Liothyronine sodium - Hypothyroidism with inadequate response to levothyroxine
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Status 1
- Capsules
- Tablets
Initiation by consultant endocrinologists and stabilisation for at least 3 months before requesting shared care.
Capsules are considerably lower cost than the tablets in Primary Care.
Patients receiving tablets in primary care may be switched to capsules (licensed and bioequivalent).
Principles for shared care found here: https://surrey.res.services/PAD/Profile/NonClinicalProfile/9136
Status 2
- Oral solution
The oral solution has not been reviewed for addition to the formulary. Please contact your Pharmacy Team for advice.
This formulation has not yet been assessed for formulary status and is not currently on the APC work-plan.
It has not yet been evaluated by the Surrey Heartlands ICS Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined.
Before prescribing, it is recommended that clinicians contact their Medicines Optimisation team to discuss possible alternatives/options.
The APC will consider recommending the prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicians can contact syheartlandsicb.APC@nhs.net if they wish to make a submission.
Documentation
PAD Profile
Other Indications
Below are listed other indications that Liothyronine sodium is used to treat.
Other Drugs
Below are listed other drugs that are used to treat Hypothyroidism with inadequate response to levothyroxine.
- No records returned.
Committee Recommendations (2)
See narrative below (June 2019) for recommend use.
NOTE:
Licensed, bioequivalent liothyronine CAPSULES have entered the market at a considerably reduced price and the APC recommend that:
- the most cost effective preparation should be prescribed (currently capsules) in all new patients
- prescribers should consider switching existing patients from tablets to capsules - for discussion with the patient at next review
The APC noted the additional information provided in the Liothyronine capsules - briefing paper below
In very rare situations where patients experience continuing symptoms with levothyroxine (that have a material impact upon normal day to day function), and other potential causes have been investigated and eliminated, a 3 month trial with additional liothyronine may occasionally be appropriate.
This is only to be initiated by a consultant NHS endocrinologist. Following this trial the consultant NHS endocrinologist will advise on the need for ongoing liothyronine.
Liothyronine for this indication will be considered AMBER on the traffic light system.
Many endocrinologists may not agree that a trial of levothyroxine / liothyronine combination therapy is warranted in these circumstances and their clinical judgement is valid given the current understanding of the science and evidence of the treatment.
Patients taking liothyronine (monotherapy or in combination) prior to NHS England guidance ‘Items that should not routinely be prescribed in primary care’ (Nov 2017) should have been reviewed by an NHS consultant endocrinologist.
For further advice and information please refer to the Policy Statement below