Absorption of Levothyroxine When Co-Administered with Various Calcium Formulations.

Abstract

Background: Calcium carbonate is a commonly used dietary supplement and has been shown to interfere with levothyroxine absorption. However, calcium citrate, which is also used for supplementation purposes, has not been studied previously and calcium acetate, which is used to treat hyperphosphatemia in renal failure, has been reported to show little or no interference with levothyroxine absorption in a retrospective pharmacoepidemiologic study. We aimed to compare the effect of these three calcium formulations on levothyroxine absorption. Materials and Methods: The study was conducted in eight healthy, euthyroid adults. We performed single-dose pharmacokinetic studies in which we measured levothyroxine absorption when given alone or when coadministered with calcium carbonate, calcium citrate, or calcium acetate in doses containing 500 mg elemental calcium. Serum thyroxine was measured at intervals over a 6-hour period after ingestion of the study drugs. Results: Coadministration of each of the three calcium preparations significantly reduced levothyroxine absorption by about 20%-25% compared with levothyroxine given alone. Conclusions: Contrary to a prior report, our data suggest that calcium acetate interferes with levothyroxine absorption in a manner similar to that seen with calcium carbonate and calcium citrate. Although the effect of calcium is modest compared with some other medications previously studied, hypothyroid patients should be cautioned to take their levothyroxine well-separated from all of these calcium formulations.

Assessment of comorbidities in patients with deranged thyroid hormone levels

“…9 Irving et al and Zamfirescu et al study showed that simultaneous administration of thyroxine and ferrous sulphate causes a recurrence of the hypothyroid state in some patients. 5,10 In our study, probable drug interaction between calcium salts and levothyroxine led to decreased absorption of levothyroxine and hence complaints of sleepiness, constipation, dry skin. Similarly, ferrous sulphate may have decreased absorption of levothyroxine, leading to complaints of decreased appetite, sleepiness, body ache, swelling over body in some patients.…”