Liothyronine

Name: Liothyronine

Liothyronine Food Interactions

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of liothyronine there are no specific foods that you must exclude from your diet when receiving this medication.

Inform MD

Before taking liothyronine, tell your doctor if you:

  • are allergic to liothyronine or any foods or medicines
  • are pregnant or intend to become pregnant, or if you are breastfeeding
  • have heart or kidney disease
  • have adrenal or pituitary gland problems

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Liothyronine FDA Warning

Drugs with thyroid hormone activity, alone or together with other therapeutic agents, have been used for the treatment of obesity. In euthyroid patients, doses within the range of daily hormonal requirements are ineffective for weight reduction. Larger doses may produce serious or even life-threatening manifestations of toxicity, particularly when given in association with sympathomimetic amines such as those used for their anorectic effects.

 

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include headache, sweating, diarrhea, irregular menstrual periods, confusion, weakness, swelling in your hands or feet, fast heart rate, chest pain, feeling short of breath, fainting, or feeling nervous, restless, or irritable.

Liothyronine Dosage and Administration

Adults

Myxedema coma is usually precipitated in the hypothyroid patient of long standing by intercurrent illness or drugs such as sedatives and anesthetics and should be considered a medical emergency. Therapy should be directed at the correction of electrolyte disturbances, possible infection, or other intercurrent illness in addition to the administration of intravenous Liothyronine (T3). Simultaneous glucocorticosteroids are required.

Liothyronine sodium injection (T3) is for intravenous administration only. It should not be given intramuscularly or subcutaneously.

  • Prompt administration of an adequate dose of intravenous Liothyronine (T3) is important in determining clinical outcome.
  • Initial and subsequent doses of Liothyronine sodium injection (T3) should be based on continuous monitoring of the patient’s clinical status and response to therapy.
  • Liothyronine sodium injection (T3) should normally be administered at least four hours-and not more than 12 hours-apart.
  • Administration of at least 65 mcg/day of intravenous Liothyronine (T3) in the initial days of therapy was associated with lower mortality.
  • There is limited clinical experience with intravenous Liothyronine (T3) at total daily doses exceeding 100 mcg/day.

No controlled clinical studies have been done with Liothyronine sodium injection (T3). The following dosing guidelines have been derived from data analysis of myxedema coma/precoma case reports collected by SmithKline Beecham Pharmaceuticals since 1963 and from scientific literature since 1956.

An initial intravenous Liothyronine sodium injection (T3) dose ranging from 25 mcg to 50 mcg is recommended in the emergency treatment of myxedema coma/precoma in adults. In patients with known or suspected cardiovascular disease, an initial dose of 10 mcg to 20 mcg is suggested (see WARNINGS). However, both the initial dose and subsequent doses should be determined on the basis of continuous monitoring of the patient’s clinical condition and response to Liothyronine sodium injection (T3) therapy. Normally at least four hours should be allowed between doses to adequately assess therapeutic response and no more than 12 hours should elapse between doses to avoid fluctuations in hormone levels. Caution should be exercised in adjusting the dose due to the potential of large changes to precipitate adverse cardiovascular events. Review of the myxedema case reports indicates decreased mortality in patients receiving at least 65 mcg/day in the initial days of treatment. However, there is limited clinical experience at total daily doses above 100 mcg. See PRECAUTIONS-Drug Interactions for potential interactions between thyroid hormones and digitalis and vasopressors.

Pediatric Use

There is limited experience with Liothyronine sodium injection (T3) in the pediatric population. Safety and effectiveness in pediatric patients have not been established.

Switching to Oral Therapy

Oral therapy should be resumed as soon as the clinical situation has been stabilized and the patient is able to take oral medication. When switching a patient to Liothyronine sodium tablets from Liothyronine sodium injection (T3), discontinue Liothyronine sodium injection (T3), initiate oral therapy at a low dosage, and increase gradually according to the patient’s response.

If L-thyroxine rather then Liothyronine sodium is used in initiating oral therapy, the physician should bear in mind that there is a delay of several days in the onset of L-thyroxine activity and that intravenous therapy should be discontinued gradually.

Contraindications

Hypersensitivity to liothyronine sodium or any component of the formulation; undocumented or uncorrected adrenal insufficiency; untreated thyrotoxicosis; artificial rewarming (injection)

Dosing Renal Impairment

No dosage adjustment provided in manufacturer’s labeling.

Administration

IV: For IV use only; do not administer IM or SubQ

Intermittent IV administration: Administer at a rate of 10 mcg/minute.

Continuous IV infusion: Cadaveric organ recovery (hormonal resuscitation) (off-label use): After IV bolus administration, may administer as a continuous infusion (Rosengard 2002; Zaroff 2002).

Pregnancy Risk Factor A Pregnancy Considerations

Endogenous thyroid hormones minimally cross the placenta; the fetal thyroid becomes active around the end of the first trimester. Liothyronine has not been found to increase the risk of teratogenic or adverse effects following maternal use during pregnancy.

Uncontrolled maternal hypothyroidism may result in adverse neonatal and maternal outcomes. To prevent adverse events, normal maternal thyroid function should be maintained prior to conception and throughout pregnancy. Levothyroxine is considered the treatment of choice for the control of hypothyroidism during pregnancy.

For the Consumer

Applies to liothyronine: oral tablet

Other dosage forms:

  • intravenous injectable, intravenous solution

Along with its needed effects, liothyronine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Get emergency help immediately if any of the following symptoms of overdose occur while taking liothyronine:

  • Arm, back or jaw pain
  • changes in appetite
  • changes in menstrual periods
  • chest pain or discomfort
  • chest tightness or heaviness
  • cold clammy skin
  • confusion
  • decreased urine output
  • diarrhea
  • dilated neck veins
  • dizziness
  • extreme fatigue
  • fainting
  • fast, slow, pounding, or irregular heartbeat or pulse
  • fever
  • hand tremors
  • headache
  • increased bowel movements
  • irregular breathing
  • irritability
  • leg cramps
  • lightheadedness
  • menstrual changes
  • nausea
  • nervousness
  • sensitivity to heat
  • shortness of breath
  • sweating
  • swelling of face, fingers, feet, or lower legs
  • troubled breathing
  • trouble sleeping
  • vomiting
  • weak pulse
  • weight gain
  • weight loss
  • wheezing

For Healthcare Professionals

Applies to liothyronine: compounding powder, intravenous solution, oral tablet

General

Reported side effects are usually indicative of excessive dosage and will usually disappear when the dose is reduced or treatment is stopped.[Ref]

Cardiovascular

Common (1% to 10%): Arrhythmia, tachycardia, cardiopulmonary arrest, hypotension, myocardial infarction
Frequency not reported: Angina, congestive heart failure, hypertension, flushing, palpitation[Ref]

Nervous system

Frequency not reported: Headache, tremor, benign intracranial hypertension[Ref]

Dermatologic

Frequency not reported: Allergic skin reaction, sweating, rash pruritus, transient hair loss[Ref]

Musculoskeletal

Frequency not reported: Twitching, muscle cramps, muscle weakness, craniostenosis, premature closure of epiphysis[Ref]

Gastrointestinal

Frequency not reported: Diarrhea, vomiting[Ref]

Immunologic

Frequency not reported: Hypersensitivity reaction[Ref]

Local

Frequency not reported: Phlebitis[Ref]

Psychiatric

Frequency not reported: Restlessness, excitability, insomnia[Ref]

Genitourinary

Frequency not reported: Menstruation irregular[Ref]

Other

Frequency not reported: Fever, edema, weight loss, heat intolerance[Ref]

Some side effects of liothyronine may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

Usual Adult Dose for Goiter

Initial dose: 5 mcg orally once a day
-Following initial dose: Increase by 5 to 10 mcg per day every 1 or 2 weeks; when 25 mcg/day is reached, dose may be increased by 12.5 or 25 mcg per day every 1 to 2 weeks until satisfactory response is attainted
Maintenance dose: 75 mcg orally once a day

Use: For use as pituitary thyroid-stimulating hormone (TSH) suppressants, in the treatment or prevention of various types of euthyroid goiters, including thyroid nodules, subacute or chronic lymphocytic thyroiditis (Hashimoto's) and multinodular goiter

Usual Adult Dose for TSH Suppression

Initial dose: 5 mcg orally once a day
-Following initial dose: Increase by 5 to 10 mcg per day every 1 or 2 weeks; when 25 mcg/day is reached, dose may be increased by 12.5 or 25 mcg per day every 1 to 2 weeks until satisfactory response is attainted
Maintenance dose: 75 mcg orally once a day

Use: For use as pituitary thyroid-stimulating hormone (TSH) suppressants, in the treatment or prevention of various types of euthyroid goiters, including thyroid nodules, subacute or chronic lymphocytic thyroiditis (Hashimoto's) and multinodular goiter

Usual Geriatric Dose for Hypothyroidism

Initiate at 5 mcg orally once a day and increase by no more than 5 mcg increments at 2 week intervals

Use: For use as replacement or supplemental therapy in patients with hypothyroidism of any etiology, except transient hypothyroidism during the recovery phase of subacute thyroiditis; this category includes cretinism, myxedema, and ordinary hypothyroidism in patients of any age (pediatric patients, adults, the elderly), or state (including pregnancy); primary hypothyroidism resulting from functional deficiency, primary atrophy, partial or total absence of thyroid gland, or the effects of surgery, radiation, or drugs, with or without the presence of goiter; and secondary (pituitary) or tertiary (hypothalamic) hypothyroidism

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