Levothyroxine Brands/Formulas
What you need to know
Back in 2023 the Australian Thyroid Foundation published an article named Patient’s Medication Choice of Brand for good reason.
At this time, changes were made to pharmacists’ regulations regarding dispensing of medications. This gave pharmacists the power to change the brand/formula of a patient’s medication from what they were prescribed to a generic brand.
Thyroid patients have been impacted by this change. Patients’ brand/formula should not be changed by a pharmacist without the patient and treating doctor’s permission and for a medical reason. Every brand/formula is different. Regardless of whether brands/formulas are bioequivalent, they do not work the same as each other.
Prescriptions no longer have to include a brand/formula’s name. Doctors have to include the generic name of the medication, Levothyroxine, which is the only stipulation. Doctors can also tick the ‘Substitute Not Allowed’ box on the prescription; however, this is not always adhered to by pharmacists.
Pharmacists should always ask a thyroid patient which brand their doctor prescribed and which they are stable on, and dispense that brand.
Two different brands of levothyroxine should not be dispensed to make up a dose i.e. 75mcgs of one brand and 50mcgs of another to make up a dose of 125mcgs, as all brands are different formulas and can cause thyroid health issues for patients. The same brand for both doses must be dispensed.
Patients trust their pharmacist will give them the best advice regarding their medication. Pharmacists should not be giving misinformation, including telling patients their usual brand is no longer available or is now made differently, or that all brands are the same. If a pharmacist does not have the patient’s usual brand/formula in stock, the pharmacist should offer to order it, which should not take any more than 24 hours to arrive at the pharmacy in most cases.
If a patient’s prescribed dose of the brand they take is in ‘short supply’, meaning not available at the moment, that is what the patient should be told, and the pharmacist should work with the patient, either by speaking to their doctor or dispensing another dose to work around the ‘short supply’ dose until it is available. The brand/formula should not be changed.
Patients are also not usually told to be conscious of the temperature control of unrefrigerated brands/formulas. Unrefrigerated brands must be kept under 25 degrees Celsius, which can be difficult for patients to monitor daily. Temperature control could easily be part of the problem, with Australian temperatures in many parts of the country rising well above 25 degrees Celsius even during cooler months. Home heating during winter months could also contribute to maintaining temperature control.
Patients regularly report their concerns to the ATF. Below are some examples of what they report:
- A return of hypothyroid symptoms
- Irregular blood results
- Side effects, including rashes
- Feeling unwell, which affects their mood and well-being
- Symptoms unrelated to the thyroid
Doctors who hear these symptoms could easily believe the patient has another health issue, and the patient could be taken on a different journey.
The ATF is concerned that so many patients are being affected because their levothyroxine brand/formula has been changed. It is possible due to this regulation change that a patient could be given 3 different brands/formulas over a year, which is unacceptable and concerning.
The ATF wants all patients to live with Good Thyroid Health and do all we can to help patients through their thyroid journey.
What can you do?
If a pharmacist has changed your Levothyroxine brand/formula to another brand and you believe it has affected or compromised your thyroid health, please let us know and also contact the Therapeutic Goods Administration (TGA) and the Australian pharmacy organisations, with your concerns and how changing brands has affected your thyroid health and wellbeing. This problem is affecting too many patients, and the ATF wants you to be aware.
Australian Thyroid Foundation – info@thyroidfoundation.org.au
The Therapeutic Goods Administration – https://tga.gov.au/contactus
National Secretariat – The Pharmacy Guild of Australia – guild.nat.@guild.org.au
Pharmaceutical Society of Australia – 1300 369 772
A Member’s First-Hand Experience
Read a member’s first-hand experience and discover why staying informed about thyroid medication brand changes is important.
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