Levothyroxine and Proton Pump Inhibitor Drugs
Are you hypothyroid, taking levothyroxine, and also taking a proton pump inhibitor (PPI) drug? PPIs are drugs that are taken to prevent or treat various conditions involving stomach acid, including ulcers and gastroesophageal reflux disease (GERD).
PPI drugs include:
omeprazole (Prilosec)
lansoprazole (Prevacid)
esomeprazole (Nexium)
pantoprazole (Protonix)
rabeprazole (Aciphex)
dexlansoprazole (Dexilant)
Hopefully, you've already been told by your doctor or pharmacist to take your levothyroxine at least 3 to 4 hours apart from your PPI drug to avoid problems with absorption of the thyroid medication. That said, new research has found that even if you take your PPI apart from your thyroid medication, absorption can be negatively affected. When you add in other factors, including interference of food and other drugs, the malabsorption can be even worse.
We already know, anecdotally, that the liquid form of levothyroxine — Tirosint-SOL oral solution — is resistant to the effects of PPI drugs, compared to tablets. But now we've got the receipts!
In one recent research study, patients were switched from levothyroxine tablets to Tirosint-SOL oral solution, at the same dose. In all cases, the patients had normalized or reduced TSH levels. (Some of the patients, for various reasons, were switched back to tablets, and their TSH levels again rose, in some cases to hypothyroid levels!)
Another new bioavailability study found that absorption of Tirosint-SOL was not affected by also taking a PPI drug at the same time.
Bottom line: If you are taking a levothyroxine drug, like Synthroid, Levoxyl, Euthyrox, Unithroid, or generic levothyroxine, and you are also taking a PPI drug, it's time to talk to your doctor about whether to switch to Tirosint-SOL.
Learn More About Your Levothyroxine Options
If you’re interested in learning more about all your levothyroxine options, and the pros and cons of different types and brands of levothyroxine, check out my free educational program, the Levothyroxine Deep Dive. The program features 3 informative video webinars — watch any time, on-demand, on any device — a free full-length book to download, and a comprehensive website. You can find the Levothyroxine Deep Dive at www.mary-shomon.com/dive.
Sources:
Ducharme, Murray et. al. "The Pharmacokinetics of a Novel Solution of Levothyroxine is Not Influenced by Proton-Pump Inhibitors," American Thyroid Association Annual Meeting Clinical Poster, October 2021, https://www.liebertpub.com/doi/full/10.1089/thy.2021.29115.abstracts
Fallahi, P et. al. "Serum TSH Levels Normalisation in Patients in Treatment with Proton Pump Inhibitors, After the Switch from Oral L-T4 in Tablet Form to L-T4 in Liquid Formulation,"American Thyroid Association Annual Meeting Clinical Poster, https://www.liebertpub.com/doi/10.1089/thy.2021.29118.lb.abstracts