Therapeutic indications

Liothyronine Sodium 25 mcg is indicated in adults and children for the treatment of myxedema coma, the treatment of severe chronic thyroid failure, and the hypothyroid states that occur in the treatment of thyrotoxicosis.

Liothyronine sodium can also be used in addition to carbimazole to prevent the development of subclinical hypothyroidism during carbimazole treatment for thyrotoxicosis.

Liothyronine sodium may be preferred for the treatment of acute and severe hypothyroid states because of its more potent and rapid effect, but thyroxine sodium is usually the Liothyronine of choice for routine replacement therapy.

Special warnings and precautions for use

In severe and prolonged hypothyroidism, adrenocortical activity may be reduced. When thyroid replacement therapy is started, metabolism increases more than adrenocortical activity and this can lead to adrenocortical insufficiency requiring additional adrenocortical steroids.

T3 instead of levothyroxine would be the replacement therapy of choice during block-and-replacement treatment of propylthiouracil (PTU) thyrotoxicosis due to PTU's inhibition of peripheral T4 to T3 conversion.

Treatment with liothyronine sodium may increase the need for insulin or antidiabetic drugs. Care is needed for patients with diabetes mellitus and diabetes insipidus.

In myxedema, care must be taken not to place an undue load on the heart muscle affected by severe and prolonged thyroid depletion. Special attention is needed in the elderly who are at increased risk of occult cardiovascular disease. The baseline ECG is recommended before starting Liothyronine Sodium t3 therapy to detect changes consistent with ischemia. Patients should undergo cardiovascular monitoring, including periodic ECGs, during treatment with liothyronine.

TSH levels should be monitored during treatment to reduce the risk of over or under treatment. The risks of overtreatment include atrial fibrillation, osteoporosis, and bone fractures.

Interactions with other medicinal products and other forms of interaction

Treatment with Liothyroninesodium may potentiate the action of anticoagulants. Phenytoin levels may be increased by liothyronine. Anticonvulsants, such as carbamazepine and phenytoin, enhance thyroid hormone metabolism and may displace thyroid hormones from plasma proteins. Initiation or discontinuation of anticonvulsant therapy may alter liothyronine dose requirements.

When co-administered with cardiac glycosides, the dose of cardiac glycosides may need to be adjusted. Cholestyramine and colestipol administered simultaneously reduce the gastrointestinal absorption of liothyronine.

Liothyronine increases the sensitivity of catecholamine receptors thus accelerating the response to tricyclic antidepressants. Several can affect thyroid function tests and this should be taken into account when monitoring patients receiving liothyronine therapy.

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