Vitamin C And Levothyroxine

Review

doi: 10.3390/ph14030206.

Levothyroxine Interactions with Food and Dietary Supplements-A Systematic Review

Affiliations

PMID: 33801406
PMCID: PMC8002057
DOI: 10.3390/ph14030206

Free PMC article

Review

Levothyroxine Interactions with Food and Dietary Supplements-A Systematic Review

Agnieszka Wiesner et al. Pharmaceuticals (Basel). 2021 .

Free PMC article

Abstract

Levothyroxine (l-thyroxine, l-T4) is a drug of choice for treating congenital and primary hypothyroidism. Although clinically significant interactions between l-T4 and food can alter the safety and efficacy of the treatment, they still seem to be generally underestimated by patients, physicians and pharmacists. This review aimed to investigate the effects of meals, beverages, and dietary supplements consumption on l-T4 pharmacokinetics and pharmacodynamics, to identify the most evident interactions, and to perform the recommendations for safe co-administering of l-T4 and food. A total of 121 studies were identified following a systematic literature search adhering to PRISMA guidelines. After full-text evaluation, 63 studies were included. The results proved that l-T4 ingestion in the morning and at bedtime are equally effective, and also that the co-administration of l-T4 with food depends on the drug formulation. We found limited evidence for l-T4 interactions with coffee, soy products, fiber, calcium or iron supplements, and enteral nutrition but interestingly they all resulted in decreased l-T4 absorption. The altered l-T4 efficacy when ingested with milk, juices, papaya, aluminium-containing preparations, and chromium supplements, as well as observed enhancement effect of vitamin C on l-T4 absorption, shall be further investigated in larger, well-designed studies. Novel formulations are likely to solve the problem of coffee, calcium and iron induced malabsorption of l-T4. Maintaining a proper time interval between l-T4 and food intake, especially for coffee and calcium, or iron supplements, provides another effective method of eliminating such interactions.

Keywords: coffee; fiber; food; interaction; levothyroxine; soy.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Cited by 4 articles

Over-the-counter protein supplement resulting in impaired thyroxine absorption in a hypothyroid patient.

Kumarathunga PADM, Kalupahana NS, Antonypillai CN. Kumarathunga PADM, et al. Endocrinol Diabetes Metab Case Rep. 2021 Jul 19;2021(21-0070):21-0070. doi: 10.1530/EDM-21-0070. Endocrinol Diabetes Metab Case Rep. 2021. PMID: 34280893 Free PMC article.
Decreased Expression of Ileal Thyroid Hormone Transporters in a Hypothyroid Patient: A Case Report.

Chung CW, Mo EY, Jung GS, Kim YH, Cho SW, Park DJ, Bae JM, Park YJ. Chung CW, et al. Front Endocrinol (Lausanne). 2021 May 26;12:664839. doi: 10.3389/fendo.2021.664839. eCollection 2021. Front Endocrinol (Lausanne). 2021. PMID: 34122338 Free PMC article.
Optimal Dosing Regimen of Osteoporosis Drugs in Relation to Food Intake as the Key for the Enhancement of the Treatment Effectiveness-A Concise Literature Review.

Wiesner A, Szuta M, Galanty A, Paśko P. Wiesner A, et al. Foods. 2021 Mar 29;10(4):720. doi: 10.3390/foods10040720. Foods. 2021. PMID: 33805435 Free PMC article. Review.
Effect of Food and Dosing Regimen on Safety and Efficacy of Proton Pump Inhibitors Therapy-A Literature Review.

Wiesner A, Zwolińska-Wcisło M, Paśko P. Wiesner A, et al. Int J Environ Res Public Health. 2021 Mar 29;18(7):3527. doi: 10.3390/ijerph18073527. Int J Environ Res Public Health. 2021. PMID: 33805341 Free PMC article. Review.

References

1. Chiovato L., Magri F., Carlé A. Hypothyroidism in Context: Where We've Been and Where We're Going. Adv. Ther. 2019;36:47–58. doi: 10.1007/s12325-019-01080-8. - DOI - PMC - PubMed
1. Kane S. The Top 200 of 2020. [(accessed on 19 October 2020)]; Available online: https://clincalc.com/DrugStats/Top300Drugs.aspx.
1. McMillan M., Rotenberg K.S., Vora K., Sterman A.B., Thevathasan L., Ryan M.F., Mehra M., Sandulli W. Comorbidities, Concomitant Medications, and Diet as Factors Affecting Levothyroxine Therapy: Results of the CONTROL Surveillance Project. Drugs RD. 2016;16:53–68. doi: 10.1007/s40268-015-0116-6. - DOI - PMC - PubMed
1. Michel R., Neafsey P. Self Medication Practices among Patients taking Levothyroxine. Internet J. Adv. Nurs. Pract. 2012;6:2–9. doi: 10.5580/22a8. - DOI
1. Colucci P., Yue C.S., Ducharme M., Benvenga S. A review of the pharmacokinetics of levothyroxine for the treatment of hypothyroidism. Eur. Endocrinol. 2013;9:40–47. doi: 10.17925/ee.2013.09.01.40. - DOI - PMC - PubMed

Publication types

LinkOut - more resources

Full Text Sources
- Europe PubMed Central
- Multidisciplinary Digital Publishing Institute (MDPI)
- PubMed Central
Other Literature Sources
- scite Smart Citations

Vitamin C And Levothyroxine

Source: https://pubmed.ncbi.nlm.nih.gov/33801406/

Vitamin C And Levothyroxine