Drilldown: Medicines

Benzonatate (1) · Cefdinir (1) · Levothyroxine (1) · Thyroid (desiccated) (1) · Torsemide (1)

Armour Thyroid, NP Thyroid, Nature-Throid, WP Thyroid (1) · Demadex, Soaanz (1) · Omnicef (discontinued in US under brand); mostly generic (1) · Synthroid, Levoxyl, Tirosint, Unithroid, Euthyrox (1) · Tessalon, Zonatuss (1)

[[:Category:Antitussives|Antitussive]] (1) · [[:Category:Beta-lactam_antibiotics|β-lactam antibiotic]] (1) · [[:Category:Cephalosporins|Cephalosporin (third-generation)]] (1) · [[:Category:Hormone_replacement|Hormone replacement]] (2) · [[:Category:Loop_diuretics|Loop diuretic]] (1) · [[:Category:Thyroid_hormones|Thyroid hormone]] (2)

None (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-00000015-QINU`"' Pediatric ingestion (capsule chewed or punctured) releases the free local anesthetic and causes seizures, cardiac arrhythmia, and death'"`UNIQ--ref-00000016-QINU`"'. (1) · '"`UNIQ--vote-00000016-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-00000017-QINU`"'. (1) · '"`UNIQ--vote-00000B40-QINU`"' The TRANSFORM-HF trial (2023) found no all-cause mortality difference between torsemide and furosemide in heart failure, although torsemide remains pharmacologically preferred where furosemide oral absorption is unreliable'"`UNIQ--ref-00000B41-QINU`"'. (1)

'"`UNIQ--vote-00000017-QINU`"' (1) · '"`UNIQ--vote-00000018-QINU`"', '"`UNIQ--vote-00000019-QINU`"' (1) · '"`UNIQ--vote-00000033-QINU`"', '"`UNIQ--vote-00000034-QINU`"', '"`UNIQ--vote-00000035-QINU`"' (1) · '"`UNIQ--vote-000009DF-QINU`"', '"`UNIQ--vote-000009E0-QINU`"', '"`UNIQ--vote-000009E1-QINU`"', '"`UNIQ--vote-000009E2-QINU`"', '"`UNIQ--vote-000009E3-QINU`"' (1) · '"`UNIQ--vote-00000B42-QINU`"', '"`UNIQ--vote-00000B43-QINU`"', '"`UNIQ--vote-00000B44-QINU`"', '"`UNIQ--vote-00000B45-QINU`"' (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) · 10-20 mg PO/IV once daily; titrate by clinical response. 1:1 IV to PO conversion (unlike furosemide's 1:2) (1) · 100-200 mg PO TID (max 600 mg/d) (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) · 300 mg PO BID, or 600 mg PO once daily, ×5-10 days; pediatric 14 mg/kg/d (1)

100, 150, 200 mg liquid-filled capsules ("perles") (1) · 15, 30, 60, 90, 120, 180, 240, 300 mg tablets (1/4 to 5 grains; 1 grain = 60 mg) (1) · 25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, 300 mcg tablets; oral capsule and IV/IM also available (1) · 300 mg capsules; 125, 250 mg/5 mL suspension (1) · 5, 10, 20, 100 mg tablets; 10 mg/mL IV (1)

None · Indication-specific · 40 mg/d · 10 mg/d · 20 mg/d · 80 mg/d · 10 mg/d (adults) · 100 mg/d · 4 g/d · 400 mg/d · 40 mg/d typical; up to 240 mg/d for Zollinger-Ellison · 5 mg/d · 50 mg/d · 600 mg/d · No fixed ceiling; titrate to clinical effect and tolerability with CDC opioid prescribing guidance constraints on morphine-milligram-equivalent (MME) totals · No fixed maximum; titrated to TSH target · TID per eye · Titrated to glucose; no fixed ceiling · Titrated to glucose; no fixed maximum · '''20 mg/day in adults >60 years''' per FDA's 2011-2012 QT-prolongation warning; 40 mg/day in adults ≤60

Other values:

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IV (2) · Oral (4) · Oral (swallow whole) (1)

15-20 minutes (1) · Hours (1) · PO 1 hour; IV 10 minutes (1) · TSH normalization 4-8 weeks (1) · TSH normalization 4-8 weeks; symptomatic improvement weeks to months (1)

12-24 hours (1) · 3-8 hours (1) · 6-8 hours (1) · Steady-state at 4-6 weeks (2)

3-4 hours (similar between PO and IV due to high oral bioavailability)'"`UNIQ--ref-00000B46-QINU`"' (1) · Not well characterized'"`UNIQ--ref-00000018-QINU`"' (1) · T4 ~7 days; T3 ~1 day'"`UNIQ--ref-0000001A-QINU`"' (1) · ~1.7 hours'"`UNIQ--ref-000009E4-QINU`"' (1) · ~7 days (euthyroid); longer in hypothyroidism (~9-10 days), shorter in hyperthyroidism'"`UNIQ--ref-00000036-QINU`"' (1)

16-21% capsule, 25% suspension (oral; iron and antacids reduce absorption substantially)'"`UNIQ--ref-000009E5-QINU`"' (1) · 40-80% (oral); reduced by food, calcium, iron, PPIs, fiber; take fasting with water'"`UNIQ--ref-00000037-QINU`"' (1) · Not well characterized'"`UNIQ--ref-00000019-QINU`"' (1) · Variable; reduced by food, calcium, iron, PPIs'"`UNIQ--ref-0000001B-QINU`"' (1) · ~80% (oral; predictable absorption — a substantive practical advantage over furosemide whose oral absorption is 10-100% variable)'"`UNIQ--ref-00000B47-QINU`"' (1)

Avoid where possible; class concerns as for other loop diuretics.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (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.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Generally considered safe in pregnancy.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited human data; animal reproductive studies not conducted<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Synthetic levothyroxine is the standard-of-care in pregnancy; desiccated thyroid use in pregnancy is not well studied.'"`UNIQ--ref-0000001C-QINU`"' (1)

[[USLegal:Prescription only|Rx-only]] in US (5)