Therapeutic indications of liothyronine
Liothyronine is a thyroid hormone indicated as supplemental therapy in patients with hypothyroidism of any etiology. Hypothyroidism occurs from primary atrophy, functional deficiency, partial or total absence of thyroid gland. Liothyronine is used for prevention of thyroid nodules, subacute or chronic lymphocytic thyroiditis and multinodular goiter. Prior to commencing the therapy with this drug, consult a doctor and make all necessary laboratory studies and examinations in order to get a clear medical evidence of hypothyroidism. Read carefully the package leaflet and get better informed about potential interaction with other drugs, possible side effects and other important information related to the use of liothyronine.

Contraindications

• Liothyronine is contraindicated in patients with apparent hypersensitivity to it or to any of its active constituents;
• Avoid liothyronine if you have untreated thyrotoxicosis or adrenal cortical insufficiency;

Warnings and precautions with liothyronine
As already mentioned above, it is indicated to consult a doctor before starting the treatment with liothyronine, in order to depict the hypothyroidism and have an initial examination of symptoms for obtaining prescription of the drug. Take all protective measures in order to avoid developing of severe adverse events and precipitation of existing symptoms.

• Take the doses exactly as prescribed. Greater doses of liothyronine may produce serious manifestations of toxicity;
• It is considered ineffective the use of thyroid hormones in the therapy of obesity, either alone or in combination with other drugs. Unless the obesity is accompanied by hypothyroidism, the use of liothyronine may be justified also for the therapy of obesity.
• Patients with clear clinical evidence of cardiovascular events should exercise particular caution to the use of liothyronine, especially in case of coronary arteries and angina pectoris. Such patients need to stay under the supervision of physicians and receive the lowest effective doses.
• It is not indicated the use of liothyronin in patients with morphologic hypogonadism, nephrosis and hypopituitarism. If the patient has clinical evidence of the enumerated diseases, it is important to treat the symptoms prior to administration of liothyronine. It is important to correct the adrenal deficiency before starting to use the drug.
• If the hypothyroidism is severe and prolonged, it is necessary to consider the use of supplemental adrenocortical steroids. Take all protective measures in order to avoid precipitation of the hyperthyroid state or aggravation of existing hyperthyroidism.
• Patients with diabetes mellitus or insipidus or adrenal cortical insufficiency that receive treatment with liothyronine may aggravate the intensity of their symptoms. Make regular visits to your physician in order to evaluate efficiency and safety from the therapy with liothyronine.
• If the patient has diabetes mellitus and receives treatment with liothyronine, it is important to adjust the doses in order to not interfere with the mechanism of action and pharmacokinetics of each other. It is a mandatory condition for avoiding hypoglycemia. It is also necessary to closely monitor the urinary glucose levels on a regular basis.
• Before starting to use liothyronine, get the full list of medicines that interact with this drug. Generally, hyperthyroidism increases the sensitivity to oral anticoagulants. If you are taking oral anticoagulants concurrently with liothyronine, closely monitor prothrombine time and adjust the doses in order to avoid aggravation of existing symptoms.
• If any signs of thyroid hormone toxicity are detected, report about them right away. The symptoms of such adverse event are the following: chest pain, palpitations, increased pulse rate, heat intolerance, excessive sweating, nervousness and other unusual event.
• It is important to periodically assess the thyroid status by making the necessary laboratory tests. Beside the full clinical evaluation of the medical condition, laboratory studies are relevant.
• It has been demonstrated that thyroid hormones do not cross the placental barrier. There have not been reported any adverse effects on fetus while on thyroid therapy administered in pregnant women. However, take all necessary measures of protection in order to avoid any adverse reactions.
• Clinical studies have shown that minimal amounts of thyroid hormones are excreted in human milk. Therefore, nursing mothers should not experience any discomfort while on therapy with liothyronine. However, caution should be exercised in nursing mothers.

Interaction with other drugs
Prior to initiation of therapy with liothyronine, prevent your doctor about all medicines you are currently taking, including prescription, non-prescription, herbal products and natural supplements. Some drugs may interfere with the mechanism of action of liothyronine and change its pharmacokinetics. It is not recommended the concurrent administration of liothyronine with the following medicines:

• Oral anticoagulants;
• Insulin or oral hypoglycemic;
• Cholestyramine;
• Estrogen, oral contraceptives;
• Tricyclic antidepressants;
• Digitalis, due to the fact that liothyronine may potentiate the toxic effects of digitalis;
• Ketamine;
• Vasopressors.

Indications of dosage and administration
Liothyronine is a drug available for oral administration as tablets of 5 mcg, 25 mcg and 50 mcg. Follow the treatment exactly as prescribed. Consult a doctor in order to get the right prescription for your medical condition. The usual recommended dose is once a day. For the treatment of mild hypothyroidism, it is recommended a dose of 25 mcg daily. The dose might be increased by up to 25 mcg every 2 weeks. The maintenance dose is 25 to 7 mcg daily. For the treatment of congenital hypothyroidism it is recommended an initial dose of 5 mcg daily. Generally, the doses are similar for all cases of hypothyroidism. However, it is important to have an initial examination before starting to use the drug. Swallow the tablets whole. Do not crush, chew or divide the tablets in separate doses unless prescribed by a physician to do so. Follow all the indications of administration and read carefully the package leaflet in order to avoid any misunderstandings.

Possible side effects with liothyronine
Like most of medicines, liothyronine may cause side effects when used in prescribed doses. This happens due to different tolerance to the drug. There have not been reported severe adverse events with liothyronine. The side effects with liothyronine are mild and transient. Rarely, it may cause allergic skin reactions. However, if any side effects occur while on therapy with liothyronine, report about it immediately and take all appropriate measures to treat the symptoms.

Overdosage with liothyronine
There have been reported cases of overdosage with liothyronine. The reported signs and symptoms of overdosage with liothyronine are the following: irritability, headache, sweating, nervousness, increased bowel motility, arrhythmia including tachycardia and menstrual irregularities. Patients with clinical evidence of cardiovascular disorders may have experience aggravated symptoms of existing diseases. Therefore, it is necessary to report immediately of overdosage with liothyronine. While treating the symptoms of overdosage with liothyronine, it is necessary to discontinue temporarily the therapy.

If you missed a dose
If you forgot to take a dose of liothyronine, do not worry; take it as soon as you remember. If it is already the time to take the next dose, leave the missed one and continue your usual schedule. Try to not miss more than two doses in a row and do not take greater doses in order to make up for the skipped ones. If you have any questions related to the skipped dose, ask a pharmacist or contact your physician.

Storage
Keep liothyronine in a clean and dry place at the room temperature below 30 degrees C. Try to avoid the direct sunlight, heat and moisture. It is recommended to store liothyronine out of the sight and reach of children. Keep the tablets in their original packaging and prior to beginning therapy with it look carefully at the expiry date at the bottom of the package. Do not use expired medicine.