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| Interactions: | Acenocoumarol
Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving Acenocoumarol therapy, the prothrombin time rate or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with thyroid hormones.Periodic reassessment during concurrent therapy should be done. Adjustments of the Acenocoumarol dose may be necessary in order to maintain the desired level of Acenocoumarol. However, patients already stabilized on thyroxine and other thyroid hormones and are euthyroid will respond normally to the introduction of anticoagulant therapy.No special precautions are necessary.
Antacids Comb.
Adverse Effect: decreased levothyroxine effectiveness Clinical Management: Concurrent administration of levothyroxine and antacids is not recommended. If concurrent use cannot be avoided, recommend monitoring serum TSH levels in patients on levothyroxine
Chloroquine
Adverse Effect: An increase in the thyroxine stimulating hormone level and decreased levothyroxine effectiveness Clinical Management: If the concurrent use of levothyroxine and chloroquine can not be avoided, recommend monitoring serum TSH levels when starting and discontinuing chloroquine therapy.
Phenindione
Adverse Effect: An increased risk of bleeding Clinical Management: In patients receiving Phenindione , the prothrombin time rate or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with Thyroxine , and reassessed periodically during concurrent therapy. Adjustments of the Phenindione dose may be necessary in order to maintain the desired level of anticoagulation. However, patients already stabilized on thyroxine and thyroid hormones and are euthyroid will respond normally to anticoagulant therapy.No special precautions are necessary.
Phenytoin
Adverse Effect: decreased levothyroxine effectiveness Clinical Management: The clinical significance of this interaction is uncertain. As with all patients receiving thyroid hormone replacement, consideration should be given to periodically assessing patient stability and adequate clinical response.
Rifampicin
Adverse Effect: decreased efficacy of levothyroxine Clinical Management: Hypothyroid patients receiving rifampin therapy may need an increase in their levothyroxine dose. Monitor the patient for signs and symptoms of hypothyroidism and monitor the serum thyroxine and TSH levels.
Selegiline
Adverse Effect: An increased risk of tachycardia, agitation, or hypomania Clinical Management: Direct-acting Thyroxine should theoretically not interact with Selegiline. However, two case reports have described adverse effects, including tachycardia and hypomania, attributed to such an interaction. Close observation for such adverse effects is warranted when these agents are administered concurrently or if the Thyroxine is given within two weeks of discontinuation of the Selegiline .
Theophylline
Adverse Effect: Decreased theophylline concentrations
Warfarin
Adverse Effect: An increased risk of bleeding Clinical Management: In patients on warfarin , the prothrombin time rate or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with thyroid hormones, and should be reassessed periodically during concurrent therapy. Adjustments of Warfarin dose may be necessary to maintain the desired level of anticoagulation. However, patients already stabilized on Thyroxine and are euthyroid will respond normally to Warfarin.No special precautions are necessary |
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