Levothyroxine equivalency flier

[bananaface]

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So, I saw this flier from Sandoz regarding their product's equivalency to both Levoxyl and Synthroid. (The FDA made the AB ratings official on July 28.)

Does anyone else notice what is interesting about these charts?

 

[Oneday_9]

The peaks seem quite different. I can't make out the y-axis....is that 15 mg/ml (if i am reading the scale correctly) significant?

 

[vafcarrot]

The lines aren't labeled A or B.... no one has anyone idea which one is which. The genius that made this chart should have made one line dotted or something.

 

[vafcarrot]

I have question. Can you interchange levoxyl with sythroid without the doctor's permission? Which one is the generic and which one is name brand?

 

[bananaface]

Levoxyl and Synthroid are both "branded generics" meaning they have a trade name but neither was the first to the FDA for product approval. The FDA is really picky about what products are called the brand/reference listed drug. A few years ago Synthroid was advertised as "the standard in thyroid replacement therapy for over 50 years." There were fines levied by the FDA afterwards. The generic name for the whole group of products is levothyroxine. The Sandoz levothyroxine product (Trade name = Levo-T but the label just reads "levothyroxine") has been determined to be bioequivalent and interchangeable with Synthroid and Levoxyl and was given an AB rating.

The FDA did not, however, give and AB rating to the Synthroid/Levoxyl pairing. People in states whose law requires an AB rating for interchange are technically supposed to call the prescriber before interchanging. Up until my state's board of pharmacy put the kabosh on it maybe 5 years ago interchange was common (also neither product was FDA approved). Even today, many pharmacists will substitute Synthroid for Levoxyl and vice versa if the doctor writes for one product and the patient has been on the other product.

In the paper I copied, once curve was red and the other is blue. But, you can see the curves follow each other pretty well on the same axis. The axis for both curves is the same, as were the trial procedures. I noticed that the Sandoz product peaks mimicked whatever product it was studied against. But, if you compare the Sandoz product to itself (look at the peak height and the concentration over time) it seems not to yield consistant results. So maybe it IS like all the other products: not even bioeqivalent to itself.

 

[vafcarrot]

Are synthroid and levoxyl interchangeable by the pharmacy when giving out drugs. Last night at work, I couldn't find any levoyxl and the pharmacist told me just to use synthroid until Monday when we could send the levoyxl. Was this way wrong to do this?

 

[bananaface]

Many prescribers in institutional settings operate under collaborative practice agreements where they can swap meds that accomplish the same therapeutic effect. Chances are you operate under one of those, but I can't say for sure.

Whether you can legally substitute without a collaborative practice agreement depends on your individual state law.

 

[Caverject]

Are synthroid and levoxyl interchangeable by the pharmacy when giving out drugs. Last night at work, I couldn't find any levoyxl and the pharmacist told me just to use synthroid until Monday when we could send the levoyxl. Was this way wrong to do this?

You're not suppose to, but there are always "gray" situations where the law would turn a blind eye....

 

[vafcarrot]

🙁 Saturday wasn't a good day for me... It was the first time I worked as the only tech on duty. I worked nonstop the entire day and when it was closing time, there was still about 20 scripts to fill that I hadn't gotten to. The pharmacist had to be somewhere and I felt like an idiot because I didn't know where some of the drugs were (all the drugs are in abc order but some of the name brands are interchanged with the generics in the abc order and I don't know the names for both). It was horrible. I was also suppose to vacuum, sweep, and take out the trash and I didn't get around to doing that. I had a dream that someone got sick because of the levoxyl and synthroid mixup and when I went into work on Monday everyone glared at me because the trash cans were full of trash.

I hope that the medication is ok about the levoxyl and synthroid. I know that it wouldn't come back to me because the pharmacist said to go ahead and do it, but she wouldn't have had to told me that if I had been able to find that stupid drug 🙁

Too many mistakes can happen in pharmacy. It worries me. The most important thing I've discovered about pharmacy since working is that a pharmacist does alot more than count pills. They are really the difference between helping a person get healthy or making them even worse because of an accidental drug mistake.

 

[bananaface]

The patient is not going to get sick from having a different brand of levothyroxine for one day. Don't beat yourself up about it. When I was working in the hospital they would switch people back and forth depending on whatever levothyroxine product they happened to have in stock (until I mentioned it to the right person). Sticking with the same product is good as there is (supposedly) less variation and the lab tests are able to be used more reliably to adjust doseage. Taking Synthroid instead of Levoxyl for one day isn't going to mess that up.

You'll learn the names eventually. It just takes time. Do they have a pocket guide anywhere that you can use? If not, you can order one here for free. You look up a brand and it tells you the generic and vice versa.