![]() Synthroid (levothyroxine sodium) dose, indications, adverse effects, interactions.. Normal doses of levothyroxine are not effective in reducing weight in euthyroid patients. Larger doses may produce serious or even life- threatening toxicity, particularly when given in association with sympathetic amines that are used for their anorectic effects. ![]() ![]() Oral dosage (capsule and tablet)Adults If otherwise healthy, initiate at full replacement dosage of roughly 1. PO. For geriatric patients or if patient has underlying cardiac disease, begin at 1. PO once daily with gradual (1. Greater than 2. 00 mcg/day is rarely required. Inadequate response to 3. In patients with severe longstanding hypothyroidism, the recommended initial dose is 1. In patients with subclinical hypothyroidism, if treated, a lower levothyroxine sodium dose (e. Welcome to Boxing for Life! This site is dedicated to teach individuals how to box, and to give back to the sport that has helped change my life.Moyer Instruments, Inc. Thyroid hormones, either alone or with other therapeutic agents, should not be used for the treatment of obesity or for weight loss. Find patient medical information for levothyroxine oral on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Levothyroxine Sodium Levothroid®; Levoxyl®; Synthroid®; other: INDICATIONS AND USAGE. Ron Arvine, President of Arvine Pipe & Supply Co., Inc. ![]() Patients who are not treated should be monitored yearly for changes in clinical status and thyroid laboratory parameters. Per treatment guidelines, levothyroxine is the preferred treatment for hypothyroidism. Adolescents in whom growth and puberty are complete 1. PO once daily. In patients with severe hypothyroidism, the recommended initial dose is 1. Hyperactivity can be minimized if initiated at a dose that is 2. ![]() The dose can be increased weekly by an amount equal to 2. Adolescents in whom growth and puberty are incomplete 2 to 3 mcg/kg/day PO once daily. Hyperactivity can be minimized if initiated at a dose that is 2. The dose can be increased weekly by an amount equal to 2. In chronic or severe hypothyroidism, initiate with 2. Children 6 to 1. 2 years 4 to 5 mcg/kg/day PO once daily. Hyperactivity in older children can be minimized if initiated at a dose that is 2. The dose can be increased weekly by an amount equal to 2. In chronic or severe hypothyroidism, initiate with 2. Children 1 to 5 years 5 to 6 mcg/kg/day PO once daily. Hyperactivity can be minimized if initiated at a dose that is 2. The dose can be increased weekly by an amount equal to 2. However, in chronic or severe hypothyroidism, initiate with 2. Infants 6 to 1. 2 months 6 to 8 mcg/kg/day PO once daily. Infants 3 to 5 months 8 to 1. PO once daily. Neonates and Infants 1 to 2 months 1. PO once daily. The dose may be increased every 4 to 6 weeks as needed. ![]() Consider lower initial doses (e. In neonates/infants with very low (less than 5 mcg/d. L) or undetectable serum T4, the initial starting dose is 5. PO once daily. Oral dosage (solution)Adults If otherwise healthy, initiate at full replacement dosage of roughly 1. PO. For geriatric patients or if patient has underlying cardiac disease, begin at 1. PO once daily with gradual (1. Greater than 2. 00 mcg/day is rarely required. Inadequate response to 3. ![]() ![]() ![]() In patients with severe longstanding hypothyroidism, the recommended initial dose is 1. Adolescents in whom growth and puberty are complete 1. PO once daily. In patients with severe hypothyroidism, the recommended initial dose is 1. Hyperactivity can be minimized if initiated at a dose that is 2. ![]() The dose can be increased weekly by an amount equal to 2. Adolescents in whom growth and puberty are incomplete 2 to 3 mcg/kg/day PO once daily. Hyperactivity can be minimized if initiated at a dose that is 2. The dose can be increased weekly by an amount equal to 2. Children 6 to 1. 2 years 4 to 5 mcg/kg/day PO once daily. Hyperactivity in older children can be minimized if initiated at a dose that is 2. The dose can be increased weekly by an amount equal to 2. Children 1 to 5 years 5 to 6 mcg/kg/day PO once daily. Hyperactivity in older children can be minimized if initiated at a dose that is 2. The dose can be increased weekly by an amount equal to 2. Infants 6 to 1. 2 months 6 to 8 mcg/kg/day PO once daily. Infants 3 to 5 months 8 to 1. PO once daily. Neonates and Infants younger than 3 months 1. PO once daily in the morning 3. The dose may be increased every 4 to 6 weeks as needed. Consider lower initial doses in neonates/infants with risks for cardiac failure. Intravenous. Some patients may need titration after this initial dosage selection to maintain euthyroid status. If the patient has previously taken their oral medication as directed on an empty stomach, the PO bioavailability of levothyroxine approaches 8. Based on medical practice, the relative bioavailability between oral and IV administration is estimated to be 4. TSH measurements a few weeks after initiating therapy to ensure proper dose adjustments. Conversely, if a patient is stabilized on IV or IM dosage, when it is time to convert back to oral dosage, many clinicians use an initial 2. IV or IM dosage based on the pharmacokinetic parameters observed in medical practice to convert to an initial oral dosage, with subsequent dosage titration based on clinical and laboratory status to individualize dose and achieve euthyroidism. Infants, Children, and Adolescents Initially, 5. IV or IM once daily in patients unable to take oral doses. Some patients may need titration after this initial dosage selection to maintain euthyroid status. Based on medical practice, the relative bioavailability between oral and IV administration is estimated to be 4. TSH measurements a few weeks after initiating therapy to ensure proper dose adjustments. Neonates Initially, 5 to 8 mcg/kg/day IV in patients initiating levothyroxine who are unable to take oral doses. In patients already taking an oral dose of levothyroxine who require parenteral administration, give 5. IV once daily. Intravenous dosage. Adults 3. 00 to 5. IV initially, with an additional 1. Continuous daily administration of 7. IV should be given until the patient is stabilized, and oral administration is feasible. Myxedema coma is a life- threatening emergency characterized by poor circulation and hypometabolism; oral therapy is not recommended since unpredictable absorption from the GI tract may occur. Guidelines state that levothyroxine IV is the preferred therapy: give a loading dose of 2. IV of levothyroxine, with lower doses given for smaller, older patients and those with a history of coronary disease or arrhythmia. A daily replacement dose of 1. IV, can be given thereafter. Institute oral therapy after the patient improves clinically. For thyroid stimulating hormone (TSH) suppression in thyroid nodules, euthyroid goiters, and well- differentiated thyroid cancer. Oral dosage (capsule and tablet)Adults Suppression of TSH requires higher doses than those used for replacement therapy. Doses are usually greater than 2 mcg/kg/day PO. Individualize dose to the disease treated and desired clinical response. Monitor patient closely with TSH concentrations and clinical status. In general, TSH concentrations are usually suppressed to less than 0. U/L for thyroid cancer; in patients with high- risk tumors, the target concentration for TSH suppression may be less than 0. U/L. For benign thyroid nodules and nontoxic multinodular goiter, the TSH is generally suppressed to a higher target (e. U/L) than that used for the treatment of thyroid cancer. Levothyroxine is contraindicated if the serum TSH is already suppressed due to the risk of precipitating overt thyrotoxicosis. MAXIMUM DOSAGENarrow therapeutic index; dosage must be individualized. Adults. Doses above 2. PO rarely needed. Elderly. Doses above 2. PO rarely needed. Adolescents. In whom growth and puberty are complete: Doses above 2. PO rarely needed. Children. Individualize dosage. Infants. Individualize dosage. Neonates. Individualize dosage. DOSING CONSIDERATIONSHepatic Impairment. Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed. Renal Impairment. Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed. ADMINISTRATIONOral Administration. Administer on an empty stomach with a full glass of water at least 3. Administer apart from medications known to decrease absorption and apart from enteral feedings. Bioavailability is best when administered in the fasting state. Oral Solid Formulations. Capsules: Do not administer capsules to patients that cannot swallow the intact capsule. The capsules should not be crushed or cut. In addition, the capsules can not be dissolved in water. Tablets: Levothyroxine tablets may rapidly disintegrate; reports exist of choking, gagging, dysphagia, and tablets being stuck in the throat. Instruct patients to take tablets with a full glass of water, which reduces the risk for this problem in most patients. Tablets may be crushed and suspended in a small amount (5 to 1. L) of water, breast milk, or non- soy based infant formula, and administered by spoon or dropper for those unable to swallow whole tablets. Administer immediately after preparation; do not store. Alternatively, an extemporaneous suspension can be prepared. Tablets may be crushed and sprinkled over a small amount (5 to 1. L) of food (e. g., cool apple sauce). Administer immediately after preparation. Do not mix crushed tablets with enteral feedings or soybean- based infant formulas; these reduce bioavailability. Do NOT dilute with any liquid other than water. The preparation should be administered immediately and consumed in its entirety to ensure all of the dose is received. Rinse the glass or cup with additional water and drink the contents to ensure the entire dose is taken. To administer directly (without water), either squeeze it into the mouth or onto a spoon and immediately consume. Storage: Store unopened ampules in the original container (pouch) at 7. F (2. 5 degrees C); excursions are permitted to 5. F (1. 5 to 3. 0 degrees C). Discard any unused ampules 1. Extemporaneous Compounding- Oral. Extemporaneous preparation of a 2. L levothyroxine oral suspension: NOTE: Levothyroxine is not available as an FDA- approved oral suspension. With a mortar and pestle, grind twenty- five 0. In a separate container, measure 4. L glycerol. Add a small amount of the glycerol to the fine powder and mix into a uniform paste.
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