Levotiroxine Aristo 137 micrograms tablets

Package leaflet: Information for the user

Introduction

Package leaflet: information for the patient

Levotiroxina Aristo 137 microgram tablets

sodium levothyroxine

Read the entire leaflet carefully before you start taking this medicine, because it contains important information for you.

• Keep this leaflet, as you may need to read it again.
• If you have any questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only, and you should not give it to other people, even if they have the same symptoms as you, because it may harm them.
• If you experience any adverse effects, consult your doctor or pharmacist, even if they are adverse effects not listed in this leaflet. See section 4.

Leaflet contents

1. What Levotiroxina Aristo is and what it is used for
2. What you need to know before taking Levotiroxina Aristo
3. How to take Levotiroxina Aristo
4. Possible adverse effects
5. How to store Levotiroxina Aristo
6. Contents of the pack and other information

1. What Levotiroxina Aristo is and what it is used for

Thyroxine is a hormone naturally produced in the body by the thyroid gland. Sodium levothyroxine is a synthetic thyroid hormone that is chemically identical to this hormone.

This medicine is used to replace missing thyroid hormone or to reduce stress on the thyroid gland.

Levotiroxina is used for:

• replacing the missing thyroid hormone in all forms of underactive thyroid function (hypothyroidism) or after removal of the thyroid gland,
• preventing the recurrence of new goiters after goiter surgery in patients with normal thyroid function,
• treating non-malignant goiter (benign struma) in patients with normal thyroid function, as additional therapy in antithyroid treatment of an overactive thyroid, once normal metabolic status has been achieved,
• treating malignant thyroid tumors, particularly after surgery to suppress the growth of new tumors, and as replacement for the missing thyroid hormone.

2. What you need to know before taking Levotiroxina Aristo

Do not take Levotiroxina:

• if you are allergic to levotiroxina or to any of the other ingredients of this medicine (listed in section 6);

• if you have a condition caused by overactivity of the thyroid gland that is untreated (hyperthyroidism, thyrotoxicosis);

• if you have adrenal gland dysfunction (adrenal insufficiency) and do not have adequate replacement therapy;

• if you have untreated pituitary gland deficiency;

• if you have any of the following conditions:

• acute myocardial infarction,

• acute inflammation of the heart muscle (myocarditis),

• acute inflammation of all layers of the heart (pancarditis),

• if you are pregnant, do not take levotiroxina together with other medications used to treat overactive thyroid (antithyroid drugs).

Before starting treatment with levotiroxina, the following disorders or conditions must be ruled out or treated:

• coronary heart disease,
• chest pain with chest tightness (angina pectoris),
• fatty deposits in the arteries (arteriosclerosis),
• high blood pressure (hypertension),
• conditions in which the pituitary/adrenal glands do not produce enough hormones (hypopituitarism and/or adrenal cortical insufficiency),
• areas of the thyroid gland producing uncontrolled amounts of thyroid hormone (thyroid autonomy).

Warnings and precautions

Thyroid hormones must not be used for weight loss. Taking thyroid hormones will not reduce your weight if your thyroid hormone levels are within the normal range. Increasing the dose without specific medical indication may cause serious adverse effects or even be life-threatening, especially when combined with certain weight-loss products (see section 2 “Other medicines and levotiroxina”).

If you need to switch your medication to another containing levotiroxina, a thyroid imbalance may occur. Speak with your doctor if you have any concerns about changing your medication. Close monitoring (clinical and biological) is required during the transition period. Inform your doctor if you experience any adverse effects, as this may indicate that your dose needs adjustment (either increased or decreased).

Consult your doctor or pharmacist before taking levotiroxina:

• if you have an underactive thyroid gland from birth or acquired during childhood;
• if you have heart problems such as angina pectoris, coronary heart disease, weak heart muscle, heart rhythm disorders, or high blood pressure or arteriosclerosis;
• if you have recently had a heart attack;
• if you are being treated with certain anticoagulants (blood-thinning medicines) (e.g., phenprocoumon). You may need to adjust the dose of this medicine (see section 2 “Other medicines and levotiroxina”);
• if you have diabetes, as your antidiabetic treatment dose may need to be adjusted, since levotiroxina may increase blood sugar levels (see section 2 “Other medicines and levotiroxina”);
• in postmenopausal women: your thyroid function should be monitored more frequently to avoid elevated levotiroxina levels in the blood, which may lead to osteoporosis (brittle bones);
• if you have epilepsy (seizures): epileptic seizures have rarely been reported when starting levotiroxina treatment or increasing the dose rapidly;
• if you have myxoedema (swelling of the skin and subcutaneous tissue), as it may be necessary to reduce the dose of levotiroxina;
• if you have intestinal disease, as this may also impair drug absorption (malabsorption syndromes, e.g. coeliac disease, lactose intolerance), and treatment may be needed to ensure your levotiroxina therapy is effective;
• if you have an underactive adrenal gland (adrenal insufficiency), pituitary gland dysfunction, or thyroid gland dysfunction with uncontrolled overproduction of thyroid hormones, as these conditions must be medically managed before starting levotiroxina.
• If you are undergoing laboratory tests to monitor your thyroid hormone levels, inform your doctor or laboratory staff that you are taking or have recently taken biotin (also known as vitamin H, vitamin B7, or vitamin B8). Biotin can interfere with laboratory test results. Depending on the test, results may be falsely elevated or falsely reduced due to biotin. Your doctor may instruct you to stop taking biotin before blood tests. Also note that other products you may be taking, such as multivitamins or supplements for hair, skin, and nails, may also contain biotin. This could affect laboratory test results. Inform your doctor or laboratory staff if you are taking these products (see information in section “Other medicines and levotiroxina”).

Contact your doctor if you experience signs of psychotic disorders.

Blood pressure will be monitored periodically when starting levotiroxina treatment in very low birth weight premature newborns, as a rapid drop in blood pressure (known as circulatory collapse) may occur.

In elderly patients, the dose should be carefully and individually adjusted, for example in those with heart problems, and they should be monitored by their doctor.

Blood tests
Before starting levotiroxina, your doctor will perform a blood test to determine how much thyroxine your thyroid gland is producing and what dose of medication you require. Once you start taking the medicine, your doctor will want you to have regular blood tests to ensure the medicine is working properly.

Other medicines and levotiroxina

Inform your doctor or pharmacist if you are taking, have recently taken, or might need to take any other medicines. This includes over-the-counter medicines, herbal remedies, and vitamin supplements. Many medicines affect how levotiroxina works. The effects of other medicines may also be affected by levotiroxina.

If you are about to undergo a test involving iodinated contrast agents, inform your doctor that you are taking levotiroxina.

If you are taking or have recently taken biotin, inform your doctor or laboratory staff when laboratory tests are being performed to monitor thyroid hormone levels. Biotin can affect laboratory test results (see Warnings and precautions).

The following medicines may affect how levotiroxina works:

• medicines to treat epilepsy or seizures, such as carbamazepine, phenytoin, primidone, and barbiturates,
• products containing St. John’s wort (a herbal medicine),
• sertraline, lithium: used to treat depression, mood disorders, and anxiety disorders,
• statins such as simvastatin and lovastatin (used to treat high cholesterol),
• rifampicin, used to treat infections,
• 5-fluorouracil, imatinib, and sunitinib (used in anticancer [antineoplastic] treatment),
• β-receptor blocking medicines such as propranolol, atenolol, and sotalol, used to treat high blood pressure and heart problems,
• medicines containing oestrogens for hormone replacement therapy (HRT) and contraception ("the pill"),
• medicines containing androgens for male hormone replacement therapy,
• glucocorticoids, such as cortisone, hydrocortisone, prednisolone, and dexamethasone, used to treat inflammation,
• amiodarone: used to treat irregular heartbeats,
• anti-inflammatory medicines, such as phenylbutazone or acetylsalicylic acid,
• methadone, used for opioid substitution treatment,
• furosemide: used to treat high blood pressure or oedema,
• propylthiouracil, used to treat overactive thyroid,
• iodide (used to protect the thyroid gland from radiation),
• oral contrast agents – taken before certain scans to make body parts more visible,
• chloroquine, proguanil, used for malaria prophylaxis and rheumatic diseases,
• ritonavir, used to control HIV and chronic hepatitis C virus,
• weight-loss medicines (e.g., orlistat),
• proton pump inhibitors (such as omeprazole, esomeprazole, pantoprazol, rabeprazole, and lansoprazol) used to reduce stomach acid production, which may reduce intestinal absorption of levotiroxina and thus make it less effective. If you are taking levotiroxina at the same time as a proton pump inhibitor, your doctor should monitor your thyroid function and may need to adjust your levotiroxina dose.

Levotiroxina should be taken at least 4–5 hours before taking the following medicines:

• calcium, magnesium, aluminium, iron, or lanthanum supplements;
• colestyramine, colestipol, or clofibrate (used to reduce blood cholesterol levels);
• sodium polystyrene sulfonate (used to treat kidney disease nephropathy);
• orlistat (weight-loss medicines);
• cimetidine (used to reduce excess stomach acid);
• proton pump inhibitors, such as omeprazole, esomeprazole, used to treat excess stomach acid;
• sucralfate, antacids (used to treat stomach ulcers).

The following medicines may be affected by levotiroxina:

• anticoagulant medicines to prevent blood clotting, such as warfarin, dicoumarol, and phenprocoumon;
• medicines to treat diabetes, such as insulin and metformin;
• tricyclic antidepressants, such as amitriptyline, imipramine, and dosulepin;
• medicines that stimulate the sympathetic nervous system, such as adrenaline (used to treat severe allergic reactions) or phenylephrine (a decongestant found in many cold and flu remedies);
• digoxin, for treating heart problems;
• phenytoin, an antiepileptic medicine.

Taking levotiroxina with food and drink

Soy-containing products and high-fibre foods may affect the absorption of levotiroxina. As a result, your doctor may need to adjust your levotiroxina dose.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor before taking this medicine.

Consistent thyroid hormone therapy is especially important during pregnancy and breastfeeding, and therefore must continue under the supervision of your treating doctor.

The need for levotiroxina may increase during pregnancy due to rising blood levels of oestrogen (female sex hormone). Therefore, thyroid function should be monitored during and after pregnancy, and the levotiroxina dose adjusted as necessary.

Even with high-dose levotiroxina treatment, the amount of thyroid hormone passing into breast milk during breastfeeding is very low and therefore harmless.

Suppression tests must not be performed during pregnancy and breastfeeding.

Driving and using machines

Levotiroxina Aristo is not expected to have any influence on the ability to drive and use machines, as levotiroxina is identical to natural thyroid hormone.

Levotiroxina Aristo contains sodium

This medicine contains less than 23 mg of sodium (1 mmol) per tablet; this is essentially “sodium-free”.

3. How to take Levotiroxina Aristo

Follow exactly the instructions for use of this medicine provided by your doctor or pharmacist. If in doubt, consult your doctor or pharmacist again.

Particular caution is required when starting thyroid hormone therapy in elderly patients, patients with coronary heart disease, and patients with chronic or severe hypothyroidism. This means that a lower initial dose should be selected, which is then increased slowly and at longer intervals, with frequent monitoring of thyroid hormone levels.

Experience has shown that a lower dose is also sufficient in patients with low body weight and in patients with extensive nodular goiter.

Dosage

For individual treatment, the tablets are available in graduated strengths ranging from 25 to 200 micrograms of levothyroxine, meaning that in most cases only one tablet per day is required.

Your doctor will determine your individual dose based on laboratory examinations and tests. In general, treatment starts with a low dose, which is increased every 2 to 4 weeks until the full individual dose is reached. During the first weeks of treatment, you will have laboratory appointments to adjust the dose.

Administration method The total daily dose should be taken in the morning on an empty stomach, at least half an hour before breakfast, since the active substance is better absorbed when the stomach is empty than before or after a meal. The tablets should be swallowed whole, without chewing, with a glass of water.

For infants, the total daily dose should be given at least half an hour before the first meal of the day. To do this, the tablet may be allowed to dissolve in a small amount of water. If necessary, the tablet may be divided. However, it is not recommended to crush or dissolve the tablet in water or other liquids, as the dose may not be accurate.

Levothyroxine may be divided into equal doses.

Duration of administration

You should take this medication for as long as your doctor advises.

If you have an underactive thyroid gland or have undergone surgery for malignant thyroid tumor, you will usually need to take levothyroxine for life.

For benign goiter and for prevention of recurrent goiter growth, you should take levothyroxine for a variable period ranging from several months or years up to lifelong treatment.

In adjunctive therapy for the treatment of an overactive thyroid, you should take levothyroxine for as long as you are taking antithyroid medication.

For the treatment of benign goiter with normal thyroid function, a treatment period of 6 months to 2 years is required. If treatment with levothyroxine has not achieved the desired result within this time, other treatment options should be considered.

If you take more levothyroxine than you should

In case of overdose or accidental ingestion, contact your doctor or pharmacist immediately, or call the Toxicology Information Service at telephone: 91 562 04 20, stating the medication and the amount ingested.

Signs of an overdose may include: agitation, confusion, irritability, fever, chest pain (angina), rapid or irregular heartbeat, rapid breathing, muscle cramps, headache, restlessness, hyperactivity, hot flushes, sweating, dilated pupils, diarrhea, tremors, difficulty sleeping, anxiety or nervousness, fatigue or emotional changes, seizures. These symptoms may take up to 6 days to appear. Bring all remaining tablets and this leaflet so that medical personnel know exactly what has been taken.

If you forget to take levothyroxine

If you miss a dose, take your usual dose at the next scheduled time. Do not take a double dose to make up for forgotten individual doses. If you are unsure, consult your doctor or pharmacist.

If you stop taking levothyroxine

For your treatment to be effective, you must take levothyroxine regularly at the dose prescribed by your doctor. Under no circumstances should you change, stop, or interrupt the prescribed treatment without consulting your doctor, as symptoms may reappear.

If you have any further questions about the use of this medicine, ask your doctor or pharmacist.

4. Possible adverse effects

Like all medicines, this medicine can cause adverse effects, although not everyone experiences them.

Stop taking the tablets and go to hospital immediately if you experience:

• an allergic reaction such as swelling of the eyelids, tongue, lips and/or throat and/or difficulty swallowing or hives with difficulty breathing (angioedema), rash or itching (especially if affecting the whole body), joint pain, sensitivity to sunlight, general feeling of being unwell (frequency unknown). You may require urgent medical attention.

Some patients may experience a serious adverse reaction due to high levels of thyroid hormone. This is known as "thyroid storm". Stop taking the tablets and go to hospital if you have any of the following symptoms (frequency unknown):

• Very high temperature, rapid heartbeat (tachycardia), irregular heartbeats, low blood pressure, heart failure, jaundice, confusion, seizures and coma.

Tell your doctor or pharmacist if any of the following adverse effects persist, worsen or if you notice any adverse effects not listed here.

Most adverse effects are similar to those of an overactive thyroid gland (hyperthyroidism, where the thyroid gland produces too much thyroxine), especially if the dose is increased too quickly at the start of treatment. They usually resolve when the dose is reduced or treatment is stopped. Inform your doctor if side effects occur. He/she will decide whether your daily dose should be reduced or whether you should stop taking the tablets for a few days. However, do not change the dose or stop taking the tablets without first consulting your doctor.

Frequency not known: frequency cannot be estimated from the available data.

• Increased appetite;
• restlessness, excitability, difficulty sleeping (insomnia);
• tremor (shakiness), headache, seizures;
• chest pain (angina), palpitations, irregular heartbeats, strong heartbeat sensations (pounding heart), heart failure, heart attack;
• high blood pressure, flushing;
• difficulty breathing (dyspnea);
• diarrhoea, vomiting, malaise, stomach aches;
• increased sweating, itching, skin rash, urticaria;
• muscle cramps, muscle weakness, joint pain;
• decreased bone density (osteoporosis), particularly in postmenopausal women taking high doses for prolonged periods;
• in women: irregular periods;
• fever (high temperature), swelling (oedema), general feeling of being unwell;
• weight loss;
• overactive thyroid (hyperthyroidism);

Additional side effects in children

Rare (may affect up to 1 in 1,000 people)

• increased intracranial pressure in children not caused by a tumour or other diseases (benign intracranial hypertension).

Frequency not known: frequency cannot be estimated from the available data

• premature interruption of a child's growth due to changes in bone growth;
• mild hair loss in children;
• skull deformity in babies caused by early closure of the sutures in the skull bones (craniosynostosis);
• heat intolerance.

In case of hypersensitivity to levothyroxine or to any of the other components of Levotiroxina Aristo, allergic reactions may occur affecting the skin and respiratory tract.

Reporting of adverse effects

If you experience any adverse effect, talk to your doctor or pharmacist, even if it is a possible adverse effect not listed in this leaflet. You can also report them directly via the Spanish Pharmacovigilance System for Human Medicinal Products: https://www.notificaram.es. By reporting adverse effects, you can help provide more information on the safety of this medicine.

5. Storage of Levotiroxina Aristo

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date stated on the carton and blister pack after "EXP". The expiry date refers to the last day of the month indicated.

Do not store above 30 °C.

Medicines must not be disposed of via wastewater or household waste. Dispose of unused medicines and their packaging at the SIGRE Point at your pharmacy. If you are in doubt, ask your pharmacist how to properly dispose of unused medicines and their packaging. This will help protect the environment.

6. Contents of the pack and other information

• The active substance is levothyroxine sodium anhydrous. Each tablet contains 137 micrograms of levothyroxine sodium anhydrous.
• The other components are microcrystalline cellulose, corn starch, heavy magnesium oxide, sodium carboxymethyl starch from corn (Type A), and vegetable magnesium stearate.

Appearance of the medicine and contents of the pack

White, round, uncoated, biconvex (bevelled edge) tablets with a score line on one side and engraved with "137" on the other side. The tablets have an approximate diameter of 7 mm and an approximate height of 3 mm.

The tablets are supplied in blisters within packs containing 25, 30, 50, 60, 90, and 100 tablets.

Only certain pack sizes may be commercially available.

Marketing Authorization Holder

Aristo Pharma GmbH
Wallenroder Straße 8-10
13435 Berlin
Germany

Manufacturer

Aristo Pharma GmbH
Wallenroder Straße 8-10
13435 Berlin
Germany

For further information about this medicine, please contact the local representative of the Marketing Authorization Holder:

Aristo Pharma Iberia, S.L.
C/ Solana, 26
28850 Torrejón de Ardoz
Madrid, Spain

This medicine is authorised in the Member States of the European Economic Area under the following names:

Austria: Levothyroxin Aristo 137 Mikrogramm Tabletten
Czech Republic: Levothyroxine Aristo 137 mikrogramu tablety
Germany: L-Thyroxin Aristo 137 Mikrogramm Tabletten
Ireland: Levothyroxine sodium Aristo 137 microgram tablets
Italy: Levotiroxina Aristo 137 mikrogrammi compresse
Netherlands: Levothyroxinenatrium Aristo 137 microgram tabletten
Poland: Eferox 137 mikrogramów tabletki
Portugal: Levotiroxina Aristo 137 microgramas comprimidos
Spain: Levotiroxina Aristo 137 microgramos comprimidos
Sweden: Levothyroxine Aristo 137 mikrogram tabletter

Date of the most recent review of this leaflet: December 2023

Other sources of information

Detailed information on this medicine is available on the website of the Spanish Agency of Medicines and Health Products (AEMPS): http://www.aemps.gob.es/