The Influence of Cholestyramine on Thyroxine Absorption

Northcutt, Robert C.; Stiel, J. N.; Hollifield, John W.; Stant, Edwin G.

doi:10.1001/jama.1969.03160100047012

Cited by 125 publications

(46 citation statements)

References 7 publications

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“…When ATDs can no longer be used because of severe adverse effects, binding resins such as cholestyramine, which binds iodothyronine, are an adjunctive measure to physically remove thyroid hormones from the enterohepatic circulation, which is increased in hyperthyroidism [31,32]. The dose of cholestyramine for effectively reducing thyroid hormone levels has been recommended to be 4 g three or four times daily [6].…”

Section: • Commentsmentioning

confidence: 99%

“…Compensatory mechanisms in each affected organ fail before achieving euthyroidism, resulting in multiple organ failure. Based on these findings, TPE has been considered to be a more essential therapeutic option than originally thought [31,41]. On the other hand, case reports from around the world, including Japan, have described TPE as ineffective in several cases.…”

Section: • Commentsmentioning

confidence: 99%

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2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition)

et al. 2016

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Section: • Commentsmentioning

confidence: 99%

Section: • Commentsmentioning

confidence: 99%

2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition)

et al. 2016

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“…After oral administration, approximately 70-80% of levothyroxine is absorbed [8]. Concomitant medication with cholestyramine [9], sucralfate [10], ferrous sulphate [11] and aluminium hydroxide [12] has been shown to reduce its absorption, as have active charcoal and dietary fibre [13]. The mechanism of intestinal absorption of levothyroxine is only partially understood.…”

Section: Introductionmentioning

confidence: 99%

Effects of grapefruit juice on the absorption of levothyroxine

Lilja¹,

Laitinen

Neuvonen³

2005

Brit J Clinical Pharma

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AimsOur aim was to study the effect of grapefruit juice on the pharmacokinetics of levothyroxine. MethodsIn a randomized cross-over study with two phases, 10 healthy subjects ingested 200 ml grapefruit juice or water (control) three times daily for 2 days. On day 3, a single 600 m g dose of levothyroxine was administered with 200 ml grapefruit juice or water, which was also ingested 1 h before and 1 h after levothyroxine. Serum concentrations of total thyroxine (T4) and thyroid-stimulating hormone (TSH) were measured up to 24 h. ResultsGrapefruit juice decreased slightly (11%; P < 0.01) the maximal increase of T4 concentration after ingestion of levothyroxine from 66.4 nmol l -1 to 59.4 nmol l -1 (95% CI on the difference -11.3, -2.7). The incremental areas under the serum T4 concentration-time curve (dAUC) during the first 4 and 6 h were also decreased slightly: dAUC(0,4 h) by 13% ( P < 0.05), from 195 nmol l -1 h to 169 nmol l -1 h (95% CI -51, -1) and dAUC(0,6 h) by 9% ( P = 0.085), from 298 nmol l -1 h to 271 nmol l -1 h (95% CI -58, 4). The decrease in the serum concentration of TSH (1.25 mU l -1 ) measured 24 h after ingestion of levothyroxine, was not altered by grapefruit juice. ConclusionsGrapefruit juice may slightly delay the absorption of levothyroxine, but it seems to have only a minor effect on its bioavailability. Accordingly, the clinical relevance of the grapefruit juice-levothyroxine interaction is likely to be small.

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“…These medications include bile acidbinding resins (1), iron salts (2), sucralfate (3), aluminumcontaining antacids (4), raloxifene (5), chromium picolinate (6), sevelamer HCl (6), colesevelam HCl (7), and lanthanum carbonate (7). The mechanism by which this malabsorption occurs is presumed to be a binding of the medication to the thyroid hormone, forming an insoluble or nonabsorbable complex (1,2,4,8,9).…”

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confidence: 99%

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

Zamfirescu¹,

Carlson²

2010

The Endocrine Society's 92nd Annual Meeting, June 19–22, 2010 - San Diego

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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.

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The Influence of Cholestyramine on Thyroxine Absorption

Cited by 125 publications

References 7 publications

2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition)

2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition)

Effects of grapefruit juice on the absorption of levothyroxine

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

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