Symptoms (typical for thyrotoxicosis): palpitations, heart rhythm disturbances, heart pain, anxiety, tremor, sleep disturbances, increased sweating, increased appetite, weight loss, diarrhea.
Treatment: depending on the severity of the symptoms, a reduction in the daily dose of the drug is recommended, or a break in treatment for several days or the appointment of beta-blockers. After the side effects disappear, treatment should be started with caution with a lower dose.
Increased individual sensitivity to the drug, untreated thyrotoxicosis, acute myocardial infarction, functional class III–IV angina, acute myocarditis, untreated adrenal insufficiency.
Combithyrex forte increases the effect of indirect anticoagulants (it is possible to reduce their dose).
The use of tricyclic antidepressants with Combithyrex forte may lead to an increase in the effect of antidepressants.
Thyroid hormones may increase the need for insulin and oral hypoglycemic drugs. More frequent monitoring of blood glucose levels is recommended during the start of treatment with the drug, as well as when changing the dosage regimen.
Combithyrex forte reduces the action of cardiac glycosides.
With the simultaneous use of colestyramine, colestipol and aluminum hydroxide reduce the plasma concentration of the drug by inhibiting its absorption in the intestine.
When used concomitantly with anabolic steroids, asparaginase, tamoxifen, pharmacokinetic interaction at the level of protein binding is possible.
When used simultaneously with phenytoin, salicylates, clofibrate, and furosemide in high doses (250 mg), the content of thyroid hormones unrelated to plasma proteins increases.
Taking estrogen-containing drugs increases the content of thyroxine-binding globulin, which may increase the need for Combithyrex forte in some patients. Somatotropin, when used concomitantly with Combithyrex forte, can accelerate the closure of epiphyseal growth zones.
Taking phenobarbital, carbamazepine, and rifampicin may increase the clearance of levothyroxine and require an increase in the dose of Combithyrex forte.
Side effects are usually not observed with proper use under the supervision of a doctor.
Possible-allergic reactions, progression of heart failure and angina.
Hypothyroidism of any origin.
Euthyroid goiter.
Replacement therapy and prevention of goiter recurrence after resection the thyroid gland.
Thyroid cancer (after surgical treatment).
The levothyroxine. When taken orally, levothyroxine is absorbed almost exclusively in the upper small intestine. Up to 80% of the dose of the drug is absorbed. Food intake reduces the absorption of levothyroxine. Cmax the serum level is reached approximately 5-6 hours after oral administration. After absorption, more than 99% of the drug binds to serum proteins (thyroxine-binding globulin, thyroxine-binding prealbumin and albumin). In various tissues montelaterone approximately 80% of levothyroxine with the formation of triiodothyronine and inactive products. Thyroid hormones are mainly metabolized in the liver, kidneys, brain, and muscles. A small amount of the drug undergoes deamination and decarboxylation, as well as conjugation with sulfuric and glucuronic acids (in the liver). The metabolites are excreted in the urine and bile. T1/2 levothyroxine — 6-7 days. With thyrotoxicosis T1/2 it is shortened to 3-4 days, and in hypothyroidism it is extended to 9-10 days.
Liothyronine. Oral absorption-95% (within 4 hours). Binding to plasma proteins is high. T1/2 - 2.5 days.
Combithyrex forte
Levothyroxine Sodium, Liothyronine
Inside, at least 30 minutes before breakfast, without chewing and with a sufficient amount of liquid, once.
The daily dose is determined individually, depending on the indications.
Hypothyroidism. Adults: the initial dose is 1 tablet. once a day, then it is possible to increase the dose by 1 tab. every 2-4 weeks until the maintenance daily dose is reached-2-5 tab.
Children: when selecting a dose for long-term treatment, take into account the body weight, height and surface of the child's body. The average recommended maintenance dose is 2-2. 5 tablets. per day.
Euthyroid goiter. Adults: the initial dose is 1-2 tablets. per day, the maintenance dose is 3-6 tablets. per day.
Adolescents: the initial dose is 1-1. 5 tablets. per day, the maintenance dose is 2.5–3.5 tablets. per day.
Children: 0.5-1 table. per day.
Prevention of recurrent goiter after surgical treatment: adults — 2-3 tables. per day.
After surgery for thyroid cancer: the initial dose is 3 tablets. per day, the maintenance dose is 6 tablets. per day.
The drug should be taken regularly.
The duration of treatment is determined by the form of the disease. As a rule, with hypothyroidism and after a thyroidectomy for thyroid cancer, treatment is carried out throughout life. The duration of use for euthyroid goiter, as well as for the prevention of relapse of goiter after surgical treatment, ranges from several months or years before use throughout life.
