Liquid Levothyroxine: Convenience Comes at a Price
Thyquidity (levothyroxine sodium oral solution, Vertice Pharma) and Tirosint-SOL (levothyroxine sodium oral solution, IBSA Pharma Inc.) are two liquid levothyroxine options available in the US to treat hypothyroidism for people who have issues with swallowing the more commonly prescribed levothyroxine in pill form.
Data published from both liquid levothyroxine manufacturers in 2022 show a possible benefit to takers of the medications: the studies show no difference in bioavailability (how much of the medicine is in the bloodstream) or in blood levels of the T4 hormone when study participants took the medicine and waited the standard 30-60 minutes before either drinking coffee or eating a high-fat meal compared to when the participants took the liquid medicine and simply started sipping on a cup of black coffee or sat down to a high-fat breakfast without waiting.
The 2022 studies support studies previously published in Europe and the US that showed liquid levothyroxine absorbs quicker than the pill formation since the liquid form does not need to go through the initial phase of pill digestion in the stomach since it is already in liquid form. This quicker absorption time is thought to be what allows the medicine to get into the body and start working even when study participants did not wait to eat or drink after taking the liquid dose.
Current FDA-approved labeling for both products lists the standard instructions to wait 30 to 60 minutes before eating or drinking. Although several studies have been conducted and published in multiple countries, the study sizes are typically 30-40 participants and may not represent the wide range of individual responses that may be observed with larger, more diverse populations.
At least one of the companies are discussing whether to apply for an updated FDA approval showing the adjusted timing options.
Hypothyroidism is more common in people with diabetes than the general population. Since people with diabetes need to adhere to complex treatment plans, it is exciting to know that there may be a more convenient option available for those who take levothyroxine!
However, convenience comes at a price. An article by Miriam Tucker published in the July 2022 edition of Clinical Endocrinology News reports the price of liquid levothyroxine is around $115 to $180 per month. If it is not covered by insurance, the medicine cost would be more than many people would be willing or able to pay. Even if it is covered by insurance the copay would be much higher than the standard generic copay of $4 or the brand name copay of around $48 per month for the pill form at most pharmacies in the US.
If you are interested to see what your options are with trying out liquid levothyroxine, discuss this topic at your next thyroid follow-up visit with your Endocrinologist or Primary Care Provider.
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