Anyone familiar with using levothyroxine IM?

[edwardmatt83]

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I have a doc asking for levothyroxine IM once a week for their patient using the IV formulation. The patient cannot take oral meds. I can't find anything that supports once a week dosing. From my research it looks like the patient would have to reconstitute with 0.9% NaCl and inject every day. Dosing should be 70% of the oral dose. It also isn't stable for more than 4 hours - so they patient would need a new vial every day.

 

[zelman]

Never heard of it, but it isn't unprecedented: link

 

[PumpkinSmasher]

At my previous facility, we used IM levothyroxine weekly on a few patients who refused or could not take oral medications for various reasons. There is some limited evidence supporting this practice, anecdotal. Just think about the the half-life of thyroxine, when deemed necessary I have seen once weekly dosing manage pt's hypothyroidism.

I would be interested in the the PCP's rational. Is this pt in a facility, refusing all orals, malabsorption issues, etc?

 

[edwardmatt83]

At my previous facility, we used IM levothyroxine weekly on a few patients who refused or could not take oral medications for various reasons. There is some limited evidence supporting this practice, anecdotal. Just think about the the half-life of thyroxine, when deemed necessary I have seen once weekly dosing manage pt's hypothyroidism.

I would be interested in the the PCP's rational. Is this pt in a facility, refusing all orals, malabsorption issues, etc?

The patient lives at home and has malabsorption issues - I was more concerned with the patient knowing proper reconstitution and stability. They will need 2 vials each week at $250 per vial.

 

[PumpkinSmasher]

I have never looked into it before but I wonder if you could contact a compounding pharmacy about making a levothyroxine suppository and titrating dose to therapeutic level....Just a thought, I imagine it would be more cost effective and not involve any injections.

 

[Wheresmyaricept]

I've heard of taking a week's worth of levothyroxine orally instead of daily. Not sure how IM would go. Assuming it was a high enough dose, it should work in theory.

 

[zelman]

The patient lives at home and has malabsorption issues - I was more concerned with the patient knowing proper reconstitution and stability. They will need 2 vials each week at $250 per vial.

It might be better to have them come to an infusion clinic type setting or doctors office for administration for the first 6 weeks to establish efficacy before throwing the self administration variable into the equation.