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Read the Patient Information Leaflet and Instructions for Use if available from your pharmacist before you start taking levothyroxine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth as directed by your doctor, usually once daily on an empty stomach, 30 minutes to 1 hour before breakfast. Some brands may also be taken 15 minutes before breakfast. Ask your pharmacist about your brand of levothyroxine.

If you are using the medication that comes in a bottle, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose. Take the medication directly from the measuring device. Do not mix with any other liquid.

If you are using the medication that comes in an ampule, the medication may be taken by first mixing it in water, or it may be taken directly (without water). To take it by mixing in water, open the ampule as directed. Then turn the ampule upside down and slowly squeeze the soft (middle) part of the ampule to empty the contents into a glass or cup of water. Release pressure and wait a few seconds. Repeat squeezing and releasing the ampule at least 5 times, until no more liquid comes out of the ampule. Stir the solution and drink all of the liquid right away. Rinse the glass or cup with more water and drink to make sure you have taken all the medicine. Do not prepare a supply ahead of time. To take this medication directly, slowly squeeze the soft (middle) part of the open ampule to empty the contents into the mouth or onto a spoon. Release pressure and wait a few seconds. Repeat squeezing and releasing the ampule at least 5 times, until no more liquid comes out of the ampule. Take all of the liquid right away.

The dosage is based on your age, weight, medical condition, lab test results, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.

Do not stop taking this medication without consulting your doctor. Thyroid replacement treatment is usually taken for life.

There are different brands of levothyroxine available. Do not change brands without first consulting your doctor or pharmacist.

Certain medications (such as cholestyramine, colestipol, colesevelam, antacids, sucralfate, simethicone, iron, sodium polystyrene sulfonate, calcium supplements, orlistat, sucroferric oxyhydroxide, lanthanum, sevelamer, among others) can decrease the amount of thyroid hormone that is absorbed by your body. If you are taking any of these drugs, separate them from this medication by at least 4 hours.

Symptoms of low thyroid hormone levels include tiredness, muscle aches, constipation, dry skin, weight gain, slow heartbeat, or sensitivity to cold. Tell your doctor if your condition does not get better or if it gets worse after several weeks of taking this medication.

See also Precautions section.

Hair loss may occur during the first few months of treatment. This effect is usually temporary as your body adjusts to this medication. If this effect lasts or gets worse, tell your doctor or pharmacist promptly.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: increased sweating, sensitivity to heat, mental/mood changes (such as nervousness, mood swings), tiredness, diarrhea, shaking (tremor), headache, shortness of breath, bone pain, easily broken bones.

Get medical help right away if you have any very serious side effects, including: chest pain, fast/pounding/irregular heartbeat, swelling hands/ankles/feet, seizures.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Before taking levothyroxine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: increased thyroid hormones (thyrotoxicosis), decreased adrenal gland function, heart disease (such as coronary artery disease, irregular heartbeat), high blood pressure, diabetes.

If you have diabetes, this drug may affect your blood sugar. Check your blood sugar regularly as directed and share the results with your doctor. Tell your doctor right away if you have symptoms such as increased thirst/urination, shakiness, unusual sweating, dizziness, or hunger. Your doctor may need to adjust your diabetes medication, exercise program, or diet.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Children may be more sensitive to certain side effects of this drug, especially headache, vision changes, and hip/leg pain. High thyroid hormone levels may lead to decreased bone development/growth and reduced final adult height. Keep all lab/medical appointments so the doctor can monitor treatment.

Older adults may be more sensitive to the side effects of this drug, especially fast/pounding/irregular heartbeat.

This drug may be used during pregnancy. Tell your doctor if you are pregnant because your doctor may need to change your dose.

Levothyroxine passes into breast milk but is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.

See also How to Use section.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: fast/pounding/irregular heartbeat, loss of consciousness, confusion, seizures.

Do not share this medication with others.

Lab and/or medical tests (such as thyroid function) should be done while you are taking this medication. Keep all medical and lab appointments.

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up unless your doctor tells you to do so. Call your doctor if you miss 2 or more doses in a row. Ask your doctor ahead of time what to do about a missed dose and follow your doctor's specific directions.

Store at room temperature away from light and moisture. This medication comes in a bottle or in ampules. If the medication comes in a bottle, store the medication in the original bottle. After opening the bottle, use the medication within the time directed by the manufacturer. Store ampules in the pouch until ready to use. The ampules should be used within 15 days after opening the pouch. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.