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Medicines > fda max

: 20 mg/d

or No fixed maximum; titrated to TSH target

or Titrated to glucose; no fixed ceiling

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None (2) · Bisoprolol (1) · Insulin degludec (1) · Insulin glargine (1) · Levothyroxine (1) · Terazosin (1) · Thyroid (desiccated) (1) · Vardenafil (1)

Armour Thyroid, NP Thyroid, Nature-Throid, WP Thyroid (1) · Belsomra (1) · Hytrin (US brand discontinued); mostly generic (1) · Lantus, Basaglar, Semglee, Toujeo (U-300) (1) · Levitra, Staxyn (1) · Synthroid, Levoxyl, Tirosint, Unithroid, Euthyrox (1) · Tresiba (1) · Trintellix (US), Brintellix (formerly) (1) · Zebeta (1)

Beta Blocker (1) · Cardioselective (β1) (1) · Dual orexin receptor antagonist (DORA) (1) · Multimodal antidepressant: SERT inhibitor + 5HT1A agonist + 5HT1B partial agonist + 5HT3/5HT7 antagonist (1) · PDE5 Inhibitor (1) · the first approved (1) · [[:Category:Alpha-1_blockers|Alpha-1 adrenergic blocker (non-selective)]] (1) · [[:Category:Antihypertensives|Antihypertensive]] (1) · [[:Category:Basal_insulins|Basal insulin]] (2) · [[:Category:BPH_treatments|Benign prostatic hyperplasia treatment]] (1) · [[:Category:Hormone_replacement|Hormone replacement]] (2) · [[:Category:Insulins|Insulin]] (2) · [[:Category:Long-acting_insulins|Long-acting insulin analog]] (1) · [[:Category:Thyroid_hormones|Thyroid hormone]] (2) · [[:Category:Ultra-long-acting_insulins|Ultra-long-acting insulin analog]] (1)

None (1) · Competitive antagonist at OX1R and OX2R. First-in-class DORA. Receptor dissociation slower than lemborexant or daridorexant. (1) · Highly β1-selective adrenergic antagonist. Greater selectivity than metoprolol or atenolol. (1) · Selective inhibitor of PDE5. Slightly higher PDE5/PDE6 selectivity vs sildenafil (less visual side effect) but more PDE1 cross-activity (occasional QT effects at high doses). (1) · Synthetic T4 (thyroxine); peripherally deiodinated to T3 (triiodothyronine), the active hormone. '"`UNIQ--vote-00000031-QINU`"' Narrow therapeutic index; brand-to-generic switches can shift TSH and require re-titration'"`UNIQ--ref-00000032-QINU`"'. (1) · '"`UNIQ--vote-00000032-QINU`"' Brand-to-brand and lot-to-lot variability in T3:T4 ratio is greater than with synthetic levothyroxine, which is why endocrine guidelines prefer the synthetic'"`UNIQ--ref-00000033-QINU`"'. (1) · '"`UNIQ--vote-00000237-QINU`"' Binds the same insulin receptor as endogenous insulin with comparable mitogenic-to-metabolic ratio; provides basal hepatic glucose suppression and peripheral glucose uptake without prandial peaks'"`UNIQ--ref-00000238-QINU`"'. (1) · '"`UNIQ--vote-0000111B-QINU`"' Intraoperative floppy iris syndrome is a recognized class effect. Recently emerging evidence (observational) suggests possible Parkinson's disease risk reduction via PGK1 binding — investigational and not a clinical indication'"`UNIQ--ref-0000111C-QINU`"'. (1) · '"`UNIQ--vote-00001356-QINU`"' Binds the same insulin receptor as endogenous insulin with comparable mitogenic-to-metabolic ratio'"`UNIQ--ref-00001357-QINU`"'. (1)

1 mg PO at bedtime to limit first-dose syncope; titrate weekly to 5-10 mg (1) · 1.6 mcg/kg/d in young healthy adults; 25-50 mcg/d in elderly or cardiac disease, titrated by TSH at 6-8 weeks (1) · 10 mg PO 30 min before bedtime (with ≥7 hours of sleep planned) (1) · 10 mg PO once daily; may increase to 20 mg as tolerated, or decrease to 5 mg if needed (1) · 10 mg ~1 h before sexual activity (1) · 2.5–5 mg daily (HTN); 1.25 mg daily (HFrEF, slow titration) (1) · 30 mg PO daily (1/2 grain); titrate by TSH at 6-8 weeks; 60 mg desiccated thyroid is approximately equivalent to 88-100 mcg levothyroxine (1) · ~10 units SC at the same time daily, or 0.1-0.2 units/kg/d; titrate by fasting glucose (2)

1, 2, 5, 10 mg capsules and tablets (1) · 100 U/mL (FlexTouch pen) and 200 U/mL (FlexTouch pen, higher-dose convenience) (1) · 100 U/mL (Lantus, Basaglar, Semglee) vials and pens; 300 U/mL (Toujeo) pens (1) · 15, 30, 60, 90, 120, 180, 240, 300 mg tablets (1/4 to 5 grains; 1 grain = 60 mg) (1) · 2.5, 5, 10, 20 mg tabs (Levitra); 10 mg ODT (Staxyn) (1) · 25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, 300 mcg tablets; oral capsule and IV/IM also available (1) · 5 mg, 10 mg, 15 mg, 20 mg tablets (1) · 5 mg, 10 mg, 20 mg tablets (1) · 5, 10 mg tabs (1)

IV (1) · Oral (7) · Subcutaneous (never IV; not for use in insulin pumps) (2)

1-2 hours (1) · 1–2 h (1) · BP and symptomatic LUTS improvement within 1-2 weeks (1) · TSH normalization 4-8 weeks (1) · TSH normalization 4-8 weeks; symptomatic improvement weeks to months (1) · Typical antidepressant 4-6 week onset (1) · ~1 hour (1) · ~30 min (2)

24 h (1) · 24 hours (1) · 4–5 h (1) · >42 hours per dose (effectively flat once at steady state) (1) · Daily dosing (1) · Steady-state at 4-6 weeks (2) · ~24 hours per dose (peakless profile by design) (1) · ~7-8 hours (1)

4–5 h (1) · 9–12 h (1) · T4 ~7 days; T3 ~1 day'"`UNIQ--ref-00000036-QINU`"' (1) · ~12 hours (1) · ~12 hours apparent (functional duration ~24 hours due to depot release kinetics)'"`UNIQ--ref-0000023B-QINU`"' (1) · ~12 hours'"`UNIQ--ref-0000111F-QINU`"' (1) · ~25 hours apparent (functional duration well over 42 hours from multi-hexamer depot)'"`UNIQ--ref-0000135A-QINU`"' (1) · ~66 hours (1) · ~7 days (euthyroid); longer in hypothyroidism (~9-10 days), shorter in hyperthyroidism'"`UNIQ--ref-00000036-QINU`"' (1)

40-80% (oral); reduced by food, calcium, iron, PPIs, fiber; take fasting with water'"`UNIQ--ref-00000037-QINU`"' (1) · >90% (oral; not significantly affected by food)'"`UNIQ--ref-00001120-QINU`"' (1) · Variable; reduced by food, calcium, iron, PPIs'"`UNIQ--ref-00000037-QINU`"' (1) · ~100% from subcutaneous depot (1) · ~100% from subcutaneous depot (by definition of the route) (1) · ~15% (extensive hepatic first-pass) (1) · ~75% (1) · ~82% (1) · ~90% (low first-pass) (1)

Category B (1) · Category C (1) · First-line in pregnancy; dose typically increased 25-30% due to estrogen-driven rise in TBG and fetal demand. Lactation safe at physiologic doses.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Insulin is the preferred glucose-lowering therapy in pregnancy; degludec has reassuring observational data.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Insulin is the preferred glucose-lowering therapy in pregnancy; glargine has reassuring observational data, though NPH and detemir remain the traditional choices.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Limited data.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Limited data; avoid (1) · Limited data; weigh benefits/risks (1) · Synthetic levothyroxine is the standard-of-care in pregnancy; desiccated thyroid use in pregnancy is not well studied[[[Pharmacopedia:Citation needed|citation needed]]] (1)

Rx (1) · Rx, Schedule IV (US) (1) · Rx-only in US (2) · [[USLegal:Prescription only|Rx-only]] in US (5)

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