Drug & supplement interaction

1,4-butanediol + Levothyroxine

Levothyroxine brand names: Euthyrox, Levothroid, Unithroid, Synthroid, Levoxyl, and others.

No Known Interaction
Medically reviewed by · Updated July 2026 · Pair last verified Sep 13, 2026
The bottom line No known interaction

We found no known interaction between 1,4-butanediol and Levothyroxine in our sources. Absence of a documented interaction is not the same as proven safety, and does not guarantee one does not exist. Do not start, stop, or change a medication or supplement based on this page; confirm with your pharmacist or doctor first. Additionally, although there is no interaction, the label for Levothyroxine states a food rule worth keeping to, and the two are separately associated with some of the same side effects, which would make a new symptom harder to attribute to one or the other.

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Interaction report

1,4-butanediol and Levothyroxine

We checked these two against our interaction database. Here is what we found.

No Known Interaction Found

We did not find a documented interaction between Levothyroxine and 1,4-butanediol in our sources. This does not guarantee that the combination is completely free of risk — there is often limited research on supplements and herbal products, especially around drug interactions.

If you decide to take both, the practical routine is simple: add one new thing at a time and note the date you started it. If the combination is going to disagree with you, it usually shows in the first days to a couple of weeks — and a start date turns “I’ve been feeling off” into something a pharmacist can actually work with. Do not stop a prescribed medicine on your own.

Always talk with your pharmacist or doctor before making changes to your medications or supplements, particularly if you take several medications or have an ongoing health condition.

1,4-butanediol safety at a glance

1,4-butanediol overall Avoid This is a toxic chemical that turns into GHB in the body and can be life-threatening.
Pregnancy Unsafe When used orally. Read the full pregnancy detail
Breastfeeding Unsafe When used orally. Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center) — the full detail is in the Special populations card below. Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Still wondering about combining Levothyroxine and 1,4-butanediol? Ask Dr. Brian Staiger, PharmD, BCPS directly ›
How we checked

Why No Interaction Is Listed for Levothyroxine

Interactions in our licensed database are recorded against drug classes, not just single drug names. Levothyroxine is filed under 3 classifications — including thyroid hormone, oral drugs. 1,4-butanediol has documented interactions with 10 drug classes — the most serious being alcohol (ethanol) (major), cns depressants (major) and narcotic drugs (major) — and none of Levothyroxine’s classifications are among them.

Classification data comes from our licensed Natural Medicines dataset. A medication can belong to classes beyond those recorded there, so this describes how the check was run — it is not a safety guarantee.

Keep it in perspective

1,4-butanediol Does Interact With Other Medications

1,4-butanediol has 250 major, 21 moderate known drug interactions in our database — Levothyroxine isn’t one of them. If you take anything else, check it against the full list below.

Major 250 Moderate 21 No known interaction 2,559 (incl. Levothyroxine)
Taking anything else?

Check Another of Your Medications Against 1,4-butanediol

Covers the 2,830 medications we’ve checked against 1,4-butanediol. Pick one to open its full report.

What to actually watch for

No Interaction Found — But Data Suggests 1,4-butanediol and Levothyroxine May Share Several of the Same Side Effects

This is not an interaction. Neither one changes how your body handles the other, and nothing here says they react together. What our sources do show is that each has separately been linked to the effects below — so taking both can make those effects more likely to turn up, and harder to pin on one or the other if they do. 2 of them are worth acting on rather than waiting out — marked below.

  • Seizures Worth acting on Additional detail

    1,4-butanediol

    “Orally, 1,4-butanediol is metabolized to gamma-hydroxybutyrate (GHB), and its psychoactive effects are primarily due to GHB. 1,4-Butanediol also causes similar CNS toxic effects to GHB, including amnesia, combativeness, confusion, agitation, coma, seizures, and death. After 1,4-butanediol overdoses, sedation gradually increases, consistent with gradual conversion to GHB.”

    1,4-butanediol · Natural Medicines adverse-effect record, reported in anxiety.

    6 sources cited
    1. 102837. Stefani M, Roberts DM. 1,4-Butanediol overdose mimicking toxic alcohol exposure. Clin Toxicol (Phila) 2020;58(3):204-7. doi: 10.1080/15563650.2019.1617419. PubMed
    2. 1318. Smith SW, Zvosec DL. Death and central nervous system depression after ingestion of 1.4-butanediol, a gamma-hydroxybutyrate-related dietary supplement. Ann Emerg Med 2000;36:S85.
    3. 3678. Anon. FDA alert on misuse of consumer products containing GHB, GBL and BD. Food and Drug Administration, Rockville, MD. June 15, 1999.
    4. 3679. Anon. Important message for health professionals: Report serious adverse events associated with dietary supplements containing GBL, GHB or BD. Food and Drug Administration, Rockville, MD. August 25, 1999. Available at: http://vm.cfsan.fda.gov/~dms/mwg
    5. 10640. Zvosec DL, Smith SW, McCutcheon JR, et al. Adverse events, including death, associated with the use of 1,4-butanediol. N Engl J Med. 2001;344:87-94.. PubMed
    6. 37465. Thai, D., Dyer, J. E., Jacob, P., and Haller, C. A. Clinical pharmacology of 1,4-butanediol and gamma-hydroxybutyrate after oral 1,4-butanediol administration to healthy volunteers. Clin.Pharmacol Ther. 2007;81(2):178-184. PubMed

    Levothyroxine

    Listed in the ADVERSE REACTIONS section of the FDA label for Levothyroxine. Read the label on DailyMed ›

  • Chest pain Worth acting on Additional detail

    1,4-butanediol

    “Orally, 1,4-butanediol and its metabolite, gamma-hydroxybutyrate (GHB), can cause chest tightness, bradycardia, and cardiac arrest.”

    1,4-butanediol · Natural Medicines adverse-effect record, reported in cardiac arrest.

    6 sources cited
    1. 1318. Smith SW, Zvosec DL. Death and central nervous system depression after ingestion of 1.4-butanediol, a gamma-hydroxybutyrate-related dietary supplement. Ann Emerg Med 2000;36:S85.
    2. 3678. Anon. FDA alert on misuse of consumer products containing GHB, GBL and BD. Food and Drug Administration, Rockville, MD. June 15, 1999.
    3. 3679. Anon. Important message for health professionals: Report serious adverse events associated with dietary supplements containing GBL, GHB or BD. Food and Drug Administration, Rockville, MD. August 25, 1999. Available at: http://vm.cfsan.fda.gov/~dms/mwg
    4. 6016. Timby N, Eriksson A. Gamma-Hydroxybutyrate-Associated Deaths. Am J Med 2000;108:518. PubMed
    5. 10640. Zvosec DL, Smith SW, McCutcheon JR, et al. Adverse events, including death, associated with the use of 1,4-butanediol. N Engl J Med. 2001;344:87-94.. PubMed
    6. 37465. Thai, D., Dyer, J. E., Jacob, P., and Haller, C. A. Clinical pharmacology of 1,4-butanediol and gamma-hydroxybutyrate after oral 1,4-butanediol administration to healthy volunteers. Clin.Pharmacol Ther. 2007;81(2):178-184. PubMed

    Levothyroxine

    Listed in the ADVERSE REACTIONS section of the FDA label for Levothyroxine. Read the label on DailyMed ›

  • Anxiety or restlessness Additional detail

    1,4-butanediol

    Recorded for 1,4-butanediol in the same Natural Medicines adverse-effect record shown under Chest pain above.

    Levothyroxine

    Listed in the ADVERSE REACTIONS section of the FDA label for Levothyroxine. Read the label on DailyMed ›

  • Trouble sleeping Additional detail

    1,4-butanediol

    Recorded for 1,4-butanediol in the same Natural Medicines adverse-effect record shown under Seizures above.

    Levothyroxine

    Listed in the ADVERSE REACTIONS section of the FDA label for Levothyroxine. Read the label on DailyMed ›

  • Diarrhea Additional detail

    1,4-butanediol

    “Orally, 1,4-butanediol can cause nausea and vomiting, diarrhea, and fecal incontinence.”

    1,4-butanediol · Natural Medicines adverse-effect record, reported in diarrhea.

    5 sources cited
    1. 1318. Smith SW, Zvosec DL. Death and central nervous system depression after ingestion of 1.4-butanediol, a gamma-hydroxybutyrate-related dietary supplement. Ann Emerg Med 2000;36:S85.
    2. 3678. Anon. FDA alert on misuse of consumer products containing GHB, GBL and BD. Food and Drug Administration, Rockville, MD. June 15, 1999.
    3. 3679. Anon. Important message for health professionals: Report serious adverse events associated with dietary supplements containing GBL, GHB or BD. Food and Drug Administration, Rockville, MD. August 25, 1999. Available at: http://vm.cfsan.fda.gov/~dms/mwg
    4. 10640. Zvosec DL, Smith SW, McCutcheon JR, et al. Adverse events, including death, associated with the use of 1,4-butanediol. N Engl J Med. 2001;344:87-94.. PubMed
    5. 37465. Thai, D., Dyer, J. E., Jacob, P., and Haller, C. A. Clinical pharmacology of 1,4-butanediol and gamma-hydroxybutyrate after oral 1,4-butanediol administration to healthy volunteers. Clin.Pharmacol Ther. 2007;81(2):178-184. PubMed

    Levothyroxine

    Listed in the ADVERSE REACTIONS section of the FDA label for Levothyroxine. Read the label on DailyMed ›

  • Vomiting / Nausea Additional detail

    1,4-butanediol

    Recorded for 1,4-butanediol in the same Natural Medicines adverse-effect record shown under Chest pain above.

    Levothyroxine

    Listed in the ADVERSE REACTIONS section of the FDA label for Levothyroxine. Read the label on DailyMed ›

Reported for 1,4-butanediol but not commonly for Levothyroxine: dependence or withdrawal symptoms, hallucinations, a slow heartbeat and confusion.

Effects for Levothyroxine come from the ADVERSE REACTIONS section of its FDA label; effects for 1,4-butanediol come from the Natural Medicines adverse-effect record, quoted above. Wording is matched across sources by our own clinical vocabulary, so treat this as a prompt to pay attention, not a diagnosis.

Special populations

1,4-butanediol in Pregnancy & Breastfeeding

Pregnancy And Lactation Unsafe

When used orally.

DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.© 2026 Therapeutic Research Center

How to take them

Some Levothyroxine Products Have a Food Rule — 1,4-butanediol Should Not Break It

At least one FDA label for a product containing Levothyroxine says to take it on an empty stomach. Most supplements — 1,4-butanediol included — are taken with a meal, so the easy mistake is swallowing both together at breakfast. Where that rule applies, keep Levothyroxine on its own and move 1,4-butanediol to a meal later in the day.

This may not be true of your version. Food instructions belong to the product, not the ingredient: two Levothyroxine products can carry different directions, and extended-release forms often differ from immediate-release ones. The label we read is quoted below — check the directions on your own box or bottle, or ask your pharmacist, for how to take the exact product you were given.

A food rule is not an interaction — it is about how much of the medicine you absorb. The directions that came with your own product, and your pharmacist, outrank anything on this page.

Overlapping uses

What Levothyroxine Is Prescribed For, and What 1,4-butanediol Has Been Studied For

These two come up together because they touch the same health topic — not because they do the same job. Levothyroxine is a prescription medicine with approved uses on its FDA label. 1,4-butanediol is a supplement: what follows is what researchers have looked at it for, and how strong that evidence is.

Levothyroxine is prescribed for: Levothyroxine replaces or supplements the thyroid hormone your body isn't making enough of. It's used for hypothyroidism — an underactive thyroid — in adults, children, and even newborns, whether the cause is the thyroid gland itself, the pituitary gland, or the hypothalamus in the brain. It's also used alongside surgery and radioiodine treatment in people with certain types of thyroid cancer, to help suppress the hormone that can stimulate cancer growth. It is not meant for weight loss, treating benign thyroid nodules in people who have enough iodine, or for hypothyroidism during recovery from a temporary condition called subacute thyroiditis.

1,4-butanediol has been studied for:

  • Depression studied, not established 1,4-butanediol has been studied for this. Natural Medicines rates the evidence: Insufficient Reliable Evidence To Rate Read what the research shows

    1,4-butanediol for depression

    Although there has been interest in using oral 1,4-butanediol for depression, there is insufficient reliable information about the clinical effects of 1,4-butanediol for this purpose.

Effectiveness ratings and the research summaries above are the verbatim record from the Natural Medicines database, which grades evidence from “Effective” down to “Insufficient Reliable Evidence To Rate”. A rating below the top of that scale means researchers have looked at it — not that it works, and never that it can stand in for a prescribed medicine. Do not stop or replace Levothyroxine on your own; if you are taking 1,4-butanediol for the same health topic, tell your prescriber, especially if the medicine is being adjusted to a target.

From our Q&A

Questions About 1,4-butanediol or Levothyroxine

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers 1,4-butanediol or Levothyroxine, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Levothyroxine

This page covers 1,4-butanediol only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Levothyroxine page lists 50 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Tiratricol (major), Acetyl-l-carnitine (moderate), Alpha-lipoic Acid (moderate) and Ascophyllum Nodosum (moderate).

By severity: 2 major · 39 moderate · 9 minor.

From our pharmacist’s overview on the Levothyroxine page

“Levothyroxine replaces a hormone your body measures in tiny amounts, so small shifts in its blood level show up in how you feel, and I treat this list with genuine care. Nearly everything on it does one of two things: blocks the pill from being absorbed in the gut, the way everyday minerals like calcium do by binding it into complexes,…”

Reviewed by 2 · Jul 18, 2026

Open the Levothyroxine interaction page

How much people look this up

Where 1,4-butanediol and Levothyroxine Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement 1,4-butanediol
Top half

#708 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Levothyroxine
Top 10

#2 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Where does our data come from?
  • Source: the Natural Medicines (TRC Healthcare) clinical database — the evidence-graded professional reference for herb & supplement interactions.
  • Citation library: 103,510 references behind our interaction content, 65,311 of them resolved to verified PubMed/DOI sources. See every 1,4-butanediol reference on this page ↓
  • Freshness: we automatically re-check this combination every week — this pair was last verified September 13, 2026. The 1,4-butanediol and Levothyroxine records this page draws on were last updated July 10, 2026.
  • What “no known interaction” means: no documented interaction in the sources above — not a guarantee of safety. Supplements are studied far less than prescription drugs, so we say exactly what the evidence supports, and nothing more.
Data structure & sourcing designed and verified by .
Supplement

About 1,4-butanediol

What is 1,4-butanediol?

  • Marketed illegally as a 'recreational' or party substance
  • Falsely sold as a sleep aid
  • Falsely promoted for bodybuilding or muscle growth
  • Industrial solvent and chemical manufacturing

1,4-butanediol is a toxic industrial chemical, not a safe dietary supplement. Once swallowed, the body converts it into GHB, a powerful central nervous system depressant that can cause coma, dangerous breathing problems, addiction, and death. It should never be taken as a supplement or recreational substance.

Synthetic industrial chemical (not a plant) · Liquid solvent (sometimes sold illegally as a 'supplement,' cleaner, or party drug)

An interaction check asks whether these two react with each other — it does not ask whether 1,4-butanediol is a good idea for someone in your situation. Here is what our 1,4-butanediol record says about it on its own.

1,4-butanediol: dosing

There is no established or recommended dose of 1,4-butanediol, because it is not a legitimate supplement or medicine. It should not be taken in any amount.If you have encountered a product that contains or is suspected to contain 1,4-butanediol, do not use it. In the U.S., you can reach Poison Control at 1-800-222-1222.

From our 1,4-butanediol monograph — the full record covers uses, side effects and every documented interaction.

Read the full 1,4-butanediol monograph & all interactions
Medication

About Levothyroxine

What Is Levothyroxine Used For?

Brand names: Euthyrox, Levothroid, Unithroid, Synthroid, Levoxyl, Levo-T, Eltroxin, Estre, Levothyroxine, Novothyrox, Levolet

Levothyroxine replaces or supplements the thyroid hormone your body isn't making enough of. It's used for hypothyroidism — an underactive thyroid — in adults, children, and even newborns, whether the cause is the thyroid gland itself, the pituitary gland, or the hypothalamus in the brain.

It's also used alongside surgery and radioiodine treatment in people with certain types of thyroid cancer, to help suppress the hormone that can stimulate cancer growth. It is not meant for weight loss, treating benign thyroid nodules in people who have enough iodine, or for hypothyroidism during recovery from a temporary condition called subacute thyroiditis.

See full Levothyroxine drug information
Keep checking

Other Drugs & 1,4-butanediol

Browse every other medication we’ve checked against 1,4-butanediol — both the ones with a known interaction and the ones without. Select any drug for the full detail.

250Major
21Moderate
0Minor
2,558No known interaction
250 Major 21 Moderate 2,558 No interaction
Major

250 interactions

Showing 60 of 250 major interactions — see all 250 on the 1,4-butanediol page.

Moderate

21 interactions

No interaction 2,558 drugs checked — show the list

We also checked 1,4-butanediol against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,558 medications checked with no known interaction — see the full 1,4-butanediol list.

See the full 1,4-butanediol interactions page
See every supplement checked against Levothyroxine, ranked by severity
Evidence & sources

1,4-butanediol References

The 20 references that drive our 1,4-butanediol monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. Smith SW, Zvosec DL. Death and central nervous system depression after ingestion of 1.4-butanediol, a gamma-hydroxybutyrate-related dietary supplement. Ann Emerg Med 2000;36:S85.
  2. Anon. Adverse events associated with ingestion of gamma-butyrolactone--Minnesota, New Mexico, and Texas, 1998-1999. MMWR Morb Mortal Wkly Rep 1999;48:137-40.
  3. Harrington RD, Woodward JA, Hooton TM, et al. Life-threatening interactions between HIV-1 protease inhibitors and the illicit drugs MDMA and gamma-hydroxybutyrate. Arch Intern Med 1999;159:2221-4.
  4. Anon. FDA alert on misuse of consumer products containing GHB, GBL and BD. Food and Drug Administration, Rockville, MD. June 15, 1999.
  5. Anon. Important message for health professionals: Report serious adverse events associated with dietary supplements containing GBL, GHB or BD. Food and Drug Administration, Rockville, MD. August 25, 1999. Available at: http://vm.cfsan.fda.gov/~dms/mwg
  6. Anon. Multistate outbreak of poisonings associated with illicit use of gamma hydroxy butyrate. JAMA 1991;265:447-8. DOI
  7. Carotenuto A, De Feo V, Fattorusso E, et al. The flavonoids of Allium ursinum. Phytochem 1996;41:531-6. PubMed
  8. Ferrara SD, Tedeschi L, Frison G, Rossi A. Fatality due to gamma-hydroxybutyric acid (GHB) and heroin intoxication. J Forensic Sci 1995;40:501-4. DOI
  9. Timby N, Eriksson A. Gamma-Hydroxybutyrate-Associated Deaths. Am J Med 2000;108:518. PubMed
  10. Schneir AB, Ly BT, Clark RF. A case of withdrawal from the GHB precursors gamma-butyrolactone and 1,4-butanediol. J Emerg Med 2001;21:31-3.. PubMed
  11. Zvosec DL, Smith SW, McCutcheon JR, et al. Adverse events, including death, associated with the use of 1,4-butanediol. N Engl J Med. 2001;344:87-94.. PubMed
  12. Mason P, Kerns II W. Gamma Hydroxybutyric Acid (GHB) Intoxication. Acad Emerg Med 2002;9:730-39.. DOI
  13. Poldrugo, F., Barker, S., Basa, M., Mallardi, F., and Snead, O. C. Ethanol potentiates the toxic effects of 1,4-butanediol. Alcohol Clin.Exp.Res 1985;9(6):493-497. PubMed
  14. Thai, D., Dyer, J. E., Jacob, P., and Haller, C. A. Clinical pharmacology of 1,4-butanediol and gamma-hydroxybutyrate after oral 1,4-butanediol administration to healthy volunteers. Clin.Pharmacol Ther. 2007;81(2):178-184. PubMed
  15. Boscolo-Berto R, Viel G, Montagnese S, Raduazzo DI, Ferrara SD, Dauvilliers Y. Narcolepsy and effectiveness of gamma-hydroxybutyrate (GHB): a systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2012 Oct;16(5):431-43. PubMed

Medication overviews come from MedlinePlus (NIH); supplement label data from the NIH Dietary Supplement Label Database. Content is written and reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

Pharmacist Counseling Corner

Taking 1,4-butanediol and Levothyroxine Together: Common Questions

Is it safe to take 1,4-butanediol with Levothyroxine?
We do not list a known interaction between 1,4-butanediol and Levothyroxine. That does not guarantee the combination is risk-free, so confirm with your pharmacist or doctor — especially if you take other medications or have a health condition.
Do 1,4-butanediol and Levothyroxine have any of the same side effects?
Yes — our sources link each of them separately to 7 of the same effects. That is not an interaction: neither changes how your body handles the other. It does mean that if one of those effects turns up, it can be harder to tell which one is behind it. They are listed on this page with the source behind each.
Should I take 1,4-butanediol and Levothyroxine at the same time of day?
At least one FDA label for a product containing Levothyroxine says to take it on an empty stomach, and supplements are usually taken with a meal — so taking them together at breakfast is the easy mistake. Where that applies, keep Levothyroxine on its own and move 1,4-butanediol to a meal later in the day. Food instructions belong to the product rather than the ingredient, so check the directions on your own box. This is about absorption, not an interaction.
Are 1,4-butanediol and Levothyroxine used for the same thing?
They overlap in purpose, which usually means the real question is whether you need both rather than whether they are safe together. This page lists the shared uses and how strong the evidence is for 1,4-butanediol in each. That is a conversation for your prescriber, especially if Levothyroxine is being adjusted to a target.
How was the 1,4-butanediol and Levothyroxine combination checked?
Interactions in our licensed database are recorded against drug classes. Levothyroxine is filed under 3 classifications, and 1,4-butanediol has documented interactions with 10 drug classes — none of Levothyroxine's classifications are among them. A medication can belong to classes beyond those recorded in our dataset, so this describes how the check was run rather than guaranteeing safety.
Does 1,4-butanediol interact with any other medications?
Yes. 1,4-butanediol has 271 documented drug interactions in our database — Levothyroxine is simply not one of them. If you take anything else, it is worth checking each one; they are all listed on this page.
Does Levothyroxine interact with any supplements?
Yes. Levothyroxine has documented interactions with 50 supplements in our database — 1,4-butanediol is not one of them. The Levothyroxine interaction page linked on this page lists every one, ranked by severity.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Where next

Keep Exploring

1,4-butanediol monograph Uses, safety profile, and every drug interaction in one place Levothyroxine drug information The full plain-English guide to this medication Levothyroxine supplement interactions Every supplement checked against Levothyroxine, ranked by severity Supplement interaction checker Check any supplement or product against your medications Browse medications A–Z Every drug we’ve checked against herbs & supplements References The 20 citations behind this page Ask a pharmacist Free, personal answer from our licensed team

Still Have a Question About Levothyroxine and 1,4-butanediol?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.