Apr 1, 2015
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
With the Parkland Rangers hosting the Telus Cup Western Regionals, there is still some exciting hockey left to play in Dauphin. But for most of us, the hockey season is wrapping up. I've enjoyed watching Bantam Female, PeeWee Female and Atom hockey this winter. All the kids I watched this winter have improved tremendously over the season. But one team I'm involved with might be the antithesis of improvement. We fielded a team for the 40th Annual Kinsmen Perogy Cup in Yorkton in March. We had a lot of fun and even won a game. But there was something different about our team. I kept asking our competition, Was anyone on your team born before the Perogy Cup started? And I kept getting blank stares back. Our team only had two members under 40. It has been two to three decades since there have been any scouts in the crowd at our games. Or in my case, never, as lack of any hockey ability has always kept the scouts away. Maybe, I should have taken our pre-tournament team breakfast as a sign. When discussions between perogy players and alumni turned to which of our relatives were in personal care homes, maybe that should have been a clue why our team was different.
Whether you are in a personal care home or the community, levothyroxine is a very common prescription medication. It is used to treat an under active thyroid gland. What is the right way to take my thyroid pill? We get that question in the pharmacy quite a bit. Levothyroxine is a little finicky, but maybe we pharmacists have made too big a deal about how finicky it is. It really isn't necessary to set you alarm for 4:30 am to take your levothyroxine before your breakfast and other pills. The important part is to take your levothyroxine the same way and same time every day. However, it is much more important that you remember to take your thyroid pills everyday than exactly how you take them. I read a nice review in Pharmacists Letter about levothyroxine myths that I think I should share.
Myth Number One: Levothyroxine must be taken in the morning and on an empty stomach. It is true that levothyroxine is absorbed best on an empty stomach. However, it is still absorbed with some food in the stomach. Again we want to find a consistent time of day that the patient is going to remember to take the thyroid pill. First thing in the morning before breakfast is still an excellent choice, but if that doesn't work for you, last thing at night before bed could work just as well. Bedtime is usually 4 hours after you've eaten and for some people it will be easier to remember. Once a patient finds a time of day they can remember to take their thyroid, their doctor can check their thyroid levels or TSH in 4 to 6 weeks. Then the doctor can adjust the dose if necessary.
Myth Number Two: All other medications must be taken four hours away from levothyroxine. The myth here is really only some medications need to be taken four hours away from your thyroid pill. Calcium pills and iron pills are the most common offenders. They really do have to be taken four hours away from your thyroid pill or they will bind it up the levothyroxine and it won't work. For the osteoporosis pills called bisphosphonates with names like fosamax and alendronate, take the osteoporosis pill first on an empty stomach, wait about 30 minutes and then take the thyroid pill. For your other meds, it might be okay to take them at the same time as you levothyroxine. We want your medications to fit into your routine, not the other way around. So ask you pharmacist if you current medication routine is okay or not.
Myth Number Three: Brands of levothyroxine should never be switched back and forth. There are two main brands of levothyroxine: Synthroid and Eltroxin. I was taught in pharmacy school that you couldn't switch back and forth between the brands. So I was very surprised that the Pharmacists Letter had experts saying it wasn't that bad. Now to be clear, all the experts said it was preferable that a patient stay on one brand of levothyroxine if possible. However, in these days of constant drug shortages, sometimes pharmacies have no choice. We call our supplier and order more of one brand of levothyroxine and our supplier says they are out. That is all the warning we get. The question then is, how big a deal is it if we have to switch a patient from one brand of levothyroxine to another. The answer is not that big a deal. The original scare came about years ago when the medications were first released. The manufacturers started publishing competing studies saying their pill was made better than the competition. But how well a pill dissolves in a beaker is different from how much is absorbed in a person. So if we have to switch a person from one brand of levothyroxine to another it is fine. If we are really concerned like if the patient is pregnant or has thyroid cancer or some other condition where we want their thyroid level to some really specific level, we can just retest their TSH 4-6 weeks after the brand change.
Find a time of day you can remember you thyroid pill and stick with it. Tell your doctor and pharmacist your medication routine and we can adjust your thyroid medication to you instead of the other way around. You dont need a How to take your levothyroxine check list. Hockey might be different, though. In case you are wondering if youy hockey team might be getting a little long in the tooth, I've devised a handy checklist. Have any team members past a big Zero like 40, 50 or 60? How many members have actually retired from work? How many members, like me, have gone to the St. Boniface Hospital Cardiac ward for a week to get some work done? How many members can describe what an on ice heart attack feels like and talk about those symptoms to warn other members? How many members are on blood thinners because of life threatening clotting disorders? How many members only skate once a year at the Perogy Cup? If I had been listening carefully during that pre-tournament breakfast, maybe I should have suggested we skip the hockey, hike our pants up to our arm pits and go directly to the casino. Or maybe hockey is a fountain of youth. It is in in my mind anyway.
I am Trevor Shewfelt from the Dauphin Clinic Pharmacy. The Pharmacy Feature is heard here every Tuesday on 730 CKDM
As always if you have any questions or concerns about these products, ask your pharmacist.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.