New medications which decrease levothyroxine absorption

John-Kalarickal, Jennifer; Pearlman, Gwen; Carlson, Harold E.

doi:10.1089/thy.2007.0060

Cited by 82Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryParathyroid Disorders and Treatments

New medications which decrease levothyroxine absorption

John-Kalarickal, Jennifer, Pearlman, Gwen, Carlson, Harold E.·2007·Thyroid

DOI 10.1089/thy.2007.0060

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Abstract

OBJECTIVE: Medications may sometimes interfere with the intestinal absorption of levothyroxine, primarily by forming an insoluble complex with the thyroid hormone in the intestinal lumen. The goal of this study was to examine the acute effects of three previously unstudied medications on levothyroxine absorption. DESIGN: We studied the effects of three medications on thyroxine absorption in seven normal volunteers. On each study day, the subjects ingested 1 mg levothyroxine sodium, either taken separately or co-administered with sevelamer hydrochloride (Renagel, a phosphate-binding medication used in the treatment of hyperphosphatemia), chromium picolinate (an over-the-counter nutritional supplement), or ezetimibe (Zetia, a drug used in the treatment of hypercholesterolemia). Serum thyroxine was measured at intervals over a 6-hour period following drug ingestion. MAIN OUTCOME: Sevelamer hydrochloride and chromium picolinate each significantly (p < 0.05) decreased the area under the serum thyroxine concentration curve, while ezetimibe had no effect. CONCLUSION: Hypothyroid patients taking sevelamer hydrochloride or chromium picolinate should be advised to separate the time of ingestion of these drugs from their thyroid hormone preparation by several hours.

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Co-administration of sevelamer decreases LT4 absorption.
“The pharmacokinetic study showed decreased LT4 absorption when these agents were coadministered (138).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [138]
Chromium picolinate supplementation has been shown to decrease LT4 bioavailability by up to 17%.
“Chromium picolinate supplementation, prescribed to control body weight, has been shown to decrease LT4 bioavailability by up to 17% (83).”
From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [83]
Some drugs (eg, ciprofloxacin, rifampicin, and chromium picolinate) and grapefruit juice alter intestinal mucosal transporters, including the monocarboxylate transporter family and organic anion transporting polypeptides.
“In addition, some drugs (eg, ciprofloxacin, rifampicin, and chromium picolinate) and grapefruit juice alter intestinal mucosal transporters, including the monocarboxylate transporter family and organic anion transporting polypeptides (81–83).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [83]
Concomitant intake of sevelamer hydrochloride significantly decreased area under the serum TT4 concentration curve.
“Likewise, concomitant intake of the phosphate binder sevelamer hydrochloride significantly decreased the area under the serum TT4 concentration curve [ 70 ].”
From Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults (2022) · cites this paper as [70]

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Authors: John-Kalarickal, J., Pearlman, G., & Carlson, H. E.
Affiliations: Endocrinology Division, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, New York.
Stony Brook School (US)
ORCID: Carlson, Harold E.
Venue: Thyroid
Publisher: SAGE Publications
Published: 2007-08
Volume: 17
Issue: 8
Pages: 763-765
ISSN: 1050-7256 (ISSN-L)
1557-9077
DOI: 10.1089/thy.2007.0060
OpenAlex: W1963538218
Cited by: 82
References: 11
Citations by year: 2025: 4 · 2024: 1 · 2023: 3 · 2022: 3 · 2021: 5 · 2020: 3 · 2019: 2 · 2018: 5 · 2017: 7 · 2016: 2 · 2015: 4 · 2014: 6 · 2013: 6 · 2012: 7
FWCI: 4.16
Type: journal article
Language: en
Open access: closed
Licence: www.liebertpub.com/nv/resources-tools/text-and-data-mining-policy/121/ (tdm)
Locations: Thyroid (publishedVersion)
PubMed (publishedVersion)
Funders: Stony Brook University
National Center for Research Resources (M01RR010710, MO1 RR10710)
NIH Clinical Center
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
Keywords: levothyroxine, drug interactions, intestinal absorption, sevelamer hydrochloride, chromium picolinate, ezetimibe, thyroid hormones, hypothyroidism, serum thyroxine, phosphate binders, timing of drug administration
MeSH terms: Ezetimibe, Sevelamer, Adult, Anticholesteremic Agents, Azetidines, Chelating Agents, Drug Interactions, Female, Humans, Hypercholesterolemia, Hypothyroidism, Intestinal Absorption, Iron Chelating Agents, Male, Picolinic Acids, Polyamines, Thyroxine

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