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Thyroid drugs available in New Zealand


Datasheets


Funded – levothyroxine (T4) - for treatment of hypothyroidism


Approved but not funded – levothyroxine (T4) - for treatment of hypothyroidism


Not approved or funded – levothyroxine (T4) - for treatment of hypothyroidism


  • Almus (Actavis)
    • In New Zealand, this levothyroxine is known under the name of its UK distributor Almus, but the manufacturer is Actavis UK Ltd.
    • This formulation of levothyroxine appears to be the only one available without the ingredient acacia. Acacia can cause asthma in some patients.

Not approved or funded - liothyronine (T3) - for additional or alternative treatment of hypothyroidism

  • Tertroxin (Mercury Pharma Group, previously Goldshield)

Not approved or funded – desiccated porcine thyroid extract - for treatment of hypothyroidism



Funded – carbimazole (antithyroid drug) - for treatment of hyperthyroidism


Not approved but funded under Special Authority – propylthiouracil (PTU) (antithyroid drug) - for treatment of hyperthyroidism

  • Propylthiouracil (AFT Pharmaceuticals, no datasheet available), Special Authority form SA1199
    • The Propylthiouracil brand supplied by AFT Pharmaceuticals is not (yet) approved by Medsafe. It must, therefore, be supplied and prescribed in accordance with the provisions of section 29 of the Medicines Act 1981. See see under Prescribing unapproved medicines.


Side effects and drug interactions


Side effects

The possible side effects of (anti-)thyroid drugs are usually well described in the data sheets. We would, however, like to warn patients and their doctors that levothyroxine of the brand Eltroxin (new formulation, GlaxoSmithKline) has been reported to cause a much wider range of side effects than those currently included in the data sheet.


Although we acknowledge that there are patients who do not appear to suffer from side effects from this brand, many of our members have been very unwell after the change in formulation of Eltroxin in 2007. We do, for that reason, recommend reading The Eltroxin formulation change: An analysis of reports received by CARM, Dr M. Tatley, Director, New Zealand Pharmacovigilance Centre, 4 September 2008.


Reporting side effects

We recommend reporting side effects (adverse reactions) of drugs to the Centre for Adverse Reactions Monitoring (CARM) in Dunedin, either by a patient's doctor or by the patient her or himself. It is preferable to use CARM's reporting form, but it is also possible to send an e-mail to CARM as long as all the information required by the form is included in the e-mail. The required information includes:

  • the start and stop dates for all medicines used (for non-suspect medicines where the dates are uncertain more general entries are acceptable, for example 'years')
  • the brand name of the medicine(s), especially if the suspected reaction is associated with a change in medicines – mark the medicine suspected of causing the side effects and provide the batch numbers (printed on the label) where available
  • the daily dose of the medicine(s) taken
  • the reason why the medicine(s) is/are used
  • the side effects experienced
  • the date since when the side effects were experienced
  • other medical conditions
  • patient details (including sex and date of birth)
  • doctor details

For more information on how, what and where to report side effects, visit the Carm website.


Drug interactions

Taking too much anti-thyroid drugs such as carbimazole and propylthiouracil (prescribed to treat hyperthyroidism, see above) can cause symptoms of hypothyroidism, just like taking too much thyroid drugs such as levothyroxine or liothyronine (prescribed to treat hypothyroidism) can result in symptoms of hyperthyroidism (thyrotoxicosis).


Several other drugs can also interfere with your thyroid function or can affect the effectiveness of your (anti-)thyroid drugs. This includes both prescription drugs and over the counter drugs. Examples are:

  • amiodarone (prescribed for treatment of cardiac rhythm disorders)
  • lithium (e.g., Lithicarb or Priadel, anti-depressants prescribed to prevent and treat depression)
  • interferon alpha (e.g., Roferon-A or Intron A, prescribed for the treatment of, among other things, leukemia and viral infections such as Hepatitis B and C)
  • interleukin-2 (used for the treatment of certain cancers)
  • thalidomide (prescribed for the treatment of, among other things, multiple myeloma (a type of bone marrow cancer), Crohn's disease, rheumatoid arthritis and systemic lupus erythematosus)
  • stavudine (brand name: Zerit) (used to treat patients infected with HIV)
  • iodine containing supplements (including kelp, seaweed)
  • iron supplements or multivitamins containing iron
  • calcium supplements or multivitamins containing calcium
  • antacids that contain aluminum or magnesium
  • some ulcer medications, such as sucralfate (brand name: Carafate)
  • some cholesterol-lowering drugs, such as cholestyramine (brand name: Questran Lite) and colestipol (brand name: Colestid)

If a patient is taking these drugs, it may sometimes be necessary to monitor the thyroid function or adjust the dosage of the thyroid medication. Patients are advised to keep their doctors informed of the drugs they are taking.


It is recommended to take antacids and calcium or iron containing drugs at a different time of the day (for example, at least four hours before or after taking thyroid medicines).


Other information relating to drugs prescribed for the treatment of thyroid conditions


Prescribing unapproved medicines

Under the Medicines Act 1981, a registered medical practitioner, dentist and midwife is permitted to prescribe, administer or arrange for the administration of medicines for the treatment of a patient in his or her care. The medicine and its use may or may not be approved. Follow the link below for information about the rights and responsibilities of medical practitioners with respect to prescribing unapproved medicines, or approved medicines for unapproved uses (such as unapproved indication, dosage or route of administration).


Prescribing non-funded medicines

Under the Named Patient Pharmaceutical Assessment (NPPA) mechanism, some medicines that are not subsidised under the Pharmaceutical Schedule can still qualify for funding (strict conditions apply).


There are three ‘pathways’ under the NPPA: Unusual Clinical Circumstances, Urgent Assessment and Hospital Pharmaceuticals in the Community. Each of these pathways have different prerequisite requirements. In addition to these pathways, Pharmac will also consider funding in some other exceptional circumstances.


If an application for funding meets the relevant prerequisites under the NPPA Policy, it will be considered against Pharmac's decision criteria for funding.


Any authorised prescriber may make a NPPA application under the Unusual Clinical Circumstances and Urgent Assessment pathways. Applications under the Hospital Pharmaceuticals in the Community pathway may only be made by District Health Board clinicians.


More information, including application forms, can be found on the website of Pharmac.


Prescriber Update Articles from Medsafe


   


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Page last updated: 18-08-2016



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