Treatment for Hypothyroidism/Under Active Thyroid

Please note ***NAME CHANGE ***
Thyroxine Replacement Hormone has been changed to Levothyroxine Replacement Hormone.
Please read the Aspen letter for further information.

As of 2017, Australia now has three brands of Levothyroxine replacement hormone available for prescription.

• Oroxine (original brand)
  

  Active Ingredient:  Levothyroxine Sodium

  Manufacturer:         Aspen Pharma Pty Ltd

  Doses Available:     50 (scored) 75, 100 & 200mcgs   -  Tablets are dispensed in foil blister strips  

  Oroxine should be stored at refrigerated temperature at all times.  It should not be left out of the refrigerator for any reason or any amount of time.

  Prescriptions must be written in the name of Oroxine for this brand to be dispensed by the pharmacist, with ‘Brand Substitute Not Allowed’ ticked on the prescription.  Please ensure you have been given the brand prescribed before leaving the pharmacy.                                                  

  This brand is available on Prescribed Benefits Scheme (PBS).  Patients who have been prescribed Oroxine and are stable on this brand, should not change brands for any reason, unless your thyroid treating doctor has recommended a change. 

  If your pharmacist does not have Oroxine available, please request it be ordered.  It should not take any longer than 24 hours to arrive.  Please ensure before you leave your pharmacy that you have been given the correct brand prescribed.

  Oroxine is bio-equivalent to Levoxine.  Doses and brands should not be interchanged.

  Please follow the correct instructions for taking Oroxine.

  Oroxine Consumer Medicine Information (CMI) is available here
  
  The ATF Medication Travel Pack (MTP), is available for members to purchase at a reduced price.  It is to be used whilst travelling or away from home to keep your Oroxine at a refrigerated temperature.

  Do not put your Oroxine in a cooler bag with an ice brick as it could easier freeze your medication and spoil it.

• Eutroxsig (Generic brand)
  

  Active Ingredient:   Levothyroxine Sodium

  Manufacturer:          Aspen Pharma Pty Ltd

  Doses Available:       50 (scored) 75, 100 & 200mcgs  -  Tablets are dispensed in foil blister strips  –

  Eutroxsig should be stored at refrigerated temperature at all times.  It should not be left out of the refrigerator for any reason or any amount of time.

  Prescriptions must be written in the name of Eutroxsig for this brand to be dispensed by the pharmacist, with ‘Brand Substitute Not Allowed’ ticked on the prescription.  Please ensure you have been given the correct brand prescribed before leaving the pharmacy.

  This brand is available on Prescribed Benefits Scheme (PBS).  Patients who have been prescribed Eutroxig and are stable on this brand, should not change brands for any reason, unless your thyroid treating doctor has recommended a change. 

  If your pharmacist does not have Eutroxsig available, please request it be ordered.  It should not take any longer than 24 hours to arrive.  Please ensure before you leave your pharmacy that you have been given the correct brand prescribed.

  Eutroxsig is bio-equivalent to Levoxine.  Doses and brands should not be interchanged

  Please follow the correct instructions for taking Eutroxsig.

  Eutroxsig Consumer Medicine Information (CMI) is available here
  
  The ATF Medication Travel Pack (MTP), is available for members to purchase at a reduced price.  It is to be used whilst travelling or away from home to keep your Eutroxsig at a refrigerated temperature.

  Do not put your Eutroxsig in a cooler bag with an ice brick as it could easier freeze your medication and spoil it.  

  
  
• Eltroxin 
  Eltroxin does not have to be stored at refrigerated temperature, however it is essential it is kept below 25 degrees Celsius. It can be refrigerated in areas of Australia which regularly rise above 25 degrees Celsius and especially important during summer months where temperatures exceed 25 degrees Celsius. It should not be left in the bathroom, near a window or left in your car.
  

  Active Ingredient: Levothyroxine Sodium

  Manufacturer:        Aspen Pharma Pty Ltd

  Doses Available:    25, 50 (scored) 75, 100, 125 & 200mcg  Tablets are dispensed in a bottle

  50, 75, 100, 125 & 200mcgs doses are available on Prescribed Benefits Scheme (PBS).  25mcgs is not available on Prescribed Benefits Scheme (PBS).

  Prescriptions must be written in the name of Eltroxin for this brand to be dispensed by the pharmacist, with ‘Brand Substitute Not Allowed’ ticked on the prescription.  Please ensure you have been given the correct brand prescribed before leaving the pharmacy. 

  If your pharmacist does not have Eltroxin available, please request it be ordered.  It should not take any longer than 24 hours to arrive. 

  Please follow the correct instructions for taking Eltroxin.

  Patients who have been prescribed Eltroxin and are stable on this brand, should not change brands for any reason, unless your thyroid treating doctor has recommended a change.        

  This brand has 10% less active ingredient than the same doses of Oroxine, Eutroxsig and Levoxine. It is not bio-equivalent to any other brand and doses and brands should not be interchanged.

  If you were to change your brand to Eltroxin from Oroxine, Eutroxsig or Levoxine, your dose may need to be adjusted to accommodate the difference in active ingredient. 

  Regular thyroid function pathology tests would need to be ordered by your treating doctor to ensure your dose of Eltroxin was adequate after changing brands.

  Eltroxin Consumer Medicine Information (CMI) is available here
  

• Levoxine
  

Levoxine does not have to be stored at refrigerated temperature, however it is essential it is kept below 25 degrees Celsius.  Especially important during summer months and in areas of Australia where the temperature regularly rises above 25 degrees Celsius.  It should not be left in the bathroom, near a window or left in your car. 

Active Ingredient:  Levothyroxine Sodium

Distributor:               Sun Pharma ANZ Pty Ltd

Doses Available:     50, 75, 100, 200  Tablets are dispensed in a bottle.  Each dose is a different colour.

Below are the additives for the different colours used in the tablets for each dose:

Levoxine is available on Prescribed Benefits Scheme (PBS).   Prescriptions must be written in the name of Levoxine for this brand to be dispensed by the pharmacist with ‘Brand Substitute Not Allowed’ ticked on the prescription.  Please ensure you have been given the brand prescribed before leaving the pharmacy.

If your pharmacist does not have Levoxine available, please request it be ordered.  It should not take any longer than 24 hours to arrive. 

Please follow the correct instructions for taking Levoxine.

Patients who have been prescribed Levoxine and are stable on this brand, should not change brands for any reason, unless your thyroid treating doctor has recommended a change. 

Levoxine is bio-equivalent to Oroxine, Eutroxsig.  It is not bio-equivalent to Eltroxin.  Doses and brands should not be interchanged. 

Levoxine Consumer Medicine Information (CMI) is available here

Oroxine, Eutroxsig, Eltroxin & Levoxine (Synthetic T4/Levothyroxine)

Levothyroxine (Oroxine/Eutroxsig/Eltroxin/Levoxine) is prescribed for patients who have had surgical removal of their thyroid gland, either a total or hemi thyroidectomy or who suffer from hypothyroidism/underactive thyroid function. Levothyroxine can also be prescribed for patients after RAI Treatment.

Oroxine/Eutroxsig/Eltroxin/Levoxine are synthetic forms of the hormone Levothyroxine (T4). These Australian brands are the closest synthetic form of thyroxine hormone to what a healthy thyroid gland produces.

If the thyroid gland is underactive, your doctor will prescribe a small dose to start your treatment, usually 50mcgs and increase the dose as the thyroid gland becomes progressively inactive.

If this medication is prescribed as a result of a total/hemi thyroidectomy, your treating doctor will determine the initial dose following surgery and after pathology tests. It is unusual for patients to cease this medication once it has begun, as thyroxine hormone is an essential hormone to regulate body function. It is usual for patients to take on the medication for life.

PLEASE NOTE: Eltroxin is not the same formula as Oroxine or Eutroxsig. It is 10% less active ingredient than Oroxine/Eutroxsig/Levoxine. 

Levoxine is bio-equivalent to Oroxine and Eutroxin. 

Levothyroxine brands are not interchangeable and two different brands should not be taken to make up a daily prescribed dose.

Time to Take Levothyroxine Medication

Recent research supports The ATF’s Recommendation to take Oroxine/Eutroxsig/Eltroxin/Levoxine first thing in the morning (as soon as your eyes are open) with a glass of water only, on an empty stomach. Wait at least 30 – 60 minutes after taking the dose before breakfast. Other prescribed medications, over the counter medications, vitamins/minerals herbal medicines and supplements should not be taken at the same time to avoid interactions with Oroxine/Eutroxsig/Eltroxin/Levoxine.

An interval of at least 4 hours after taking Oroxine/Eutroxsig/Eltroxin/Levoxine is recommended by Prof. Jim Stockigt before taking other medications. (Thyroid News No 7 Sept/Oct 2001). This is due to possible interactions and lower absorption. The longer you can leave taking other medications the better, as many medications, vitamins and supplements intact with Oroxine/Eutroxsig/Eltroxin/Levoxine.  (Please speak to your treating doctor if it’s possible to take other medications late in the day or night to avoid any interaction).

Storage of Oroxine and Eutroxsig

It is essential to refrigerate Oroxine and Eutroxsig blister strips between 2-8 degrees Celsius not yet in use. (refrigerated temperature). The ATF recommend all blister strips be kept refrigerated at all times. Remove your blister(s) from the refrigerator in the morning to retrieve your dose. This is to safeguard against spoilage from room temperatures rising throughout the day, due to seasonal change, or room heating during colder months.

Laboratory tests have shown that if not stored correctly, there is a reduction in potency of the active ingredient, thyroxine sodium.

Storage of Eltroxin

Eltroxin does not need to be kept at refrigerated temperature. Eltroxin should be kept below 25 degrees Celsius. Particularly during summer months and in areas of Australia that regularly reach 25 degree Celsius.  Please note Eltroxin is not the same formula as Oroxine/Eutroxsig/Levoxine. 

Tertroxin (Liothyronine sodium) - information

Tertroxin is a synthetic form of "liothyronine" (T3), which is a naturally occurring thyroid hormone, produced by the thyroid gland.

Levothyroxine – thyroid hormone replacement (T4) medication breaks down into Liothyronine (T3) once it absorbs after ingesting. 

Tertroxin is usually prescribed, after very careful consideration, by a thyroid treating specialist (Endocrinologist) who will determine if it will benefit the patient.  It can be prescribed to take with Levothyroxine (T4) medication or alone.  Please seek advice from an Endocrinologist who will monitor your pathology results regularly whilst taking Tertroxin.

Interaction of Vitamins, Supplements and Herbal Extracts When Taking Levothyroxine

The ATF do not recommend taking any vitamins, supplements or herbal extracts, unless you have been diagnosed by way of pathology testing of a definite deficiency and increasing additional nutrient through your daily food intake has not improved the deficiency.

Example: If you have low iron levels and increasing your weekly intake of red meat has not improved your iron levels. Therefore your treating doctor has recommended a supplement to improve your intake.

Many vitamins, supplements and herbal extracts interact with Levothyroxine and can cause Levothyroxine levels and absorption to be affected.

If you do need to take a vitamin, supplement or herbal extract please be very cautious and leave many hours between taking your Levothyroxine dose and then the supplement to avoid any unnecessary problems.

Do not store Oroxine/Eutroxsig/Eltroxin/Levoxine or any other medicines in a bathroom, near a sink or window or in the car.

If tablets become soft, crumble, and/or discoloured, you believe they are not effective, or you have developed side-effects, please contact the following and report:report to the please contact:

Therapeutic Goods Administration (TGA) – Reporting Adverse Events

www.tga.gov.au/reporting-adverse-events

The Australian Thyroid Foundation

Email: info@thyroidfoundation.org.au 

Adverse Medicine Event Line

Phone: 1300 134 237

NPS Medicines Line

Phone:  1300 Medicines (1300 633 424)