Levothyroxine is a replacement for a hormone that is normally produced by your thyroid gland to regulate the body’s energy and metabolism. Levothyroxine is given when the thyroid does not produce enough of this hormone on its own.

Levothyroxine treats hypothyroidism (low thyroid hormone). Levothyroxine is also used to treat or prevent goiter (enlarged thyroid gland), which can be caused by hormone imbalances, radiation treatment, surgery, or cancer.

Levothyroxine should not be used to treat obesity or weight problems.

Levothyroxine may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Synthroid (Levothyroxine)?

Since thyroid hormone occurs naturally in the body, almost anyone can take levothyroxine. You should not use this medication if you have had a heart attack, a thyroid disorder called thyrotoxicosis, or an adrenal gland problem that is not controlled by treatment.

Before taking this medication, tell your doctor if you have heart disease, coronary artery disease, anemia (lack of red blood cells), diabetes, problems with your pituitary or adrenal glands, or a history of blood clots.

If you use insulin or take diabetes medicine by mouth, ask your doctor if your dose needs to be changed when you start using levothyroxine.

Different brands of levothyroxine may not work the same. If you get a prescription refill and your new pills look different, talk with your pharmacist or doctor.

It may take several weeks before your body starts to respond to this medication. Do not stop taking this medication suddenly. Even if you feel well, you may still need to take this medicine every day for the rest of your life to replace the thyroid hormone your body cannot produce.

There are many other medicines that can affect levothyroxine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

What should I discuss with my healthcare provider before taking Synthroid (Levothyroxine)?

Since thyroid hormone occurs naturally in the body, almost anyone can take levothyroxine. You should not use this medication if you have had a heart attack, a thyroid disorder called thyrotoxicosis, or an adrenal gland problem that is not controlled by treatment.

Before taking this medication, tell your doctor if you have heart disease, coronary artery disease, anemia (lack of red blood cells), diabetes, problems with your pituitary or adrenal glands, or a history of blood clots.

If you use insulin or take diabetes medicine by mouth, ask your doctor if your dose needs to be changed when you start using levothyroxine.

Levothyroxine is in the FDA pregnancy category A. This means that it is safe to use while you are pregnant. It is also safe to use while you are breast-feeding a baby. This drug does pass into breast milk, but it is not expected to be harmful to a nursing infant.

Tell your doctor if you become pregnant during treatment. You may need to increase your dose during pregnancy or if you plan to breast-feed.

In most cases, you will need to take levothyroxine for the rest of your life. Taking levothyroxine over long periods of time may cause bone loss, which can lead to osteoporosis. Talk with your doctor about how this could affect you.

How should I take Synthroid (Levothyroxine)?

Take levothyroxine exactly as your doctor has prescribed it for you. Do not use more of the medication than recommended. Do not take levothyroxine for longer than your doctor has prescribed.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

It is very important to take levothyroxine with a full glass (8 ounces) of water. The levothyroxine tablet can dissolve very quickly and swell in the throat, possibly causing choking or gagging. Take this medicine on an empty stomach, 30 minutes before eating. Levothyroxine is usually taken in the morning. Follow your doctor’s dosing instructions and try to take this medication at the same time each day.

It may take several weeks before your body starts to respond to this medication. Do not stop taking this medication suddenly. Even if you feel well, you may still need to take this medicine every day for the rest of your life to replace the thyroid hormone your body cannot produce.

To be sure this medication is helping your condition, your blood will need to be tested on a regular basis. Your kidney or liver function may also need to be tested. It is important that you not miss any scheduled visits to your doctor.

Tell any doctor or dentist who treats you that you are using levothyroxine.

Store levothyroxine at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include chest pain, pounding heartbeat, tremor, shortness of breath, leg cramps, confusion, vomiting, diarrhea, or seizures.

Synthroid (Levothyroxine) side effects

Stop using levothyroxine and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

• headache;
• sleep problems (insomnia);
• nervous or irritable feeling;
• fever, hot flashes, sweating;
• changes in your menstrual periods;
• appetite changes, weight changes;

Less serious side effects may include mild hair loss.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect Synthroid (Levothyroxine)?

The following drugs may cause medical problems if you use them with levothyroxine: lithium, amiodarone, or antidepressants. Tell your doctor if you have recently received radiation therapy with iodine (such as I-131).

This list is not complete and there are many other drugs that can interact with levothyroxine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Certain medicines can be continued, but they may make levothyroxine less effective if taken at the same time. If you use any of the following drugs, use them at least 4 hours before or 4 hours after you take levothyroxine:

• calcium carbonate (Caltrate, Citracal, Oystercal, and others);
• ferrous sulfate iron supplement;
• sucralfate (Carafate);
• sodium polystyrene sulfonate (Kayexalate, Kionex, and others);
• antacids that contain aluminum (Amphojel, Gaviscon, Maalox, Mylanta, Riopan, Rulox, Tums, and others); and
• cholesterol-lowering drugs cholestyramine (Questran) and colestipol (Colestid).

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Albuterol and ipratropium are bronchodilators that relax muscles in the airways and increase air flow to the lungs.

Combivent is used to prevent bronchospasm in people with chronic obstructive pulmonary disease (COPD) who are also using other medicines to control their condition.

Combivent may also be used for other purposes not listed in this medication guide.

Important information about Combivent (Albuterol and Ipratropium)

Do not use Combivent if you are allergic to soybeans, peanuts, or other food products that contain soya lecithin.

Call your doctor right away if you feel that this medicine is not working as well as usual, or if it makes your condition worse. If it seems like you need to use more of any of your medications in a 24-hour period, talk with your doctor.

Extreme heat can cause the medicine canister to burst. Do not store your inhaler in your car on hot days. Do not throw an empty canister into open flame.

Before using Combivent (Albuterol and Ipratropium)

Do not use Combivent if you are allergic to soybeans, peanuts, or other food products that contain soya lecithin.

Before using Combivent, tell your doctor if you have:

• heart disease, high blood pressure, or congestive heart failure;
• a seizure disorder such as epilepsy;
• diabetes;
• overactive thyroid;
• glaucoma;
• an enlarged prostate or problems with urination; or
• liver or kidney disease.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take Combivent.

FDA pregnancy category C. Combivent may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether Combivent passes into breast milk or if it could harm a nursing baby. Do not use Combivent without telling your doctor if you are breast-feeding a baby.

How should I use Combivent (Albuterol and Ipratropium)?

Use Combivent exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the instructions on your prescription label.

Combivent may increase the risk of asthma-related death. It is critical that you use only the prescribed dose of this medicine and follow all patient instructions for safe use of the medication.

Combivent comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

When using the inhaler device for the first time, prime it by spraying 2 test sprays into the air, away from your face. Also prime the inhaler if you have not used it for 3 days or longer.

The instructions below are for standard use of the inhaler and nebulizer devices. Your doctor may want you to use your device differently. Be sure you understand all instructions that are specific to your use of Combivent.

To use the inhaler:

• Shake the canister vigorously for at least 10 seconds before each spray.
• Uncap the mouthpiece of the inhaler. Breathe out fully. Put the mouthpiece into your mouth and close your lips. Keep your eyes closed to prevent spraying any medicine into your eyes. Breathe in slowly while pushing down on the canister. Hold your breath for 10 seconds, then breathe out slowly.
• If you use more than one inhalation at a time, wait at least 2 minutes before using the second inhalation.
• Keep your inhaler clean and dry, and store it with the cap on the mouthpiece. Clean your inhaler once a week by removing the canister and placing the mouthpiece under warm running water for at least 30 seconds. Allow the parts to dry before putting the inhaler back together.

To use the solution with a nebulizer:

• Measure the correct amount of medicine using the dropper provided, or use the proper number of ampules. Place the liquid into the medication chamber of the nebulizer. If using a medicine dropper, do not allow the dropper to touch any surface including your hands or the nebulizer.
• Attach the mouthpiece or face mask to the drug chamber. Then, attach the drug chamber to the compressor. Sit upright in a comfortable position. Place the mouthpiece into your mouth or put the face mask on, covering your nose and mouth. Breathe in slowly and evenly until you have inhaled all of the medicine (usually 5 to 15 minutes). The treatment is complete when no more mist is formed by the nebulizer and the drug chamber is empty.
• Clean the nebulizer after each use. Follow the cleaning directions that came with your nebulizer.

Call your doctor right away if you feel that this medicine is not working as well as usual, or if it makes your condition worse. If it seems like you need to use more of any of your medications in a 24-hour period, talk with your doctor.

To be sure Combivent is helping your condition, your lung function will need to be tested on a regular basis. It is important that you not miss any scheduled visits to your doctor.

It is important to use Combivent regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely. Keep using all of your other medications as prescribed by your doctor.

Store Combivent at room temperature away from moisture and heat. Extreme heat can cause the medicine canister to burst. Do not store it in your car on hot days. Do not throw an empty canister into open flame.

Keep track of the number of sprays you have used and throw away the inhaler canister after 200 sprays, even if it feels like there is still medicine in it.

What happens if I miss a dose?

Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and use the medicine at the next regularly scheduled time. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of Combivent can be fatal. Overdose symptoms may include chest pain or heavy feeling, rapid or uneven heart rate, pain spreading to the arm or shoulder, nausea, sweating, weakness, or general ill feeling.

Combivent (Albuterol and Ipratropium) side effects

Stop using Combivent and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using Combivent and call your doctor at once if you have any of these serious side effects:

• bronchospasm (wheezing, chest tightness, trouble breathing), especially after starting a new canister of this medicine;
• chest pain and fast, pounding, or uneven heart beats;
• swelling of your ankles or feet;
• pain or burning with urination; or
• increased blood pressure (severe headache, blurred vision, trouble concentrating, chest pain, numbness, seizure).

Less serious side effects may include:

• headache, dizziness, nervousness;
• drowsiness or sleep problems (insomnia);
• cough, hoarseness, sore throat, runny or stuffy nose;
• dry mouth, unusual taste in your mouth;
• tremors, numbness or tingly feeling;
• nausea, vomiting, upset stomach, diarrhea, constipation; or
• blurred vision.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect Combivent (Albuterol and Ipratropium)?

Before using Combivent, tell your doctor if you are taking any of the following medicines:

• atropine (Donnatal, and others);
• belladonna;
• clidinium (Quarzan);
• dicyclomine (Bentyl);
• glycopyrrolate (Robinul);
• hyoscyamine (Anaspaz, Cystospaz, Levsin, and others);
• mepenzolate (Cantil);
• methantheline (Provocholine);
• methscopolamine (Pamine), scopolamine (Transderm-Scop);
• propantheline (Pro-Banthine);
• a beta-blocker such as acebutolol (Sectral), atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor), or propranolol (Inderal);
• a stimulant, ADHD medication, diet pills, or over-the-counter cold or allergy medicines;
• a diuretic (water pill) such as furosemide (Lasix), bumetanide (Bumex), ethacrynic acid (Edecrin), torsemide (Demadex), hydrochlorothiazide (Hydrodiuril), chlorthalidone (Hygroton, Thalitone), or chlorothiazide (Diuril); or
• an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).

This list is not complete and there may be other drugs that can interact with Combivent. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

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