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poodlebone

generic vs. brand name levothyroxine

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poodlebone

I have been taking the Levoxyl brand of levothyroxine ever since I was first diagnosed with hypothyroidism. I think it's been 10-11 years now. My very first prescription was written for Synthroid but not as DAW/brand medically necessary so I was given Levoxyl at the pharmacy. It counts as a generic substitution for Synthroid but it's called a branded generic. When I switched pharmacies the new one would order the Levoxyl for me since they usually carried other generic companies. I then switched to mail order, still getting my Levoxyl. My insurance mail order pharmacy changed yet again and is now Express Scripts. Last week I mailed in my new prescriptions that my CDE wrote and today I went online to check on my order. My plan costs $10 for a generic drug and I get 90 days for only 2 co-pays, $20. This time I saw I was charged only $10 for the 90 pills and also noticed it now just said levothyroxine, not Levoxyl.

 

I know that generics are all supposed to be the same but a few people have told me that I should stick with just one brand ("brand" being a pill made by one specific company) when it comes to thyroid meds. I'm a little freaked out over getting a non-Levoxyl product. The Levoxyl itself is cheap enough and saving $10 every 3 months isn't a big draw for using another generic.

 

Do people on levothyroxine (Synthroid etc) get different brands/manufacturers from time to time or do you try to stay with just one company? With the generic generics, it's hard to tell. Levoxyl has a distinct shape so I always know what I'm getting. I guess my CDE forgot to mark DAW on the script and I usually remind her but totally forgot. I may e-mail her and ask her to write me a new prescription to get filled locally and then another one written correctly to send in to Express Scripts in a few months. I may just be blowing this whole thing out of proportion and the brand X generic I'll get will work just as well.

 

My mother refuses to take anything other than the Synthroid brand. I must have inherited this worry from her!

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sarahspins

From what I understand, taking a generic isn't a big deal as long as you take the same "brand" of the generic.. and as long as you are stable and not needing lots of dosage adjustments, it should be fine.

 

If you are like me, and one dosage never seems to work very very long, and are constantly having it adjusted, my doctor feels that it's better to just take a brand name so that there is added consistency between the different dosages.. since the generics are allowed to be a certain percentage 'off' from name brand and still be labeled at given dosages, you have no way of knowing if your 137mcg pill is really that, of if it might be closer to 125mcg, or even 150mcg... and if you need to switch to a different dosage, if you get a generic you have no idea if the pharmacy will substitute a different brand for each one, and how it might actually relate to what you had been taking.

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Scout

I've been on Synthroid and generic levothyroxine in the past. I could tolerate Synthroid but not the generic. The active ingredient is the same in both, so that was not the problem. The problem with the generic was the different filler and/or coating they added. I would itch like mad and scratch my chest raw without realizing it until I noticed I had scratches oozing blood. This also happened with a completely different med and it was my pharmacist who made the link and explained that it was the filler used in the pill.

 

Now, however, I take dessicated porcine thyroid - natural thyroid replacement. It's simply called Thyroid in Canada and Armour in the U.S. For me it was a world of difference compared to synthetic thyroid meds like Synthroid or generic Levothyroxine. All the brain fog is gone, and I feel like me again. Before, even though the synthetic thyroid meds helped, I always felt medicated and not quite as sharp as I had been before, and the fatigue and lethargy was still there, just less so than before. I went through several years of dose changes and even had Cytomel (T3) added, etc.. But no dose change or additional meds did the trick. I am a diehard convert to dessicated thyroid!

 

I've even told my husband that if they ever took it off the market then we would start raising pigs and I'd learn how to slaughter, remove, and dessicate the thyroid myself! And he thinks I'm joking... but I'm not. No, really, I'm not. That's how much difference I feel being on the porcine thyroid!

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Jan B

What Scout said is really interesting . . . I've heard this from others. I wonder if I've accepted feeling the way I do, when I could feel a lot better? I seem ok:confused:

 

I started on Synthroid and was on that for at least 10 years before I started trying generics. Once, when I wasn't quite balanced, and couldn't seem to find balance, my doctor mentioned getting back on the real deal - Synthroid. However, for a few years I've been taking the generic Levothyroxine at the same dosage (200 mcg) and as long as I take it every morning, I'm fine. The only time I notice anything is when I'm stupid and go a week without getting it refilled.

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Scout

Jan, I guess the only way for you to find out would be to switch for trial period (say 1-3 months) and then evaluate. But I can understand if you are feeling okay that you may not want to try. I mean, why fix something if it ain't broke?

 

But... on the other hand, there are some decided health benefits to natural thyroid that simply aren't present in Levothyroxine. For one thing, the natural contains calcitonin which helps you utilize the calcium you take in. That is, you get the calcitonin if you take the thyroid med sublingually, but not if you swallow it - stomach acid destroys it, although the T4 & T3 works just the same. Natural thyroid also contains T1 and T2 in trace amounts, which our own thyroids, if they were working properly, would also normally produce.

 

My feeling is with natural thyroid one is getting the 'whole package' rather than just the one big main component of T4. But YMMV of course!

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foxl

Yep, I have had the same experience -- no difference based on manufacturer. I am on levoxyl after a bout a decade of synthroid.

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ksa01

I took the generic Unithroid for 5 years without problems then my numbers started indicating the need for constant changes in dosage. My endo recommended switching to the name brand Levoxyl because of the better consistency of the dosage amount as explained by Sarahspins above. Since switching, my dosage needs have been very consistent. I have to say that it must have been due to the variance of the generic because I only changed brands not dosage.

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sarahspins

BTW, I want to add that I'm stuck in this "sometimes my thyroid seems to work some, and sometimes it doesn't do squat" which is why my dosage has changed so much/often. I have been on everything from 125mcg to 200mcg over the past year. I am now on 150mcg with an extra 25mcg thrown in once a week and I seem to be doing "okay".. I am verging on hypo, which might mean I move up to alternating 150 and 175 every other day, but 175mcg is too much.

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poodlebone
From what I understand, taking a generic isn't a big deal as long as you take the same "brand" of the generic.. and as long as you are stable and not needing lots of dosage adjustments, it should be fine.

 

If you are like me, and one dosage never seems to work very very long, and are constantly having it adjusted, my doctor feels that it's better to just take a brand name so that there is added consistency between the different dosages.. since the generics are allowed to be a certain percentage 'off' from name brand and still be labeled at given dosages, you have no way of knowing if your 137mcg pill is really that, of if it might be closer to 125mcg, or even 150mcg... and if you need to switch to a different dosage, if you get a generic you have no idea if the pharmacy will substitute a different brand for each one, and how it might actually relate to what you had been taking.

 

Sarah,

 

It seems like my dose increases every few years. I've been on 112mcg for the past 2 years, I think. I started on either 25 or 50, don't remember. Two years ago when my dose was increased my first test result came back really high. My CDE didn't believe it and gave me another lab form and it was still hgih but not nearly as bad as the initial test. I was increased to 112mcg and my lab tests have been good since then. In another year or two that may change. The entire time I've been taking Levoxyl and I rarely miss a dose. I am almost always able to take it at least an hour before eating although sometimes when I'm really running late in the morning I only have 30-45 minutes between the pill and breakfast.

 

I worked in a pharmacy during high school and part of college and I know we would often switch generic companies or get the same medication from different suppliers at different times. There were always customers complaining that their pills looked different and wanted to make sure they were getting the right medication (not levothyroxine specific, just meds in general). I'm sure the big chain stores change suppliers often depending on who has the best deal.

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poodlebone

I've even told my husband that if they ever took it off the market then we would start raising pigs and I'd learn how to slaughter, remove, and dessicate the thyroid myself! And he thinks I'm joking... but I'm not. No, really, I'm not. That's how much difference I feel being on the porcine thyroid!

 

You could make your own insulin at the same time!

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Scout

LOL Liz. Yes I could. Now there's a nifty home business, eh?

 

Who knew that having these autoimmune diseases could open up such opportunities?

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Jan B

I am going to talk to my doctor about Armour. I'm glad you brought it up Scout. I know what you mean about leaving well enough alone . . . but gee, I'm at least going to explore the option more & maybe give it a try. It's time for a blood draw and labs anyway.

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Scout

Oh, cool, Jan! Let us know if you do end up doing a trial of Armour and how you feel on it. One thing though, I vaguely recall something about Armour changing its formulation so that it is no longer worth taking it sublingually. But don't take my word on that as it's something I read and didn't really retain because I take the Canadian formulation of dessicated thyroid which is simply called Thyroid here.

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poodlebone

I may ask my CDE about Armour as well. Do people take it in addition to a typical Synthroid/levothyroxine pill or is a substitution? When I was first told that my thyroid was low my PCP said he would start me out on the lowest dose of medication. He said that it would take awhile to build up but in a couple of months I should start to feel better. Even though my lab tests came back in range and still do, except for every few years when my dose needs to be increased, I am always tired and still have a lot of the usual symptoms of hypothyroidism you read about. It's not like being sick, but just always tired. There was a period of time where I did feel much better but I think that was due to the fact that I got a pump and was able to lose a lot of weight. After a couple of years I went back to feeling the same.

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Scout

Liz, you take it instead of Synthroid or Levothyroxine. It's worth noting that dessicated thyroid was the way doctors treated hypothyroidism for a hundred years prior to synthetic thyroid being developed in the 60s (I think it was the 60s, too lazy to check if my memory is correct). And at that, doctors treated by symptons not by blood test. What is normal for one person, isn't necessarly the next person's normal.

 

For example, on my lab tests the range for TSH .30- 3.0. However, I do best between .10 to .25. At the lowest end of the 'normal' range, I get symptomatic again. Luckily, my GP agrees with me on this now, although it took literally years for her to get over looking at the blood test result without listening to how I actually FELT. But now she can see the difference because I am not in her office every month telling her I feel awful and dragged out and just don't feel normal. It took 13 years for me to:

 

a) get the right DX (they thought I had RA for for the first 8 years)

B) go through all the possible combos of meds and demand natural thyroid instead

c) get on the right dose for me, and have my doctor comfortable with me running somewhat under the normal range.

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foxl

The reason it was supplanted by synthetic thyroxine is that quality control was easier with the synthetic. It was easier to measure the amount of hormone activity in lower dose ranges.

 

I had an uncle who died of a heart attack, ostensibly because of thyroxine overdose, in the 1960's. From taking dessicated thyroid.

 

However, Armour dessicated thyroid contains T4, T3, rT3, T2, and straight iodine, as well. Some studies (about ... 15 yrs back?) have shown that T3 (which is also a metabolite of T4) is more effective than T4, particularly in the brain. Others say it is not more effective.

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Scout

That may have been touted as the reason, but it's not one I personally believe. Dessicated thyroid is cheap and easily available and if stringent quality control standards are employed, as they should be in the making of any drug for human consumption, there is little variance in active content.

 

On the other hand, by manufacturing it synthetically drug companies were able to then charge exorbitant amounts for the drug.

 

Synthroid itself has a somewhat checkered history. If you Google Mary Shomon's Thyroid-Info site there is an update on Synthroid with today's date. Synthroid was asking the FDA to be declared a 'new' drug. Why? Presumably so they could charge more for it.

 

Here is an excerpt from her site, which is the Food & Drug Administration responding to the manufacturer's request:

 

III. Synthroid Has a History of Problems

 

According to the FDA,"...Synthroid has a long history of manufacturing problems...In August of 1989, Knoll initiated a recall of 21 lots of Synthroid tablets...because of a decrease in potency during stability studies."

 

The letter goes on to outline recalls in February 1991 affecting 26 lots of subpotent Synthroid, and a recall of lots of subpotent Synthroid in June 1991. An April 1991 inspection of Synthroid's manufacturing facility resulted in the firm being cited for two deviations from good manufacturing practices. Another manufacturing review in December of 1992 uncovered nine separate incidents of failure to follow good manufacturing practices.

 

As the FDA letter indicates, the problems continued. "FDA also found that the firm had continued to manufacture and distribute low dosage Synthroid tablets during 1990, 1991 and 1992."

 

 

"Although you claim that Synthroid has been carefully manufacturered, the violations of current good manufacturing practices discussed above indicate that Knoll has not always manufactured Synthroid in accordance with current standards for pharmaceutical manufacturing." -- United States Food and Drug Administration Letter to Synthroid Manufacturer, Knoll Pharmaceuticals, April 26, 2001

A 1994 review of the testing facility found additional problems with testing of product, and another recall in 1998 took place of subpotent product.

 

Says the FDA:

 

"The history of potency failures...indicates that Synthroid has not been reliably potent and stable. Furthermore, Knoll's use of an overage that has not remained consistent over the years suggests that Synthroid has stability, potency and consistency problem. Although you claim that Synthroid has been carefully manufacturered, the violations of current good manufacturing practices discussed above indicate that Knoll has not always manufactured Synthroid in accordance with current standards for pharmaceutical manufacturing."

 

IV. Patients Need a Precise Dose of Levothyroxine Sodium

 

The FDA letter summarizes all the dangers of inconsistent dosing for hypothyroid patients. In particular, they state: "...patients using Synthroid have experienced significant, unintended variations in their doses of levothyroxine sodium...these variations are not conducive to proper control of hypothyroidism."

 

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Jan B

I just got back from seeing my doctor. He is not convinced that Armour is better than Synthroid or Levothyroxine. He believes the stories we hear about it being better are anecdotal and not based on science alone. He didn't argue that some people really do better with it. Since I have no complaints and have been doing well on Levothyroxine, he does not believe a change is a good idea. However, he'll do what I request.

 

His primary reason for me staying on my current pill/dosage, etc. is the ease of acquiring the Levothyroxine and the low price (I pay 7.50 for a 3 month supply). **** I did just read your above post Scout!!**** He talked about it being hard to even find Armour everywhere. (My own pharmacy would stock it if they knew I would consistently use it, but I didn't argue with him.) Then he brought up another issue that would not really be a problem (if you have a pharmacy that is customer oriented), regarding not being able to always get the proper dosage, and having to take 2 pills instead of one, thereby paying double my copay amount.

 

So . . . since I wanted to more or less make peace w/this man, I listened instead of being more pushy. But I'm open to learn more and look around more!

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Scout

Jan, my doctor wasn't convinced at first either, but she finally put me on it when I kept asking. Now, after seeing how much better I am, she's tried on other patients, and last time I asked, it was a dozen or so. She still puts people on Synthroid first, but if they keep coming back and saying they feel better, but not a lot better, or still have some complaints, she suggest dessicated thyroid. At first my pharmacy was the only one in the area which carried it, but then a few others in a neighbouring town started as well. When I recently switched pharmacies they had it in stock, so I am guessing it is on the upswing in popularity. They have a variety of dosages too.

 

That said, if I had done well on Synthroid from the get go, I doubt I would have even researched other options, never mind switched. You pay a very low price for your meds, too. Of course, Americans pay a lot less for meds in general, I think. But a little over 5 years ago I was paying about $90 (I think... maybe it was $60) for a 3 months supply. Contrast that with $21 for my dessicated thyroid, and I am on a higher dose too.

 

Anyhow, you can keep it in mind, but if your meds are working well for you there doesn't seem to be any rush to switch.

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cherokee_psh

I have used this generic for 5 years without problems. I discovered switching from Synthroid to this generic would save me over $400 a year. I printed this information out and took it to the doctors, who told me there is no difference and we will watch it. It did fine.

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poodlebone

I got my order from the mail order pharmacy yesterday. I have to say the generic pills are very boring. I like the shape of the Levoxyl! My sister is a doctor and said several of her patients hate Levoxyl because they say it gets stuck in their throats as they swallow it but I don't have that problem. By switching to the generic I would save only $40 a year so it's really not worth it to me. I'm going to e-mail my CDE and ask for new prescriptions - one that I can get filled locally and one to mail in for a 90 day supply once the refill date comes up. If I could be assured of egtting the generic from the same manufacturer every single time I might not worry about it so much but pharmacies switch suppliers all the time.

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gettingby

Liz, I've been taking Levothyroxine since my doc put me on thyroid treatment. I know several years ago that Duck was having issues with meds and there was a thread here about Armour. Couldn't find it myself. Maybe he will read this thread and give us a run down again.

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foxl

I used to gag on my thyroxine, EVERY TIME. Maybe it is because I am used to monster metformin now ... but I also CHEW (well dissolve it, really) my T4, every morning, and no longer gag!

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GrammaBear

I was taking levothyroxine when I was first diagnosed with low thyroid. And for a while it seemed to be doing what it was supposed to do. Then I began feeling so tired and run down that my doctor kept checking my levels. Finally he decided to switch to Synthroid to see if the brand name might make a difference. I've been taking Synthroid for little over a year and my levels have finally stabilized. I do see my Endocrinologist very soon and I'm going to ask him about the Armour because I just seem too tired a lot of the time...again.

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Scout

My dessicated thyroid pill is sweetened with sucralose. I wake up at 4:45 AM when my husband gets up, stick the pills under my tongue, and go back to sleep. When I get up at 7-7:30 AM there is nothing but a faint, lingering sweetness in my mouth.

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