur with prolonged use or high dosages. These latter toxicities may be fatal and often not recognized until they become life-threatening. Patients with preexisting liver diseases should be monitored more closely during therapy with anabolic steroids if they are used. If liver function declines or toxicity occurs, therapy should be withdrawn and the cause investigated.

Polycythemia

Major:

fluoxymesterone

Fluoxymesterone has a major potential interaction with Polycythemia.

Androgenic anabolic steroids may cause polycythemia when given in high dosages or for prolonged periods. Patients with preexisting polycythemia may experience worsening of their condition. Frequent monitoring of clinical status and hemoglobin and hematocrit levels is recommended if androgen therapy is administered to these patients.

Prostate Cancer

Major:

fluoxymesterone

Fluoxymesterone has a major potential interaction with Prostate Cancer.

The use of androgenic anabolic steroids is contraindicated for male patients with carcinoma of the breast or prostate. Circulating androgens can be converted in peripheral tissues to estrogens and dihydrotestosterone, which may act as promoters of tumor growth in the breast and prostate, respectively. Likewise, androgenic agents may cause enlargement of the prostate and should be used cautiously in patients with or predisposed to prostatic hypertrophy.

Renal Dysfunction

Major:

fluoxymesterone

Fluoxymesterone has a major potential interaction with Renal Dysfunction.

Androgenic anabolic steroids may cause sodium and water retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with fluid overload or are at risk for developing edema. The manufacturers consider the use of androgenic agents to be contraindicated in patients with severe cardiac, renal and/or hepatic dysfunction.

Moderate:

fluoxymesterone

Fluoxymesterone has a moderate potential interaction with Renal Dysfunction.

Androgenic anabolic steroids decrease urinary excretion of calcium, which may result in hypercalcemia. Therapy with androgenic agents should be administered cautiously in patients with hypercalcemia, disorders of bone metabolism such as hyperparathyroidism, or renal dysfunction. Some manufacturers consider the use of androgenic anabolic steroids to be contraindicated in patients with hypercalcemia.

Seizures

Moderate:

Tirosint-Sol

The levothyroxine in Tirosint-Sol has a moderate potential interaction with Seizures.

Thyroid hormones may alter the seizure threshold. Seizures have been reported rarely following the initiation of levothyroxine therapy. Therapy with thyroid hormones should be administered cautiously in patients predisposed to seizures.

Underactive Thyroid

Minor:

fluoxymesterone

Fluoxymesterone has a minor potential interaction with Underactive Thyroid.

When androgenic anabolic steroids are used in patients with thyroid disorders, clinicians should be aware that these agents may affect thyroid function tests. Specifically, thyroid-binding globulin levels may be decreased, resulting in lower total T4 serum levels and increased resin uptake of T3 and T4. Free thyroid hormone levels remain unchanged, however.

More resources

fluoxymesterone

A total of 89 drugs are known to interact with fluoxymesterone.

Tirosint-Sol

A total of 254 drugs are known to interact with Tirosint-Sol.

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.