Levothyroxine Sodium - Good And Bad Generic Brands

My wife is having hypothyroid symptoms again. I checked the brand and it is Lupin, which is an Indian brand. I have not had good luck with Indian brands for other things myself.

I did find a review by someone saying they got switched to Lupin and their Hypothyroid symptoms came back. But 1 review does not make a case.

It will be very helpful to people to get feedback on what brands people have had good or bad experiences with and what they went from and to. And what the symptoms were or what went away. So they can be aware when pharmacies switch brands and what to look for when searching for a better brand.

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In a lot of ways levothyroxine seems to be a special case with brands because it's not some sort of "brand x doesn't work" scenario, but rather it's that the different manufacturer brands seem to be delivering different effective doses for the same sizes.

I have a theory that this is because the dosage that you take is pretty tiny, and this particular drug is extremely sensitive to being taken alongside of food. And the whole way digestion works has subtle differences from person to person.

What differs from brand to brand is the inactive ingredients. And those inactive ingredients look to your body more or less like food -- and that can differ from me to you. So you have brand #1 and it's got a little sugar in the binders. That sugar causes both of us to fail to absorb some of the drug, but for one of us the effect is larger than the other. So if there's brand A and brand B, then suppose you see 99% of brand A and 98% of brand B, and I see 90% of brand A and 80% of brand B. So if you take 300 mcg of either brand you have the same effect, while for me I take 325 mcg and brand A gives both of us almost the same dose while brand B underdoses me a lot while you are fine.

The science observes that different people have different absorption levels, but the thing about foodishness of the binders is my speculation about a mechanism. The science says that you should find a dose on a particular brand that works well for you and then stick to the brand, and when you need to adjust the dose you need to do it within the same brand.

Note here that this isn't good vs bad on the manufacturer side, it's just how individuals react. Also note that the problem works both ways! If I standardized on a 375 mcg dose of brand B and then switched over to brand A then the problem would be an overdose. Whereas if you had standardized on the 300 mcg of brand B, 300 mcg of brand A is only a tiny amount more for you.

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Re: cathyf (# 1)

Inactive ingredients in medications are called excipients. They are also registered with the FDA and you can look them up. Some have their own effects on the body. Some help with absorption, others help pass through the liver, others may have minor unrelated medicinal affects themselves. Some may have no effect at all. You can research those things to find out more.

The below link you can use to actually see the ingredients in the brand and dose that you use. And see the manufacturer if different from the label.

https:/­/­dailymed.nlm.nih.gov/­dailymed/­search.cfm?labeltype=all&query=LEVOTHYROXINE&pagesize=200&page=1&audience=professional

Example, here are the inactive ingredients in my wife's generic brand along with the registered identification number for each.

- CROSCARMELLOSE SODIUM (UNII: M28OL1HH48)
- D&C YELLOW NO. 10 (UNII: 35SW5USQ3G)
- FD&C BLUE NO. 1 (UNII: H3R47K3TBD)
- FD&C YELLOW NO. 6 (UNII: H77VEI93A8)
- MAGNESIUM STEARATE (UNII: 70097M6I30)
- MANNITOL (UNII: 3OWL53L36A)
- SODIUM BICARBONATE (UNII: 8MDF5V39QO)
- STARCH, CORN (UNII: O8232NY3SJ)

The Active Pharmaceutical Ingredients (API) are usually quite close to that of the brand. And their bioequivalence when a study was done on over a thousand medications were mostly within 3.5% if I recall correctly. You can read about bioequivalence from the link below since everyone has the wrong idea about what it actually is. But bioequivalence is not the same as effectiveness which the FDA doesn't test. Which is where the problems with generics lie. Plus, after they pass the BE tests, the are left to self regulate which some have not been so good at.

https:/­/­www.psychiatrist.com/­jcp/­psychopharmacology/­bioequivalence-generic-drugs-simple-explanation-food/­

And about my wife's brand issue, I checked with the pharmacy and they say she has been on the same brand for over 2 years. So, likely her levels have naturally changed again. And not a brand issue this time.

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