Those with high concentrations should have outpatient review 3-6 days after ingestion to detect delayed onset hyperthyroidism. Levothyroxine systemic 50 mcg (0.05 mg) (M L 5) The resultant solutions contain approximately 20, 40, or 100 mcg/mL, respectively, of levothyroxine sodium.
-Initial loading dose: 300 to 500 mcg IV once-Maintenance dose: 50 to 100 mcg IV once a day until patient can tolerate oral therapy Comment:-Age, general physical condition, cardiac risk factors, severity and duration of myxedema coma should be considered when determining the initial and maintenance dosages. Part of a dose of Levothyroxine is metabolised to triiodothyronine. Select one or more newsletters to continue. Levotiron 75mcg 100 cachets- Pharmaceutical. These signs can take up to 5 days to appear. • Adrenal gland disorder or adrenal insufficiency.Patients with panhypopituitarism or other causes predisposing to adrenal insufficiency may react to levothyroxine treatment, and it is advisable to start corticosteroid therapy before giving levothyroxine to such patients.In individuals suspected to have cardiovascular disease or to be at high risk, it is important to perform an ECG prior to commencement of levothyroxine treatment in order to detect changes consistent with ischaemia in which case, levothyroxine should be initiated at a low dose, followed by cautious dose escalation to avoid worsening of ischaemia or precipitation of an infarct.Special care is needed for the elderly and for patients with symptoms of myocardial insufficiency, or ECG evidence of myocardial infarction.Levothyroxine sodium should be used with caution in patients with cardiovascular disorders, including angina, coronary artery disease and hypertension, and in the elderly who have a greater likelihood of occult cardiac disease.To minimise the risk of adverse effects of undetected overtreatment, such as atrial fibrillation and fractures associated with low serum levels of thyroid stimulating hormone (TSH) in older patients, it is important to monitor serum TSH and adjust the dose accordingly during long term usePatients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.Levothyroxine should be introduced very gradually in patients aged over 50 years (See section 4.2) and those with long standing hypothyroidism to avoid any sudden increase in metabolic demands.Thyroid replacement therapy may cause an increase in dosage requirements of insulin or other anti-diabetic therapy (such as metformin).
In this age group it is preferable to administer an approved oral solution of levothyroxine. The final daily dose may be up to 50 to 200 micrograms.For patients aged over 50 years, with or without cardiac disease, clinical response is probably a more acceptable criteria of dosage rather that serum levels.The maintenance dose is generally 100 to 150 micrograms per m² body surface area. The dose for children depends on their age, weight and the condition being treated. There may be increased toxicity in those with pre-existing heart disease.Give oral activated charcoal if more than10mg has been ingested by an adult or more than 5mg by a child, within 1 hour. Patients with normal free thyroxine concentrations do not require follow up. Signs of an overdose may include: fever, chest pain (angina), racing or irregular heartbeat, muscle cramps, headache, restlessness, flushing, sweating, diarrhoea, tremor, insomnia and hyperpyrexia. adrenaline or phenylephrine) are also enhanced.Cardiac glycosides: If levothyroxine therapy is initiated in digitalised patients, the dose of digitalis may require adjustment. Continue typing to refine. Triiodothyronine has a rapid action but a shorter duration of activity than Levothyroxine.The chief action of Levothyroxine is to increase the rate of cell metabolism.Levothyroxine sodium is incompletely and variably absorbed from the gastrointestinal tract. Hyperthyroid patients may need their digoxin dosage gradually increased as treatment proceeds because initially patients are relatively sensitive to digoxin.NSAIDs: False low plasma concentrations have been observed with concurrent anti-inflammatory treatment such as phenylbutazone or acetylsalicylic acid and levothyroxine therapy.Beta Blockers: levothyroxine (thyroxine) accelerates metabolism of propranolol, atenolol and sotalol. Conversely, androgens and corticosteroids may decrease serum concentrations of Levothyroxine-binding globulins.
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