Drilldown: Medicines

Benzonatate (1) · Cefdinir (1) · Esomeprazole (1) · Levothyroxine (1) · Pantoprazole (1) · Thyroid (desiccated) (1)

Armour Thyroid, NP Thyroid, Nature-Throid, WP Thyroid (1) · Nexium, Nexium 24HR (OTC) (1) · Omnicef (discontinued in US under brand); mostly generic (1) · Protonix (1) · Synthroid, Levoxyl, Tirosint, Unithroid, Euthyrox (1) · Tessalon, Zonatuss (1)

[[:Category:Antisecretory_agents|Gastric acid suppressant]] (2) · [[: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:Proton_pump_inhibitors|Proton pump inhibitor (PPI)]] (2) · [[: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-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-00000117-QINU`"' Compared with omeprazole, pantoprazole has a more linear pharmacokinetic profile and is metabolized predominantly via CYP2C19 with CYP3A4 contribution; less CYP2C19-driven drug interaction with clopidogrel than omeprazole'"`UNIQ--ref-00000118-QINU`"'. (1) · '"`UNIQ--vote-000008E1-QINU`"' Like omeprazole, it is an acid-activated prodrug that covalently and irreversibly binds the H+/K+ ATPase. CYP2C19 PGx remains clinically relevant for both'"`UNIQ--ref-000008E2-QINU`"'. (1)

'"`UNIQ--vote-00000017-QINU`"' (1) · '"`UNIQ--vote-00000033-QINU`"', '"`UNIQ--vote-00000034-QINU`"', '"`UNIQ--vote-00000035-QINU`"' (1) · '"`UNIQ--vote-00000034-QINU`"', '"`UNIQ--vote-00000035-QINU`"' (1) · '"`UNIQ--vote-00000119-QINU`"', '"`UNIQ--vote-0000011A-QINU`"', '"`UNIQ--vote-0000011B-QINU`"', '"`UNIQ--vote-0000011C-QINU`"' (1) · '"`UNIQ--vote-000008E3-QINU`"', '"`UNIQ--vote-000008E4-QINU`"', '"`UNIQ--vote-000008E5-QINU`"', '"`UNIQ--vote-000008E6-QINU`"', '"`UNIQ--vote-000008E7-QINU`"' (1) · '"`UNIQ--vote-000009DF-QINU`"', '"`UNIQ--vote-000009E0-QINU`"', '"`UNIQ--vote-000009E1-QINU`"', '"`UNIQ--vote-000009E2-QINU`"', '"`UNIQ--vote-000009E3-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) · 100-200 mg PO TID (max 600 mg/d) (1) · 20-40 mg PO once daily, 30-60 minutes before breakfast (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) · 40 mg PO or IV once daily (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) · 20 mg, 40 mg delayed-release tablets; 40 mg IV vial; oral suspension 40 mg/packet (1) · 20, 40 mg delayed-release capsules; 2.5, 5, 10, 20, 40 mg oral suspension packets; 20, 40 mg IV (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)

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 (3) · Oral (5) · Oral (swallow whole) (1)

15-20 minutes (1) · 2-3 hours per dose; full acid suppression after 3-5 days (1) · Acid suppression within hours; full effect after 3-5 days of dosing (1) · Hours (1) · TSH normalization 4-8 weeks (1) · TSH normalization 4-8 weeks; symptomatic improvement weeks to months (1)

12-24 hours (1) · 24+ hours (irreversible enzyme binding) (1) · 24-72 hours per dose (irreversible enzyme binding) (1) · 3-8 hours (1) · Steady-state at 4-6 weeks (2)

Not well characterized'"`UNIQ--ref-00000018-QINU`"' (1) · T4 ~7 days; T3 ~1 day'"`UNIQ--ref-00000036-QINU`"' (1) · ~1 hour (plasma); pharmacodynamic effect persists 24+ hours'"`UNIQ--ref-0000011D-QINU`"' (1) · ~1.5 hours (plasma); pharmacodynamic effect 24+ hours via target turnover'"`UNIQ--ref-000008E8-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-00000037-QINU`"' (1) · ~64-90% (oral; increases at higher doses and with multi-day dosing)'"`UNIQ--ref-000008E9-QINU`"' (1) · ~77% (oral; not affected by food or antacids)'"`UNIQ--ref-0000011E-QINU`"' (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) · Generally considered safe; widely used in obstetric reflux.<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<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Widely used in obstetric reflux; reassuring data.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1)

OTC (20 mg, 14-day course) and [[USLegal:Prescription only|Rx-only]] (higher and longer durations) in US (1) · [[USLegal:Prescription only|Rx-only]] in US (5)