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Cited by 83Thyroid Disorders and TreatmentsDrug Solubulity and Delivery SystemsPharmacogenetics and Drug Metabolism

Nonspecific intestinal adsorption of levothyroxine by aluminum hydroxide

Liel, Yair, Sperber, Ami D., Shany, Shraga·1994·The American Journal of Medicine
DOI 10.1016/0002-9343(94)90303-4
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Abstract

Purpose To evaluate the adverse effect of aluminum hydroxide on levothyroxine pharmacokinetics in hypothyroid patients and study the mechanism of this effect.Design An in vivo open study supplemented by in vitro experiments.Setting A university hospital-based outpatient service.Intervention Administration for 2 to 4 weeks of an aluminum hydroxide-containing preparation to patients balanced on replacement thyroxine therapy.Measurements Serum thyrotropin (TSH).Results A significant increase in serum TSH was observed during seven periods of aluminum hydroxide administration (7.19 +/- 1.3 versus 2.62 +/- 0.8 mU/L; P = 0.012). In vitro studies indicated a considerable nonspecific adsorptive capacity of aluminum hydroxide for thyroxine.Conclusions The results indicate an adverse effect of aluminum hydroxide on levothyroxine bioavailability through a mechanism involving nonspecific adsorption, or complexing, of levothyroxine to aluminum hydroxide. We recommend close monitoring of serum TSH levels in patients receiving oral thyroid hormone replacement therapy who concurrently take aluminum hydroxide-containing medications. Adjustment of the levothyroxine dose, or cessation of the antacid, may be necessary.

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Crossref · 10.1016/0002-9343(94)90303-4

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  • Only two of the medications that alter LT4 absorption have been studied in a cross-over study design of chronic therapy, with two other studies also conducted prospectively.

    “Only two of these medications have been studied in a cross-over study design of chronic therapy (132,145), with two other studies also conducted prospectively (140,143).”

    From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [143]

  • Following documentation of increased LT4 requirement in a patient taking an aluminum-containing antacid (142), the same investigators showed an increase in TSH levels in five patients who were asked to take aluminum hydroxide with their LT4 (143).

    “Following documentation of increased LT4 requirement in a patient taking an aluminum-containing antacid (142), the same investigators showed an increase in TSH levels in five patients who were asked to take aluminum hydroxide with their LT4 (143).”

    From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [143]

  • Direct complexation and chelation play important roles in the malabsorption of LT4 induced by the intake of many drugs, including calcium and iron supplements, aluminum-containing antacids, bile acid sequestrants, and some foods (eg, fiber-rich foods, coffee, and milk).

    “It is widely acknowledged that direct complexation and chelation play important roles in the malabsorption of LT4 induced by the intake of many drugs, including calcium and iron supplements (72, 73), aluminum-containing antacids (74), bile acid sequestrants (75, 76), and some foods (eg, fiber-rich foods, coffee, and milk) (22, 77, 78).”

    From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [74]

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Authors
Liel, Y., Sperber, A. D., & Shany, S.
Affiliations
Ben-Gurion University of the Negev (IL)
ORCID
Venue
The American Journal of Medicine
Publisher
Elsevier BV
Published
1994-10
Volume
97
Issue
4
Pages
363-365
ISSN
0002-9343 (ISSN-L)
DOI
10.1016/0002-9343(94)90303-4
OpenAlex
W2068307987
Cited by
83
References
13
Citations by year
2025: 2 · 2024: 2 · 2023: 1 · 2022: 6 · 2021: 2 · 2020: 1 · 2019: 1 · 2018: 3 · 2017: 3 · 2016: 3 · 2015: 1 · 2014: 5 · 2013: 2 · 2012: 1
FWCI
1.71
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The American Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmaceutical Science › Drug Solubulity and Delivery Systems
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacogenetics and Drug Metabolism
Keywords
levothyroxine, aluminum hydroxide, drug adsorption, drug interactions, hypothyroidism, thyroid hormone replacement, serum thyrotropin, antacids, bioavailability
MeSH terms
Adsorption, Aluminum Hydroxide, Ambulatory Care, Humans, Hypothyroidism, Intestinal Mucosa, Intestines, Thyrotropin, Thyroxine

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