Liothyronine sodium - Hypothyroidism with inadequate response to levothyroxine

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