Levothyroxine Interactions with Food and Dietary Supplements–A Systematic Review
Levothyroxine (<span style="font-variant: small-caps;">l</span>-thyroxine, <span style="font-variant: small-caps;">l</span>-T4) is a drug of choice for treating congenital and primary hypothyroidism. Although clinically significant interactions between <...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-03-01
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| Series: | Pharmaceuticals |
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| Online Access: | https://www.mdpi.com/1424-8247/14/3/206 |
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| author | Agnieszka Wiesner Danuta Gajewska Paweł Paśko |
| author_facet | Agnieszka Wiesner Danuta Gajewska Paweł Paśko |
| author_sort | Agnieszka Wiesner |
| collection | DOAJ |
| description | Levothyroxine (<span style="font-variant: small-caps;">l</span>-thyroxine, <span style="font-variant: small-caps;">l</span>-T4) is a drug of choice for treating congenital and primary hypothyroidism. Although clinically significant interactions between <span style="font-variant: small-caps;">l</span>-T4 and food can alter the safety and efficacy of the treatment, they still seem to be generally underestimated by patients, physicians and pharmacists. This review aimed to investigate the effects of meals, beverages, and dietary supplements consumption on <span style="font-variant: small-caps;">l</span>-T4 pharmacokinetics and pharmacodynamics, to identify the most evident interactions, and to perform the recommendations for safe co-administering of <span style="font-variant: small-caps;">l</span>-T4 and food. A total of 121 studies were identified following a systematic literature search adhering to PRISMA guidelines. After full-text evaluation, 63 studies were included. The results proved that <span style="font-variant: small-caps;">l</span>-T4 ingestion in the morning and at bedtime are equally effective, and also that the co-administration of <span style="font-variant: small-caps;">l</span>-T4 with food depends on the drug formulation. We found limited evidence for <span style="font-variant: small-caps;">l</span>-T4 interactions with coffee, soy products, fiber, calcium or iron supplements, and enteral nutrition but interestingly they all resulted in decreased <span style="font-variant: small-caps;">l</span>-T4 absorption. The altered <span style="font-variant: small-caps;">l</span>-T4 efficacy when ingested with milk, juices, papaya, aluminium-containing preparations, and chromium supplements, as well as observed enhancement effect of vitamin C on <span style="font-variant: small-caps;">l</span>-T4 absorption, shall be further investigated in larger, well-designed studies. Novel formulations are likely to solve the problem of coffee, calcium and iron induced malabsorption of <span style="font-variant: small-caps;">l</span>-T4. Maintaining a proper time interval between <span style="font-variant: small-caps;">l</span>-T4 and food intake, especially for coffee and calcium, or iron supplements, provides another effective method of eliminating such interactions. |
| first_indexed | 2024-03-09T05:57:33Z |
| format | Article |
| id | doaj.art-b7d59eb495a743569fe3e7060a6cfea0 |
| institution | Directory Open Access Journal |
| issn | 1424-8247 |
| language | English |
| last_indexed | 2024-03-09T05:57:33Z |
| publishDate | 2021-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Pharmaceuticals |
| spelling | doaj.art-b7d59eb495a743569fe3e7060a6cfea02023-12-03T12:12:24ZengMDPI AGPharmaceuticals1424-82472021-03-0114320610.3390/ph14030206Levothyroxine Interactions with Food and Dietary Supplements–A Systematic ReviewAgnieszka Wiesner0Danuta Gajewska1Paweł Paśko2Department of Food Chemistry and Nutrition, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna, 30-688 Kraków, PolandDepartment of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences - SGGW (WULS), 159C Nowoursynowska, 02-787 Warsaw, PolandDepartment of Food Chemistry and Nutrition, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna, 30-688 Kraków, PolandLevothyroxine (<span style="font-variant: small-caps;">l</span>-thyroxine, <span style="font-variant: small-caps;">l</span>-T4) is a drug of choice for treating congenital and primary hypothyroidism. Although clinically significant interactions between <span style="font-variant: small-caps;">l</span>-T4 and food can alter the safety and efficacy of the treatment, they still seem to be generally underestimated by patients, physicians and pharmacists. This review aimed to investigate the effects of meals, beverages, and dietary supplements consumption on <span style="font-variant: small-caps;">l</span>-T4 pharmacokinetics and pharmacodynamics, to identify the most evident interactions, and to perform the recommendations for safe co-administering of <span style="font-variant: small-caps;">l</span>-T4 and food. A total of 121 studies were identified following a systematic literature search adhering to PRISMA guidelines. After full-text evaluation, 63 studies were included. The results proved that <span style="font-variant: small-caps;">l</span>-T4 ingestion in the morning and at bedtime are equally effective, and also that the co-administration of <span style="font-variant: small-caps;">l</span>-T4 with food depends on the drug formulation. We found limited evidence for <span style="font-variant: small-caps;">l</span>-T4 interactions with coffee, soy products, fiber, calcium or iron supplements, and enteral nutrition but interestingly they all resulted in decreased <span style="font-variant: small-caps;">l</span>-T4 absorption. The altered <span style="font-variant: small-caps;">l</span>-T4 efficacy when ingested with milk, juices, papaya, aluminium-containing preparations, and chromium supplements, as well as observed enhancement effect of vitamin C on <span style="font-variant: small-caps;">l</span>-T4 absorption, shall be further investigated in larger, well-designed studies. Novel formulations are likely to solve the problem of coffee, calcium and iron induced malabsorption of <span style="font-variant: small-caps;">l</span>-T4. Maintaining a proper time interval between <span style="font-variant: small-caps;">l</span>-T4 and food intake, especially for coffee and calcium, or iron supplements, provides another effective method of eliminating such interactions.https://www.mdpi.com/1424-8247/14/3/206levothyroxinefoodinteractioncoffeefibersoy |
| spellingShingle | Agnieszka Wiesner Danuta Gajewska Paweł Paśko Levothyroxine Interactions with Food and Dietary Supplements–A Systematic Review Pharmaceuticals levothyroxine food interaction coffee fiber soy |
| title | Levothyroxine Interactions with Food and Dietary Supplements–A Systematic Review |
| title_full | Levothyroxine Interactions with Food and Dietary Supplements–A Systematic Review |
| title_fullStr | Levothyroxine Interactions with Food and Dietary Supplements–A Systematic Review |
| title_full_unstemmed | Levothyroxine Interactions with Food and Dietary Supplements–A Systematic Review |
| title_short | Levothyroxine Interactions with Food and Dietary Supplements–A Systematic Review |
| title_sort | levothyroxine interactions with food and dietary supplements a systematic review |
| topic | levothyroxine food interaction coffee fiber soy |
| url | https://www.mdpi.com/1424-8247/14/3/206 |
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