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LEVOTHYROXINE 50MICROGRAMS/5ML ORAL SOLUTION

Active substance(s): LEVOTHYROXINE SODIUM

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PACKAGE LEAFLET: INFORMATION FOR THE PATIENT
Levothyroxine 25 micrograms/5ml, 50 micrograms/5ml, and 100 micrograms/5ml Oral Solution
Levothyroxine sodium
(referred to as Levothyroxine Oral Solution in the remainder of this leaflet
Read all of this leaflet carefully before you start taking this medicine because it
example, dobutamine and isoprenaline)
contains important information for you.
• glucocorticoids (steroid hormones used to treat adrenal insufficiency and other
- Keep this leaflet. You may need to read it again.
diseases)
- If you have any further questions, ask your doctor, pharmacist or nurse.
• soy-containing products (these can decrease absorption of levothyroxine).
- This medicine has been prescribed for you only. Do not pass it on to others.
It may harm them, even if their signs of illness are the same as yours.
Let your doctor or pharmacist know. Levothyroxine Oral Solution can be taken
- If you get any of the side effects, talk to your doctor, pharmacist or nurse.
with these medicines but not at the same time.
This includes any possible side effects not listed in this leaflet.
If you go into hospital to have an operation, tell the anaesthetist or the medical
What is in this leaflet:
staff that you are taking Levothyroxine Oral Solution. It may react with an
1. What Levothyroxine Oral Solution is and what it is used for
anaesthetic (Ketamine) which you may be given before an operation.
2. What you need to know before you take Levothyroxine Oral Solution
3. How to take Levothyroxine Oral Solution
Please tell your doctor if you are taking or have recently taken any other
4. Possible side effects
medicines, including medicines obtained without a prescription.
5. How to store Levothyroxine Oral Solution
6. Contents of the pack and other information
Levothyroxine Oral Solution with food, drink and alcohol
You should take your Levothyroxine Oral Solution on an empty stomach, usually
1. WHAT LEVOTHYROXINE ORAL SOLUTION IS AND WHAT IT IS USED FOR
before breakfast.
Levothyroxine Oral Solution is used to treat hypothyroidism, a condition in which
the thyroid gland is underactive and so does not make enough thyroxine for the
body's needs.
Levothyroxine Oral Solution is also used to treat thyroid cancer and diffuse
non-toxic goitre or Hashimoto's thyroiditis, conditions in which the thyroid gland
becomes enlarged causing a swelling in the front of the neck.

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2. WHAT YOU NEED TO KNOW BEFORE YOU TAKE LEVOTHYROXINE
ORAL SOLUTION
Do not take Levothyroxine Oral Solution:
• if you are allergic to levothyroxine or any of the other ingredients of this
medicine (listed in section 6)
• if you suffer from adrenal insufficiency and you do not have adequate
corticosteroid cover
• if you have a heart attack (acute myocardial infarction), inflammation of the
heart muscle (acute myocarditis) or inflammation of the sac surrounding the
heart (acute pancarditis)
• if you are pregnant do not take this medicine in combination with medicines to
treat hyperthyroidism (see the section on Pregnancy and breast-feeding).
Warnings and precautions
Talk to your doctor before taking Levothyroxine Oral Solution:
• if you have heart disease, problems with your circulation or high blood pressure
• if you are suffering from an overactive thyroid gland (hyperthyroidism), an
underactive adrenal gland, diabetes, or have had an underactive thyroid gland
for some time.
Children
Levothyroxine Oral Solution is not suitable for children under five years of age
due to the amount of the ingredient propylene glycol in the medicine (see
section 6 and “Levothyroxine Oral Solution contains” in section 2 of this leaflet).
Other medicines and Levothyroxine Oral Solution
Please tell your doctor or pharmacist if you are taking, have recently taken or
might use any other medicines.

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Levothyroxine can interfere with the action of some other drugs and some drugs
can have an effect on Levothyroxine. In particular tell your doctor or pharmacist if
you take the following drugs:
• medication to stop your blood clotting (for example warfarin)
• medication for depression (for example sertraline, imipramine, amitriptyline)
• medication for epilepsy (for example phenytoin, phenobarbital, carbamazepine)
• medication for diabetes
• rifampicin (for infections, particularly tuberculosis)
• digoxin or amiodarone (for your heart)
• propranolol (for high blood pressure), lovastatin (for high cholesterol levels) or
phenylbutazone or aspirin (anti-inflammatory drugs)
• oestrogen, oestrogen containing products and oral contraceptives, androgens
or corticosteroids
• sucralfate, cimetidine or aluminium hydroxide for a stomach ulcer
• colestyramine to lower your cholesterol levels, or calcium carbonate or iron
supplements
• chloroquine or proguanil for the prevention of malaria
• protease inhibitors (for example ritonavir, indinavir and lopinavir) used to treat HIV
• sevelamer (used to treat high levels of phosphate in the blood in patients with
renal failure)
• tyrosine kinase inhibitors (for example imatinib and sunitinib) used to treat cancer
• propylthiouracil (used to treat hyperthyroidism)
• beta-agonists, used to treat cardiac arrest and low blood pressure (for

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Pregnancy and breast-feeding
Ask your doctor or pharmacist for advice before taking any medicine.
If you are pregnant or breast-feeding, think you may be pregnant or are planning
to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
If you are pregnant while taking this medicine your doctor will monitor you closely.
Driving and using machines
Your medicine is unlikely to affect your ability to drive or to operate machinery.
Levothyroxine Oral Solution contains sodium methyl parahydroxybenzoate,
sodium propyl parahydroxybenzoate, propylene glycol and maltitol
Levothyroxine Oral Solution contains maltitol. If you have been told by your
doctor that you have an intolerance to some sugars, contact your doctor before
taking this medicinal product. Also contains sodium methyl parahydroxybenzoate
(E219) and sodium propyl parahydroxybenzoate (E217) which may cause allergic
reactions (possibly delayed). Propylene glycol may cause alcohol-like symptoms.
3. HOW TO TAKE LEVOTHYROXINE ORAL SOLUTION
Always take this medicine exactly as your doctor has told you. Check with your
doctor if you are not sure. Levothyroxine Oral Solution should be swallowed.
Your doctor will have decided what dose you should take each day depending on
your condition. Your doctor will take blood samples at regular intervals to monitor
your response to treatment. If you are switching from the oral solution to the
tablet version of levothyroxine or from the tablet version to the oral solution of
levothyroxine your doctor will monitor you more closely.
Administration
You should take your Levothyroxine Oral Solution on an empty stomach, usually
before breakfast.
For hypothyroidism the usual daily dosages are:
Adults and children over 12 years:
The starting dose is 50 to 100 micrograms a day, increasing by 25 to 50
micrograms every 3-4 weeks, until you are taking the right amount for your
condition. The usual maintenance dose is 100 to 200 micrograms daily.
For diffuse non toxic goitre or Hashimoto’s thyroiditis the recommended dose is
50-200 micrograms per day.
For the treatment of thyroid cancer the recommended dose is
150-300 micrograms per day.
Older patients (over 50 years of age):
The starting dose is 12.5 micrograms a day, increasing by 12.5 micrograms
every 2 weeks until the correct dose is obtained. The usual final dose is between
50 and 200 micrograms daily. This dose also applies to patients with severe
hypothyroidism, and to those with heart disease.
Children between five and 12 years:
The dose for children depends on their age or weight. They will be monitored to
make sure they get the right dose. 5 micrograms per kg bodyweight may be used
as a guide.
Children under five years:
Levothyroxine Oral Solution is not suitable for children under five years of age
due to the amount of the ingredient propylene glycol in the medicine (see
section 6 and “Levothyroxine Oral Solution contains” in section 2 of this leaflet).

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The duration of treatment is usually for life if you are being treated for
hypothyroidism, non toxic diffuse goitre or Hashitmoto’s thyroiditis.

Do not be alarmed by this list of possible events. You may not have any of them.

Please use the oral syringe provided to deliver your specific dose (see
instructions below). The syringe can be used to measure your dose by drawing
the liquid to the correct mark on the syringe. For example if your dose is 50
micrograms daily then the corresponding volume would be:
For the 25 microgram/5ml strength – 2 x 5ml (10ml in total)
For the 50 microgram/5ml strength – 5ml
For the 100 microgram/5ml strength – 2.5 ml
How to use the oral syringe:
1. Shake the bottle well, making sure the cap is firmly on the bottle.
2. Remove the cap. Note : Keep the cap nearby to close the bottle after each
use.
3. Push the plastic adapter into the neck of the bottle. Note: The adapter must
always stay in the bottle.
4. Take the syringe and check the plunger is fully down.
5. Keep the bottle upright and insert the oral syringe firmly into the plastic
adapter
6. Turn the whole bottle with the syringe upside down.
7. Slowly pull the plunger down fully so that the syringe fills with medicine.
Push the plunger back up completely to expel any large air bubbles that may
be trapped inside the oral syringe.
8. Then pull the plunger slowly back to the volume you need for your dose.
9. Turn the whole bottle with the syringe the right way up and take the syringe
out of the bottle.
10. The dose of medicine can now be swallowed directly from the oral syringe.
Please ensure that you are sitting upright and the plunger must be pushed
slowly to allow you to swallow the dose.
11. Replace the child resistant cap after use, leaving the adapter in place.
12. Cleaning: After use, wipe the outside of the syringe with a dry, clean tissue.

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If you take more Levothyroxine Oral Solution than you should
If you accidentally take an overdose of your medicine, either call your doctor
straight away, or go to your nearest hospital casualty department. Symptoms of
overdose include fever, irregular heart beat, muscle cramps, headache,
restlessness, flushing, sweating or diarrhoea. Always take any remaining
medicine, the container and the label with you, so that the medicine can be
identified.
If you forget to take Levothyroxine Oral Solution
If you forget to take your medicine, take your dose when you remember and then
take your next dose at the usual time. Do not take two doses at the same time. If
you have forgotten several doses tell your doctor when you have your next
check-up or blood test.
If you stop taking Levothyroxine Oral Solution
It can be dangerous to stop taking your medicine without your doctor's advice.
If you are worried, ask your doctor or pharmacist for advice.
If you have any further questions on the use of this medicine, ask your doctor
4. POSSIBLE SIDE EFFECTS
Like all medicines, this medicine can cause side effects, although not everybody
gets them. These usually only happen if the dose you are taking is too high.
If any of the following happen, stop taking Levothyroxine Oral Solution and
tell your doctor immediately or go to the casualty department at your
nearest hospital
• Swelling of the hands, feet, ankles, face, lips, mouth, or throat which may
cause difficulty in swallowing or breathing
• Hives
• Fainting
• Yellowing of the skin and eyes also called jaundice
These are all very serious side effects. If you have them, you may have a serious
allergic reaction to Levothyroxine Oral Solution. You may need urgent medical
attention or hospitalisation. All of these very serious side effects are very rare.
Tell your doctor if you notice any of the following:
Fast or irregular heart beats, palpitations, chest pain, muscle cramps or
weakness, headache, restlessness, excitability, flushing, sweating, diarrhoea,
vomiting, fever, menstruation problems, tremor, sleeplessness, heat intolerance
and excessive weight loss. Rash, itching and puffiness may also occur.

Reporting of side effects
If you get any side effects, talk to your doctor or pharmacist. This includes any
possible side effects not listed in this leaflet. You can also report side effects
directly via the national reporting systems listed below:
United Kingdom:
Yellow Card Scheme
Website: www.mhra.gov.uk/yellowcard
Ireland:
HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2;
Tel: +353 1 6764971; Fax: +353 1 6762517;
Website: www.hpra.ie; e-mail: medsafety@hpra.ie
By reporting side effects you can help provide more information on the safety of
this medicine.
5. HOW TO STORE LEVOTHYROXINE ORAL SOLUTION
Keep this medicine out of sight and reach of children.
Do not use this medicine after the expiry date, which is stated on the carton. The
expiry date refers to the last day of that month. The solution should not be used
for longer than three months after the bottle has been opened.
Do not store above 25°C.
Do not throw away any medicines via wastewater or household waste. Ask your
pharmacist how to throw away medicines you no longer use. These measures
will help to protect the environment.
6. CONTENTS OF THE PACK AND OTHER INFORMATION
What Levothyroxine Oral Solution contains:
The active substance is levothyroxine sodium. Each 5ml of oral solution contains
25micrograms, 50micrograms or 100micrograms of levothyroxine sodium.
It also contains the following inactive ingredients:
citric acid monohydrate, sodium methyl parahydroxybenzoate (E219), sodium
propyl parahydroxybenzoate, propylene glycol (100mg/5ml), maltitol liquid,
sodium hydroxide, hydrochloric acid, sodium hydroxide and purified water.
What Levothyroxine Oral Solution looks like and contents of the pack
Levothyroxine Oral Solution is a clear colourless liquid. Each amber glass bottle
contains either 100ml or 150ml of oral solution. A plastic dosing syringe (pipette)
is also included to help measure the dose.
Not all pack sizes may be marketed.
Marketing Authorisation Holder and Manufacturer
Marketing authorisation holder: Wockhardt UK Ltd, Ash Road North,
Wrexham, LL13 9UF, UK.
Manufacturer: CP Pharmaceuticals Ltd, Ash Road North, Wrexham,
LL13 9UF, UK.
This Medicinal Product is authorised in the Member States under the
following names:
UK and Ireland:
Levothyroxine 25 micrograms/5ml Oral Solution
Levothyroxine 50 micrograms/5ml Oral Solution
Levothyroxine 100 micrograms/5ml Oral Solution
Other sources of information:
To listen to or request a copy of this leaflet in Braille, large print or audio please
call, free of charge: 0800 198 5000 (UK only)
Please be ready to give the following information:
Product name

Reference number

Levothyroxine 25 micrograms/5ml Oral Solution

29831/0493

Levothyroxine 50 micrograms/5ml Oral Solution

29831/0494

Levothyroxine 100 micrograms/5ml Oral Solution

29831/0495

This is a service provided by the Royal National Institute of Blind People.
For the Republic of Ireland please call +44 1978 669272

Children may have some hair loss at the beginning of treatment, however this is
usually temporary and the hair returns.

107317/1
23LF01301PW

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Very rarely, if far too much Levothyroxine Oral Solution has been taken in one go
or over many years, the heart may fail and coma and death have been reported.
If you feel unwell in any other way, tell your doctor as soon as you can.

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This leaflet was last revised in 01/2016

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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