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Drug Interactions between liothyronine and Prudoxin

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

liothyronine doxepin topical

Applies to: liothyronine and Prudoxin (doxepin topical)

MONITOR: Coadministration of thyroid hormone replacement therapy with tricyclic antidepressants may accelerate the onset or potentiate the action of tricyclic antidepressants, increasing the risk of cardiac arrhythmias and CNS stimulation. The proposed mechanism may be an increased receptor sensitivity to catecholamines. Some clinicians have used this interaction therapeutically. However, individual cases of paroxysmal tachycardia, hypothyroidism, and thyrotoxicosis have also been reported.

MANAGEMENT: Patients receiving concomitant thyroid hormone replacement therapy and tricyclic antidepressant therapy should be closely monitored for cardiac arrhythmias and CNS stimulation. Advise patients to contact their doctor if they experience toxicity symptoms such as: anxiety, agitation, insomnia, shortness of breath, irregular or fast heartbeat, and lightheadedness or dizziness.

References

  1. Prange AJ, Wilson IC, Rabon AM, Lipton MA (1969) "Enhancement of imipramine antidepressant activity by thyroid hormone." Am J Psychiatry, 126, p. 457-69
  2. Wilson IC, Prange AJ, McClane TK, Rabon AM, Lipton MA (1970) "Thyroid-hormone enhancement of imipramine in nonretarded depressions." N Engl J Med, 282, p. 1063-7
  3. Wheatley D (1972) "Potentiation of amitriptyline by thyroid hormone." Arch Gen Psychiatry, 26, p. 229-33
  4. (2002) "Product Information. Elavil (amitriptyline)." Stuart Pharmaceuticals
  5. (2002) "Product Information. Synthroid (levothyroxine)." Abbott Pharmaceutical
  6. (2001) "Product Information. Anafranil (clomipramine)." Basel Pharmaceuticals
  7. (2001) "Product Information. Cytomel (liothyronine)." Monarch Pharmaceuticals Inc
  8. Altshuler LL, Bauer M, Frye MA, et al. (2001) "Does thyroid supplementation accelerate tricyclic antidepressant response? A review and meta-analysis of the literature." Am J Psychiatry, 158, p. 1617-22
  9. Joffe RT (1998) "The use of thyroid supplements to augment antidepressant medication." J Clin Psychiatry, 59 Suppl 5, 26-9; discussion 30-1
  10. Joffe RT, Singer W, Levitt AJ, MacDonald C (1993) "A placebo-controlled comparison of lithium and triiodothyronine augmentation of tricyclic antidepressants in unipolar refractory depression." Arch Gen Psychiatry, 50, p. 387-93
  11. Cooke RG, Joffe RT, Levitt AJ (1992) "T3 augmentation of antidepressant treatment in T4-replaced thyroid patients." J Clin Psychiatry, 53, p. 16-8
  12. Cooke RG (1990) "T3 augmentation of a tricyclic antidepressant in a patient receiving T4 maintenance therapy." Am J Psychiatry, 147, p. 255
  13. Extein IL, Gold MS (1988) "Thyroid hormone potentiation of tricyclics." Psychosomatics, 29, p. 166-74
  14. Schwarcz G, Halaris A, Baxter L, Escobar J, Thompson M, Young M (1984) "Normal thyroid function in desipramine nonresponders converted to responders by the addition of L-triiodothyronine." Am J Psychiatry, 141, p. 1614-6
  15. Goodwin FK, Prange AJ Jr, Post RM, Muscettola G, Lipton MA (1982) "Potentiation of antidepressant effects by L-triiodothyronine in tricyclic nonresponders." Am J Psychiatry, 139, p. 34-8
  16. Swartz CM (1982) "Dependency of tricyclic antidepressant efficacy on thyroid hormone potentiation: case studies." J Nerv Ment Dis, 170, p. 50-2
  17. (2005) "Product Information. Triostat (liothyronine)." JHP Pharmaceuticals
  18. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  19. Cerner Multum, Inc. "Australian Product Information."
  20. Posternak M, Novak S, Stern R, et al. (2008) "A pilot effectiveness study: placebo-controlled trial of adjunctive L-triiodothyronine (T3) used to accelerate and potentiate the antidepressant response." Int J Neuropsychopharmacol, 11, p. 15-25
View all 20 references

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Drug and food interactions

Moderate

liothyronine food

Applies to: liothyronine

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

  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
View all 4 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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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.

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