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Levothyroxine Interactions with Food and Dietary Supplements–A Systematic Review

Department of Food Chemistry and Nutrition, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna, 30-688 Kraków, Poland
Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences - SGGW (WULS), 159C Nowoursynowska, 02-787 Warsaw, Poland
Author to whom correspondence should be addressed.
Academic Editors: Paolo Arosio and Félix Carvalho
Pharmaceuticals 2021, 14(3), 206;
Received: 29 December 2020 / Revised: 7 February 2021 / Accepted: 25 February 2021 / Published: 2 March 2021
(This article belongs to the Section Pharmacology)
Levothyroxine (l-thyroxine, l-T4) is a drug of choice for treating congenital and primary hypothyroidism. Although clinically significant interactions between l-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 l-T4 pharmacokinetics and pharmacodynamics, to identify the most evident interactions, and to perform the recommendations for safe co-administering of l-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 l-T4 ingestion in the morning and at bedtime are equally effective, and also that the co-administration of l-T4 with food depends on the drug formulation. We found limited evidence for l-T4 interactions with coffee, soy products, fiber, calcium or iron supplements, and enteral nutrition but interestingly they all resulted in decreased l-T4 absorption. The altered l-T4 efficacy when ingested with milk, juices, papaya, aluminium-containing preparations, and chromium supplements, as well as observed enhancement effect of vitamin C on l-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 l-T4. Maintaining a proper time interval between l-T4 and food intake, especially for coffee and calcium, or iron supplements, provides another effective method of eliminating such interactions. View Full-Text
Keywords: levothyroxine; food; interaction; coffee; fiber; soy levothyroxine; food; interaction; coffee; fiber; soy
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MDPI and ACS Style

Wiesner, A.; Gajewska, D.; Paśko, P. Levothyroxine Interactions with Food and Dietary Supplements–A Systematic Review. Pharmaceuticals 2021, 14, 206.

AMA Style

Wiesner A, Gajewska D, Paśko P. Levothyroxine Interactions with Food and Dietary Supplements–A Systematic Review. Pharmaceuticals. 2021; 14(3):206.

Chicago/Turabian Style

Wiesner, Agnieszka, Danuta Gajewska, and Paweł Paśko. 2021. "Levothyroxine Interactions with Food and Dietary Supplements–A Systematic Review" Pharmaceuticals 14, no. 3: 206.

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