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14.09.2017 | Original Article

Drug interactions in users of tablet vs. oral liquid levothyroxine formulations: a real-world evidence study in primary care

verfasst von: Valeria Guglielmi, Alfonso Bellia, Elisa Bianchini, Gerardo Medea, Iacopo Cricelli, Paolo Sbraccia, Davide Lauro, Claudio Cricelli, Francesco Lapi

Erschienen in: Endocrine | Ausgabe 3/2018

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Abstract

Purpose

Several medications may interact with levothyroxine (LT4) intestinal absorption or metabolism, thus reducing its bioavailability. We investigated the variability of thyroid stimulating hormone (TSH) levels and prescribed daily dosages (PDDs) of LT4 before and during potential drug–drug interactions (DDIs) in users of tablets vs. oral liquid LT4 formulations.

Methods

By using the Italian general practice Health Search Database (HSD), we retrospectively selected adult patients with at least one LT4 prescription from 2012 to 2015 and at least 1 year of clinical history recorded. The incident prescription of interacting medications (e.g., proton pump inhibitors, calcium or iron salts) was the index date. Analysis was carried out using a self-controlled study design.

Results

Overall, 3965 users of LT4 formed the study cohort (84.1% women, mean age 56 ± 16.5 years). TSH variability on the entry date was greater among liquid LT4 users than in those prescribed with tablets as shown by the difference between 75th and 25th centile, which were 3.01 and 3.8, respectively. The incidence rate ratio (IRR) for TSH variability did not differ between groups, before and during exposure to DDIs. In contrast, PDDs less likely increased during the exposure to DDI with oral liquid LT4 compared with tablets (IRR = 0.84; 95% CI: 0.77–0.92), especially in patients with post-surgical hypothyroidism (IRR = 0.75; 95% CI: 0.64–0.85).

Conclusions

In clinical practice, the use of oral liquid LT4 is not associated with increased PDDs, compared with tablets formulation, during exposure to DDIs. These results support the need for individualizing LT4 formulation to prescribe, especially in patients with various comorbidities and complex therapeutic regimens.

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Titel: Drug interactions in users of tablet vs. oral liquid levothyroxine formulations: a real-world evidence study in primary care
verfasst von: Valeria Guglielmi
Alfonso Bellia
Elisa Bianchini
Gerardo Medea
Iacopo Cricelli
Paolo Sbraccia
Davide Lauro
Claudio Cricelli
Francesco Lapi
Publikationsdatum: 14.09.2017
Verlag: Springer US
Erschienen in: Endocrine / Ausgabe 3/2018
Print ISSN: 1355-008X
Elektronische ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-017-1412-4

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Drug interactions in users of tablet vs. oral liquid levothyroxine formulations: a real-world evidence study in primary care

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