LIOTHYRONINE SODIUM

Posology Adults:

Starting dose of 10 or 20 micrograms every 8 hours, increasing after one week, if necessary, to the usual recommended daily dose of 60 micrograms in two or three divided doses. Myxoedema Coma: 60 micrograms given by stomach tube, then 20 micrograms every 8 hours.

It is more usual to start treatment with intravenous liothyronine. Adjunct to carbimazole treatment of thyrotoxicosis: 20 micrograms every 8 hours. Elderly and Children Patients: 5 micrograms daily.

Method of Administration:

Oral For patients who have difficulty in swallowing a whole tablet, such as the elderly and young children, a whole tablet may be crushed and allowed to dissolve/disperse in a minimum of 20 mL of water. The entire volume of liquid should be consumed to ensure ingestion of the full dose.

The solubility of liothyronine in water enables this as a method of administration. If a dose lower than 20 micrograms is required, an appropriate tablet strength should be used.

The following effects are indicative of excessive dosage and usually disappear on reduction of dosage or withdrawal of treatment for a day or two. The undesirable effects are listed below by organ class and the following frequency convention: Not known: frequency cannot be estimated from the available data.

System Organ Class Frequency Adverse events Cardiac disorders Not known Anginal pain, cardiac arrhythmias, palpitations, tachycardia Gastrointestinal disorders Not known Diarrhoea, vomiting General disorders and administration site conditions Not known Fever, flushing, fever and heat intolerance Immune system disorders Not known Hypersensitivity reactions including rash, pruritus and oedema also reported.

Metabolism and nutrition disorders Not known Excessive loss of weight Musculoskeletal and connective tissue disorders Not known Muscle cramps, muscular weakness Nervous system disorders Not known Headache, tremor, Psychiatric disorders Not known Restlessness, excitability, insomnia, Skin and subcutaneous tissue disorders Not known Sweating Vascular disorders Not known Flushing Paediatric population • Transient hair loss in children (Not Known) Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important.

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In severe and prolonged hypothyroidism, adrenocortical activity may be decreased. When thyroid replacement therapy is started, metabolism increases more than adrenocortical activity and this can lead to adrenocortical insufficiency requiring supplemental adrenocortical steroids.

Liothyronine rather than levothyroxine would be the replacement therapy of choice during block and replace treatment of thyrotoxicosis with propylthiouracil (PTU) due to the inhibition by PTU of the peripheral conversion of T4 to T3.

Liothyronine sodium treatment may result in an increase in insulin or anti-diabetic drug requirements. Care is required for patients with diabetes mellitus and diabetes insipidus. Panhypopituitarism or predisposition to adrenal insufficiency (initiate corticosteroid therapy before starting liothyronine), pregnancy, breast-feeding (see section

1. Patients with angina of effort or cardiovascular diseases and thyrotoxicosis.