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levothyroxine sodium 88 ug Tablet, 60-count

by Preferred Pharmaceuticals, Inc. · 60 TABLET in 1 BOTTLE (68788-7759-9)

NDC 68788-7759-09

🏷️ FDA NDC (as labeled) 68788-7759-9 billing pads the package segment with a zero

This package

Contains60-count Pack sizes3 compare ↓

Also priced by: Part D plans $0.1283/unit — full pricing hub ↓

Also comes in: 30 tablets 68788-7759-03 100 tablets 68788-7759-01

Rx only Brand On market Non-controlled

🗂️ Data synced Jul 24, 2026 · sources: openFDA · FDA label (DailyMed) · FDA Orange & Purple Book · First Databank · CMS NADAC, ASP, Medicare & Medicaid · RxNorm

📋 All sources & update times →

This page is curated, coded, and maintained by Dr. Brian Staiger, PharmD

Compiled from public FDA, CMS, DailyMed, NADAC, and related drug data sources. Editorial policy

⚠️

Other active recalls for Levothyroxine Sodium (different manufacturers) — 6 · tap to view

These affect other manufacturers’ products for the same ingredient — not necessarily the exact NDC on this page.

Class II · Aug 6, 2026 — Subpotent Drug (ACCORD HEALTHCARE, INC.) · FDA recall D-0781-2026

Class II · Aug 6, 2026 — Subpotent Drug (ACCORD HEALTHCARE, INC.) · FDA recall D-0786-2026

Class II · Aug 6, 2026 — Subpotent Drug (ACCORD HEALTHCARE, INC.) · FDA recall D-0782-2026

Class II · Aug 6, 2026 — Subpotent Drug (ACCORD HEALTHCARE, INC.) · FDA recall D-0775-2026

Class II · Aug 6, 2026 — Subpotent Drug (ACCORD HEALTHCARE, INC.) · FDA recall D-0777-2026

Class II · Aug 6, 2026 — Subpotent Drug (ACCORD HEALTHCARE, INC.) · FDA recall D-0776-2026

Each entry is an official FDA enforcement report — look up any recall number in the FDA recall database ↗

🆔 Identity & classification

FDA NDC (as labeled) 68788-7759-9

Product NDC 68788-7759

11-digit billing NDC 68788775909

NCPDP billing unit EA — each (per item)

RxCUI 966253

UNII 9J765S329G

Application # NDA021116

SPL Set ID 65c8b305-8ffb-4aa5-aca1-f4e4ead71a9c

Established class (EPC) l-Thyroxine

Chemical class Thyroxine

DEA schedule Non-controlled

Marketing category NDA

Marketing status On market

FDA listing status Listed (active directory)

Marketing start 2020-07-01

Route ORAL

Dosage form TABLET

Substance LEVOTHYROXINE SODIUM

GPI-14 28100010100317

GPI class Levothyroxine Sodium

TE code (Orange Book) AB1,AB2,AB3,AB4 · RLD · RS

Why two NDCs? The FDA registers this code as 68788-7759-9 — a 5-4-1 layout, and that's what's printed on the package and shown on DailyMed. For insurance claims, every NDC is standardized to a uniform 11-digit 5-4-2 format by adding a zero to the package segment → 68788-7759-09. Same drug, same package — only the format differs.

Where does this data come from?

Identifiers from the FDA openFDA NDC Directory and Structured Product Labeling; RxCUI from RxNorm (NLM); GPI from Medi-Span; GCN / HIC / AHFS / legend from First Databank.

🏷️ RxNorm drug class

This medicine belongs to the l-Thyroxine class.

Pharmacologic class l-Thyroxine

Drug family (ATC) Thyroid hormones

Where does this data come from?

Therapeutic classes from RxNorm RxClass (U.S. National Library of Medicine) — Established Pharmacologic Class (FDA), ATC drug family (WHO) and mechanism of action, matched by this product’s RxCUI.

🏭 Manufacturer & labeler

LabelerPreferred Pharmaceuticals, Inc.

Application holderALVOGEN INC

FDA applicationNDA021116 (NDA)

Labeler code68788

First marketedJul 2020

Product typeHuman Prescription Drug

Portfolio178 products on file

🔎 All NDCs from Preferred Pharmaceuticals, Inc.

The labeler markets the product; the application holder owns the FDA approval. They’re often the same company but can differ (e.g. a repackager or an authorized generic). A mailing address / phone appears here when the manufacturer includes it in the product’s FDA label (not all do).

Where does this data come from?

Labeler, application holder and registered establishment from the FDA openFDA NDC Directory and Drugs@FDA; address/contact from the product’s FDA label.

🩺 Clinical

📖 What it is MedlinePlus · NLM

Levothyroxine is used to treat hypothyroidism (condition where the thyroid gland does not produce enough thyroid hormone). It is also used with surgery and radioactive iodine therapy to treat thyroid cancer. Levothyroxine is in a class of medications called hormones. It works by replacing thyroid hormone that is normally produced by the body. Without thyroid hormone, your body cannot function properly, which may result in poor growth, slow speech, lack of energy, excessive tiredness, constipation, weight gain, hair loss, dry, thick skin, increased sensitivity to cold, joint and muscle pain, he...

Read the full MedlinePlus article ↗

📗 Our plain-language guide HelloPharmacist

Your thyroid gland isn't making enough of a hormone called T4, which your whole body depends on to regulate your energy, metabolism, heart rate, and more. Levothyroxine is a precis...
What exactly is levothyroxine doing for me — why do I need to take it every day?
Timing really does make a difference with this medication. Food — especially high-fiber foods or anything soy-based — can block your gut from absorbing it properly. Taking it 30 to...
Why does it matter so much when I take it — can't I just take it with breakfast?

📖 Read our full Levothyroxine guide →

Patient education

📘 MedlinePlus patient leaflet ↗

Supplement & herbal interactions

Some supplements/herbs that may interact with Levothyroxine Sodium — tap one for details:

Activated CharcoalMajor Coffee CharcoalModerate European MandrakeModerate GlucomannanModerate Guar GumModerate Gum ArabicModerate Slippery ElmModerate TragacanthModerate

🌿 Every supplement checked against Levothyroxine Sodium (50 interactions) — ranked by severity →

Where does this data come from?

Plain-language summary from MedlinePlus (U.S. National Library of Medicine); supplement & herbal interactions and nutrient depletion data from the Natural Medicines database; our full guide is HelloPharmacist editorial content.

💊 What it looks like

Color Green

ShapeCapsule

Imprint88;T;4

Size1 mm

ScoringScored — splits in 2

One label can cover several strengths, so colors may be combined — always confirm a loose pill against the dispensed prescription label or a pharmacist.

Where does this data come from?

Physical description (imprint, shape, color, scoring, coating) from this product’s FDA Structured Product Labeling (SPL), mirrored from DailyMed / openFDA.

🧪 Inactive Ingredients / Excipients

Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.

💡 Tap an ingredient (hover on desktop) to see what it is and why it’s used.

UNII 1P9D0Z171K
BHT is a synthetic antioxidant that prevents fats and oils in medicines from breaking down and becoming rancid. It helps keep the product stable and effective during storage.
UNII 35SW5USQ3G
A synthetic yellow dye used to color medicines. It helps make tablets, capsules, and liquids visually distinct so patients can easily identify their medication.
UNII O7TSZ97GEP
A mineral compound that serves as a filler and binding agent in tablets and capsules. It adds bulk to the medicine and helps hold ingredients together during manufacturing.
UNII H3R47K3TBD
FD&C Blue No. 1 is a synthetic blue dye approved for use in foods and medicines. It serves as a colorant to give the medication its distinctive appearance and help with product identification.
UNII H77VEI93A8
A synthetic yellow dye used to color medications. It helps identify the drug and make it visually distinctive, with no effect on how the medicine works.
UNII 70097M6I30
Magnesium stearate is a salt made from magnesium and stearic acid, a fatty substance. It's used in tablets and capsules as a lubricant and glidant to help ingredients flow smoothly during manufacturing and prevent sticking.
UNII OP1R32D61U
Microcrystalline cellulose is a purified form of cellulose, a natural fiber from plant sources. It acts as a binder and filler in tablets and capsules, helping hold ingredients together and give the medicine its shape and size.
UNII FZ989GH94E
Povidone is a synthetic polymer made from a plastic-like material. It acts as a binder to hold tablet ingredients together and as a disintegrant to help the tablet break apart in your stomach so the medicine can be absorbed.
UNII 5856J3G2A2
A starch-based powder made from potatoes and processed with sodium. It acts as a disintegrant, helping the tablet or capsule break apart quickly in the stomach so the medicine can be absorbed.

9 inactive ingredients listed in the exact product block matched to this NDC.

Where does this data come from?

Data sourced from official FDA Structured Product Labeling (SPL) via DailyMed — ingredient classCode="IACT" elements from the exact product block matched by this NDC. Label-section narrative from DailyMed / the openFDA label index is shown separately when available.

Inactive ingredient FAQ

Are inactive ingredients the same for every manufacturer?

No. Inactive ingredients can differ by manufacturer, dosage form, strength, and package / product version.

Why might an inactive ingredient be missing?

Some SPLs do not provide a complete structured inactive-ingredient list, and older or unusual labels may only include the information in narrative text.

Can inactive ingredients matter?

Yes. They can matter for allergies, intolerances, dyes, gluten / lactose concerns, preservatives, and formulation differences — but confirm with a pharmacist or the manufacturer when it’s clinically important.

💲 Pricing

A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.

Price system	Per each	Per package
Retail pharmacies payNADAC · weekly	Not in the retail survey — common for institutional, discontinued, or low-volume packs.
Medicaid paysCMS SDUD · 12 mo	No recent Medicaid claims on file for this NDC — rare and low-volume NDCs are suppressed in the public data.
Medicare drug plans payPart D · Q2 2026	$0.1283	$7.70 / 60 tablets

Where does this data come from?

NADAC (National Average Drug Acquisition Cost) is the CMS weekly pharmacy-acquisition-cost survey — what pharmacies pay. ASP (Average Sales Price) is the CMS Medicare Part B drug-payment file, published quarterly. Medicaid pays is computed by us from CMS State Drug Utilization Data (total reimbursed ÷ units, trailing 12 months) — gross of rebates and inclusive of dispensing fees, so it reflects what Medicaid paid, not an acquisition cost. Medicare drug plans pay is the median negotiated point-of-sale unit cost across plans listing this NDC in the CMS quarterly Prescription Drug Plan pricing files, before rebates. The VA pays is the federal contract price (FSS, and the statutory Big 4 ceiling where listed) from the VA National Acquisition Center pharmaceutical price file. All are free public government data; each measures a different payer, so the figures are not directly comparable.

🔁 Therapeutic equivalents

Product	Labeler	Pack	NADAC/unit	TE	Status	Price vs. this
Levothyroxine Sodium 88 ug 00378-1807-10	Mylan	1000 tablets	$0.050	AB1,AB2,AB3,AB4	Availability likely	—
Levothyroxine Sodium 88 ug 00527-3283-43	Lannett	1000 tablets	$0.050	AB1,AB2,AB3	Availability likely	—
Levothyroxine Sodium .088 mg 00904-6952-61	Major	100 tablets	$0.050	AB1,AB2,AB3	Availability likely	—
Levothyroxine sodium 88 ug 16729-0450-15	Accord	90 tablets	$0.050	AB1,AB2,AB3,AB4	Availability likely	—
Levothyroxine Sodium 88 ug 33342-0396-10	Macleods	90 tablets	$0.050	AB1,AB2,AB3,AB4	Availability likely	—
Levothyroxine Sodium 88 ug 42292-0038-20	Mylan	100 tablets	$0.050	AB1,AB2,AB3,AB4	Availability likely	—
levothyroxine sodium 88 ug 47781-0649-10	Alvogen,	1000 tablets	$0.050	AB1,AB2,AB3,AB4	Availability likely	—
Levothyroxine Sodium .088 mg 60687-0486-01	American	100 tablets	$0.050	AB1,AB2,AB3	Availability likely	—
Levothyroxine Sodium .088 mg 68180-0968-01	Lupin	100 tablets	$0.050	AB1,AB2,AB3	Availability likely	—
Levothyroxine Sodium .088 mg 69238-1833-01	Amneal	100 tablets	$0.050	AB1,AB2,AB3	Availability likely	—
Levothyroxine Sodium 88 ug 72603-0663-01	NorthStar	1000 tablets	$0.050	AB1,AB2,AB3,AB4	Availability likely	—
Levo-T 88 ug 55466-0107-11	Neolpharma,	90 tablets	$0.050	AB1,AB2,AB3	Discontinued	—
Levoxyl 88 ug 60793-0853-01	Pfizer	100 tablets	$0.959	AB1,AB3	Availability likely	—
Synthroid 88 ug 00074-6594-19	AbbVie	1000 tablets	$1.663	AB1,AB2	Availability likely	—
Unithroid 88 ug 60846-0804-01	Amneal	100 tablets	$4.191	AB1,AB2,AB3	Availability likely	—
Levothyroxine sodium 88 ug 00480-8693-01	Teva	100 tablets	—	AB1,AB2,AB3,AB4	Discontinued	—
Levothyroxine Sodium .088 mg 00615-8598-05	NCS	15 tablets	—	AB1,AB2,AB3	FDA listed	—
Levothyroxine Sodium .088 mg 31722-0287-01	Camber	100 tablets	—	AB4	FDA listed	—
Levothyroxine Sodium .088 mg 50090-4951-00	A-S	30 tablets	—	AB1,AB2,AB3	FDA listed	—
Levothyroxine sodium 88 ug 50090-6087-00	A-S	30 tablets	—	AB1,AB2,AB3,AB4	FDA listed	—
Levothyroxine Sodium .088 mg 50090-6984-00	A-S	90 tablets	—	AB1,AB2,AB3	FDA listed	—
Levothyroxine Sodium 88 ug 50090-7608-00	A-S	30 tablets	—	AB1,AB2,AB3,AB4	FDA listed	—
Levothyroxine Sodium 88 ug 50090-7609-00	A-S	90 tablets	—	AB1,AB2,AB3,AB4	FDA listed	—
Levothyroxine sodium 88 ug 50090-7871-00	A-S	90 tablets	—	AB1,AB2,AB3,AB4	FDA listed	—
Levothyroxine Sodium 88 ug 50090-7901-00	A-S	30 tablets	—	AB1,AB2,AB3,AB4	FDA listed	—
Levothyroxine Sodium 88 ug 50090-7902-00	A-S	90 tablets	—	AB1,AB2,AB3,AB4	FDA listed	—
Levothyroxine Sodium .088 mg 51655-0483-26	Northwind	90 tablets	—	AB1,AB2,AB3	FDA listed	—
Levothyroxine Sodium 88 ug 51655-0529-52	Northwind	30 tablets	—	AB1,AB2,AB3,AB4	FDA listed	—
Levothyroxine Sodium .088 mg 51655-0705-52	Northwind	30 tablets	—	AB1,AB2,AB3	FDA listed	—
Levothyroxine Sodium 88 ug 51655-0728-52	Northwind	30 tablets	—	AB1,AB2,AB3	FDA listed	—
Levothyroxine Sodium .088 mg 55154-4309-00	Cardinal	10 tablets	—	AB1,AB2,AB3	FDA listed	—
Levothyroxine Sodium 88 ug 63629-2092-01	Bryant	1000 tablets	—	AB1,AB2,AB3	FDA listed	—
Levothyroxine Sodium .088 mg 68071-3814-03	NuCare	30 tablets	—	AB1,AB2,AB3	FDA listed	—
levothyroxine sodium 88 ugthis 68788-7759-09	Preferred	60 tablets	—	AB1,AB2,AB3,AB4	FDA listed	—
Levothyroxine sodium 88 ug 68788-7943-01	Preferred	100 tablets	—	AB1,AB2,AB3,AB4	FDA listed	—
Levothyroxine sodium 88 ug 68788-8792-03	Preferred	30 tablets	—	AB1,AB2,AB3,AB4	FDA listed	—
Levothyroxine sodium 88 ug 70518-3154-00	REMEDYREPACK	90 tablets	—	AB1,AB2,AB3,AB4	FDA listed	—
Levothyroxine Sodium 88 ug 70518-4434-00	REMEDYREPACK	90 tablets	—	AB1,AB2,AB3,AB4	FDA listed	—
Levothyroxine Sodium .088 mg 71205-0261-30	Proficient	30 tablets	—	AB1,AB2,AB3	FDA listed	—
levothyroxine sodium 88 ug 71335-1438-01	Bryant	30 tablets	—	AB1,AB2,AB3,AB4	FDA listed	—
Levothyroxine Sodium 88 ug 71335-1734-01	Bryant	30 tablets	—	AB1,AB2,AB3	FDA listed	—
Levothyroxine sodium 88 ug 71335-1966-01	Bryant	30 tablets	—	AB1,AB2,AB3,AB4	FDA listed	—
Levothyroxine Sodium 88 ug 71335-2290-01	Bryant	1000 tablets	—	AB1,AB2,AB3	FDA listed	—
Levothyroxine sodium 88 ug 71335-2538-01	Bryant	30 tablets	—	AB1,AB2,AB3,AB4	FDA listed	—
Levothyroxine Sodium 88 ug 72162-1090-00	Bryant	1000 tablets	—	AB1,AB2,AB3	FDA listed	—
Levothyroxine Sodium 88 ug 72189-0163-90	DIRECT	90 tablets	—	AB1,AB2,AB3,AB4	FDA listed	—
Levothyroxine Sodium 88 ug 72189-0604-90	Direct_rx	90 tablets	—	AB1,AB2,AB3,AB4	FDA listed	—
Euthyrox 88 ug 72305-0088-30	Provell	30 tablets	—	—	Discontinued	—
Levothyroxine Sodium .088 mg 72865-0239-10	XLCare	1000 tablets	—	AB4	FDA listed	—
Levothyroxine Sodium .088 mg 82804-0281-30	Proficient	30 tablets	—	AB1,AB2,AB3	FDA listed	—
Levothyroxine sodium 88 ug 87063-0086-00	ASCLEMED	1000 tablets	—	AB1,AB2,AB3,AB4	FDA listed	—

About this product: this is the brand-name version. FDA-approved generic versions are listed, and recent pricing/market data suggests they may be available.

Where does this data come from?

Equivalents are other NDCs of the same ingredient, form and route from the openFDA NDC Directory, ranked least-expensive-first by NADAC. Therapeutic-equivalence (AB) ratings come from the FDA Orange Book; biologics use the FDA Purple Book for biosimilar & interchangeable status.

⏳ Availability & generic status

🏛️

2020

On the market since

Jul 2020

📍

2026

Currently FDA-listed

6 years listed

🔓

Generic versions listed

see equivalents

✅Generic appears available

FDA-approved generic versions are listed, and recent pricing/market data suggests they may be available — see Therapeutic equivalents.

Where does this data come from?

Patents and exclusivity from the FDA Orange Book (small-molecule drugs), refreshed from public FDA data. Generic launch timing is an estimate, not a guarantee.

📊 Medicare Part D spend CMS · PART D · 2026 (Q1)

Medicare Part D (outpatient prescription) spending for Levothyroxine Sodium — the program that covers self-administered drugs. 19 manufacturers.

⚠️ Drug-level data: CMS publishes Part D spending by drug, not by NDC — these figures combine every manufacturer, strength and package size sold under the name Levothyroxine Sodium. That’s a different level of aggregation than the Medicaid card above, which is specific to this exact 11-digit NDC (pack size included), so the two aren’t directly comparable.

Period

Total Part D spend

$118.86M

Claims incl. refills

10.9M

Beneficiaries

7.8M

Spend / beneficiary

$15.20

Spend / claim

$10.88

Trend by period

💵 About the dollar figures: spending is what Part D plans paid before confidential manufacturer rebates, so the program’s real net cost is lower. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part D Spending by Drug (data.cms.gov), updated quarterly.

🔬 Reported adverse events (FAERS)

Read carefully: FAERS reports are voluntary and unverified. Counts are not incidence, do not establish causation, are subject to reporting bias, and cannot be used to compare one drug to another. Shown for signal context only. Reports for Levothyroxine sodium — the ingredient across all brands.

Top reported reactions

Fatigue26,585

Nausea22,605

Headache19,408

Diarrhoea18,759

Dyspnoea16,717

Pain16,375

Dizziness15,848

Age at onset

Neonate282

Infant75

Child220

Adolescent179

Adult19,320

Elderly21,623

Reporter sex

Male · 19%

Female · 81%

Unknown · 0%

Serious outcomes

Hospitalization90,712

Death20,300

Life-threatening10,774

Disabling9,272

Reports over time (by year) — tap or hover for the count & year

Most recent year is provisional (FAERS lags ~3 months).

Where does this data come from?

Adverse-event reports from the FDA Adverse Event Reporting System (FAERS) via openFDA. FAERS reports are voluntary and unverified — counts are not incidence and don’t establish causation.

📦 Packaging — all sizes for this product

Package NDC	Description	Marketing start	Status
68788-7759-01	100 TABLET in 1 BOTTLE (68788-7759-1)	2020-07-01	Active
68788-7759-03	30 TABLET in 1 BOTTLE (68788-7759-3)	2020-07-01	Active
68788-7759-09 You're viewing this	60 TABLET in 1 BOTTLE (68788-7759-9)	2020-07-01	Active

You're viewing one of 3 pack sizes for this product.

Pack size FAQ

What quantity is in NDC 68788-7759-09?

NDC 68788-7759-09 is a 60-count package — 60 tablet in 1 bottle.

What is the difference between NDC 68788-7759-09 and NDC 68788-7759-03?

Both are levothyroxine sodium 88 ug Tablet — the drug itself is identical. NDC 68788-7759-09 is the 60-count package, while NDC 68788-7759-03 is the 30 tablets package.

What NDC number is used to bill for this package of levothyroxine sodium 88 ug Tablet?

Bill NDC 68788-7759-09 — the 11-digit billing format is 68788775909. Pharmacy and medical claims use the 11-digit form; the FDA label may print a shorter form of the same code.

🧭 About this NDC listing & data coverage

Finished prescription product

What data is (and isn’t) available for this NDC — tap to expand

NDC identity (package / product / labeler codes)	✓ Available
Labeler	✓ Available
Product & package description	✓ Available
Marketing category & status	✓ Available
Active ingredient / dosage form / route	✓ Available
FDA label (SPL via DailyMed)	✓ Available
Package photos	✓ Available
Inactive ingredients (structured)	✓ Available
NADAC pharmacy acquisition price (CMS)	— Not published for this NDC CMS publishes NADAC only for NDCs reported in its retail-pharmacy survey.
Orange Book / therapeutic-equivalence data	✓ Available
HCPCS J-code billing crosswalk	— Not published for this NDC Most self-administered / retail products have no J-code — that is normal.
Medicaid utilization (CMS SDUD)	— Not published for this NDC CMS reports utilization only for NDCs with Medicaid claims above its privacy threshold.

“Not published” reflects what the public FDA / CMS / NLM sources provide for this exact package code — it is a property of the data feeds, not a judgment about the product.

Questions about this listing

Why is there no price listed?

The pricing shown on our NDC pages comes from CMS NADAC, a voluntary survey of retail community pharmacy invoices. CMS does not publish a NADAC for every NDC — packages outside the retail survey (institutional and hospital products, bulk packages, discontinued items, and many OTC items) may never receive one. A missing price reflects the survey's scope, not this product's actual cost, and does not mean the product is free or unavailable.

Is the NDC printed on the package the same as the 11-digit billing NDC?

Yes, they identify this exact package in different formats. The FDA registers it as 68788-7759-9, which is what is printed on the packaging and shown on DailyMed. Insurance claims use a fixed 11-digit 5-4-2 format, so the short segment is padded with a leading zero: 68788-7759-09, written without dashes as 68788775909. The Identity section at the top of this page lists every form of this code.

What do the three segments of this NDC mean?

In 68788-7759-09, the first segment (68788) is the labeler code FDA assigned to Preferred Pharmaceuticals, Inc.; the middle segment (7759) identifies this specific product — its ingredient, strength, and dosage form; and the last segment (09) identifies this exact package size and type. Together they name one specific package of one specific product.

Is this package still being marketed?

Yes, per the latest FDA NDC Directory data on this page: this package is listed as actively marketed, with no marketing end date reported by Preferred Pharmaceuticals, Inc.. Listing status can change — the directory data on this page refreshes weekly.

Does this product come in other package sizes?

Yes — the FDA directory lists 2 other package presentations of this same product, including 30 tablets (68788-7759-03), 100 tablets (68788-7759-01). Each has its own NDC and its own page — see the package list near the top of this page.

Who lists this product with the FDA?

Preferred Pharmaceuticals, Inc. is the labeler of record for this NDC — the company under whose FDA-assigned code the package is listed. The labeler may be the manufacturer itself or a distributor marketing the product under its own code.

Do I need a prescription for this product?

This NDC is listed with FDA as a prescription product, so it is dispensed under a prescriber's order. Your pharmacist can tell you whether any over-the-counter forms of the same medication exist.

This page identifies an FDA-listed package (the NDC) and reports public regulatory and pricing data about the listing. It is reference information, not a medical recommendation — talk to your pharmacist or prescriber about your own medication.

Where does this data come from?

Listing facts (marketing category, packager status, marketing dates) from the FDA openFDA NDC Directory; label availability from DailyMed; pricing coverage from CMS NADAC; equivalence scope from the FDA Orange Book.

📄 Full prescribing information FDA SPL

The complete FDA label for this product — the official prescribing information, verbatim, section by section. Jump with a chip, search within the label, or expand everything.

🚨 Boxed Warning 🎯 Indications and Usage ⏱️ Dosage and Administration 💊 Dosage Forms and Strengths ⛔ Contraindications ⚠️ Warnings and Cautions 🤒 Adverse Reactions 🔄 Drug Interactions 🔄 Drug / Laboratory Test Interactions 👥 Use in Specific Populations 🤰 Pregnancy 🧒 Pediatric Use 🧓 Geriatric Use 🆘 Overdosage 🧬 Clinical Pharmacology 🧬 Mechanism of Action 📦 How Supplied / Storage and Handling 📦 Storage and Handling 📋 Description 💬 Information for Patients

🚨 Boxed Warning 159 words ▾

WARNING: NOT FOR TREATMENT OF OBESITY OR FOR WEIGHT LOSS Thyroid hormones, including Levothyroxine Sodium Tablets, either alone or with other therapeutic agents, should not be used for the treatment of obesity or for weight loss. In euthyroid patients, doses within the range of daily hormonal requirements are ineffective for weight reduction. Larger doses may produce serious or even life threatening manifestations of toxicity, particularly when given in association with sympathomimetic amines such as those used for their anorectic effects [see Adverse Reactions ( ) , Drug Interactions ( 7.7 ) , and Overdosage ( 10 )] .

WARNING: NOT FOR TREATMENT OF OBESITY OR FOR WEIGHT LOSS See full prescribing information for complete boxed warning • Thyroid hormones, including Levothyroxine Sodium Tablets should not be used for the treatment of obesity or for weight loss. • Doses beyond the range of daily hormonal requirements may produce serious or even life threatening manifestations of toxicity ( , 10 ).

🎯 Indications and Usage 199 words ▾

1 INDICATIONS AND USAGE Levothyroxine Sodium Tablets are L-thyroxine (T4) indicated for: • Hypothyroidism: As replacement therapy in primary (thyroidal), secondary (pituitary), and tertiary (hypothalamic) congenital or acquired hypothyroidism. () • Pituitary Thyrotropin (Thyroid-Stimulating Hormone, TSH) Suppression: As an adjunct to surgery and radioiodine therapy in the management of thyrotropin-dependent well-differentiated thyroid cancer. () Limitations of Use: - Not indicated for suppression of benign thyroid nodules and nontoxic diffuse goiter in iodine-sufficient patients. - Not indicated for treatment of hypothyroidism during the recovery phase of subacute thyroiditis.

Hypothyroidism Levothyroxine Sodium Tablets are indicated as a replacement therapy in primary (thyroidal), secondary (pituitary), and tertiary (hypothalamic) congenital or acquired hypothyroidism. Pituitary Thyrotropin (Thyroid-Stimulating Hormone, TSH) Suppression Levothyroxine Sodium Tablets are indicated as an adjunct to surgery and radioiodine therapy in the management of thyrotropin-dependent well-differentiated thyroid cancer. Limitations of Use: • Levothyroxine Sodium Tablets are not indicated for suppression of benign thyroid nodules and nontoxic diffuse goiter in iodine-sufficient patients as there are no clinical benefits and overtreatment with Levothyroxine Sodium Tablets may induce hyperthyroidism [see Warnings and Precautions ( 5.4 )]. • Levothyroxine Sodium Tablets are not indicated for treatment of hypothyroidism during the recovery phase of subacute thyroiditis.

⏱️ Dosage and Administration ~3 min read ▾

2 DOSAGE AND ADMINISTRATION • Administer once daily, preferably on an empty stomach, one-half to one hour before breakfast. ( 2.1 ) • Administer at least 4 hours before or after drugs that are known to interfere with absorption. ( 2.1 ) • Evaluate the need for dose adjustments when regularly administering within one hour of certain foods that may affect absorption.

( 2.1 ) • Starting dose depends on a variety of factors, including age, body weight, cardiovascular status, and concomitant medications. Peak therapeutic effect may not be attained for 4-6 weeks. ( 2.2 ) • See full prescribing information for dosing in specific patient populations.

( 2.3 ) • Adequacy of therapy determined with periodic monitoring of TSH and/or T4 as well as clinical status. ( 2.4 )

2.1General Administration Information Administer Levothyroxine Sodium Tablets as a single daily dose, on an empty stomach, one-half to one hour before breakfast. Administer Levothyroxine Sodium Tablets at least 4 hours before or after drugs known to interfere with Levothyroxine Sodium Tablets absorption [see Drug Interactions ( 7.1 )] . Evaluate the need for dose adjustments when regularly administering within one hour of certain foods that may affect Levothyroxine Sodium Tablets absorption [see Drug Interactions ( 7.9 ) and Clinical Pharmacology ( 12.3 )] .

Administer Levothyroxine Sodium Tablets to infants and children who cannot swallow intact tablets by crushing the tablet, suspending the freshly crushed tablet in a small amount (5 mL to 10 mL or 1 teaspoon to 2 teaspoons) of water and immediately administering the suspension by spoon or dropper. Do not store the suspension. Do not administer in foods that decrease absorption of Levothyroxine Sodium Tablets, such as soybean-based infant formula [see Drug Interactions ( 7.9 )] .

2.2General Principles of Dosing The dose of Levothyroxine Sodium Tablets for hypothyroidism or pituitary TSH suppression depends on a variety of factors including: the patient's age, body weight, cardiovascular status, concomitant medical conditions (including pregnancy), concomitant medications, co-administered food and the specific nature of the condition being treated [see Dosage and Administration ( 2.3 ), Warnings and Precautions ( 5 ) , and Drug Interactions ( )] . Dosing must be individualized to account for these factors and dose adjustments made based on periodic assessment of the patient's clinical response and laboratory parameters [see Dosage and Administration ( 2.4 )] .

The peak therapeutic effect of a given dose of Levothyroxine Sodium Tablets may not be attained for 4 to 6 weeks.

2.3Dosing in Specific Patient Populations Primary Hypothyroidism in Adults and in Adolescents in Whom Growth and Puberty are Complete Start Levothyroxine Sodium Tablets at the full replacement dose in otherwise healthy, non-elderly individuals who have been hypothyroid for only a short time (such as a few months). The average full replacement dose of Levothyroxine Sodium Tablets is approximately 1.6 mcg per kg per day (for example: 100 mcg per day to 125 mcg per day for a 70 kg adult). Adjust the dose by 12.5 mcg to 25 mcg increments every 4 to 6 weeks until the patient is clinically euthyroid and the serum TSH returns to normal.

Doses greater than 200 mcg per day are seldom required. An inadequate response to daily doses of greater than 300 mcg per day is rare and may indicate poor compliance, malabsorption, drug interactions, or a combination of these factors. For elderly patients or patients with underlying cardiac disease, start with a dose of 12.5 mcg per day to 25 mcg per day.

Increase the dose every 6 to 8 weeks, as needed until the patient is clinically euthyroid and the serum TSH returns to normal. The full replacement dose of Levothyroxine Sodium Tablets may be less than 1 mcg per kg per day in elderly patients. In patients with severe longstanding hypothyroidism, start with a dose of 12.5 mcg per day to 25 mcg per day.

Adjust the dose in 1…

💊 Dosage Forms and Strengths 125 words ▾

3 DOSAGE FORMS AND STRENGTHS Levothyroxine Sodium Tablets, in the shape of caplet are available as follows: Tablet Strength Tablet Color Tablet Markings 25 mcg Orange "T|4" and "25" 50 mcg White "T|4" and "50" 75 mcg Violet "T|4" and "75" 88 mcg Mint Green "T|4" and "88" 100 mcg Yellow "T|4" and "100" 112 mcg Rose "T|4" and "112" 125 mcg Brown "T|4" and "125" 137 mcg Deep Blue "T|4" and "137" 150 mcg Light Blue "T|4" and "150" 175 mcg Lilac "T|4" and "175" 200 mcg Pink "T|4" and "200" 300 mcg Green "T|4" and "300" Tablets: 25 mcg, 50 mcg, 75 mcg, 88 mcg, 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, and 300 mcg ()

⛔ Contraindications 28 words ▾

4 CONTRAINDICATIONS Levothyroxine Sodium Tablets are contraindicated in patients with uncorrected adrenal insufficiency [see Warnings and Precautions ( 5.3 )] . • Uncorrected adrenal insufficiency. ( 4 )

⚠️ Warnings and Cautions ~3 min read ▾

5 WARNINGS AND PRECAUTIONS • Cardiac adverse reactions in the elderly and in patients with underlying cardiovascular disease: Initiate Levothyroxine Sodium Tablets at less than the full replacement dose because of the increased risk of cardiac adverse reactions, including atrial fibrillation. ( 2.3 , 5.1 , 8.5 ) • Myxedema coma: Do not use oral thyroid hormone drug products to treat myxedema coma. ( 5.2 ) • Acute adrenal crisis in patients with concomitant adrenal insufficiency: Treat with replacement glucocorticoids prior to initiation of Levothyroxine Sodium Tablets treatment.

( 5.3 ) • Prevention of hyperthyroidism or incomplete treatment of hypothyroidism: Proper dose titration and careful monitoring is critical to prevent the persistence of hypothyroidism or the development of hyperthyroidism. ( 5.4 ) • Worsening of diabetic control: Therapy in patients with diabetes mellitus may worsen glycemic control and result in increased antidiabetic agent or insulin requirements. Carefully monitor glycemic control after starting, changing, or discontinuing thyroid hormone therapy.

( 5.5 ) • Decreased bone mineral density associated with thyroid hormone over-replacement: Over-replacement can increase bone resorption and decrease bone mineral density. Give the lowest effective dose. ( 5.6 )

5.1Cardiac Adverse Reactions in the Elderly and in Patients with Underlying Cardiovascular Disease Over-treatment with levothyroxine may cause an increase in heart rate, cardiac wall thickness, and cardiac contractility and may precipitate angina or arrhythmias, particularly in patients with cardiovascular disease and in elderly patients. Initiate Levothyroxine Sodium Tablets therapy in this population at lower doses than those recommended in younger individuals or in patients without cardiac disease [see Dosage and Administration ( 2.3 ) , Use in Specific Populations ( 8.5 )] .

Monitor for cardiac arrhythmias during surgical procedures in patients with coronary artery disease receiving suppressive Levothyroxine Sodium Tablets therapy. Monitor patients receiving concomitant Levothyroxine Sodium Tablets and sympathomimetic agents for signs and symptoms of coronary insufficiency. If cardiac symptoms develop or worsen, reduce the Levothyroxine Sodium Tablets dose or withhold for one week and restart at a lower dose.

5.2Myxedema Coma Myxedema coma is a life-threatening emergency characterized by poor circulation and hypometabolism, and may result in unpredictable absorption of levothyroxine sodium from the gastrointestinal tract. Use of oral thyroid hormone drug products is not recommended to treat myxedema coma. Administer thyroid hormone products formulated for intravenous administration to treat myxedema coma.

5.3Acute Adrenal Crisis in Patients with Concomitant Adrenal Insufficiency Thyroid hormone increases metabolic clearance of glucocorticoids. Initiation of thyroid hormone therapy prior to initiating glucocorticoid therapy may precipitate an acute adrenal crisis in patients with adrenal insufficiency. Treat patients with adrenal insufficiency with replacement glucocorticoids prior to initiating treatment with Levothyroxine Sodium Tablets [see Contraindications ( 4 )].

5.4Prevention of Hyperthyroidism or Incomplete Treatment of Hypothyroidism Levothyroxine Sodium Tablets have a narrow therapeutic index. Over- or undertreatment with Levothyroxine Sodium Tablets may have negative effects on growth and development, cardiovascular function, bone metabolism, reproductive function, cognitive function, emotional state, gastrointestinal function, and glucose and lipid metabolism. Titrate the dose of Levothyroxine Sodium Tablets carefully and monitor response to titration to avoid these effects [see Dosage and Administration ( 2.4 )] .

Monitor for the presence of drug or food interactions when using Levothyroxine Sodium Tablets and adjust the dose as necessary [see Drug Interactions ( 7.9 )and Clinical Pharmacology ( 12.3 )] .

5.5 Worsening of Diabe…

🤒 Adverse Reactions ~1 min read ▾

6 ADVERSE REACTIONS Adverse reactions associated with Levothyroxine Sodium Tablets therapy are primarily those of hyperthyroidism due to therapeutic overdosage [see Warnings and Precautions ( 5 ) , Overdosage ( 10 )] . They include the following: • General: fatigue, increased appetite, weight loss, heat intolerance, fever, excessive sweating • Central nervous system: headache, hyperactivity, nervousness, anxiety, irritability, emotional lability, insomnia • Musculoskeletal: tremors, muscle weakness, muscle spasm • Cardiovascular: palpitations, tachycardia, arrhythmias, increased pulse and blood pressure, heart failure, angina, myocardial infarction, cardiac arrest • Respiratory: dyspnea • Gastrointestinal: diarrhea, vomiting, abdominal cramps, elevations in liver function tests • Dermatologic: hair loss, flushing, rash • Endocrine: decreased bone mineral density • Reproductive: menstrual irregularities, impaired fertility Seizures have been reported rarely with the institution of levothyroxine therapy.

Adverse reactions associated with Levothyroxine Sodium Tablets therapy are primarily those of hyperthyroidism due to therapeutic overdosage: arrhythmias, myocardial infarction, dyspnea, muscle spasm, headache, nervousness, irritability, insomnia, tremors, muscle weakness, increased appetite, weight loss, diarrhea, heat intolerance, menstrual irregularities, and skin rash. () To report SUSPECTED ADVERSE REACTIONS, contact Alvogen, Inc. at 1-866-770-3024 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. Adverse Reactions in Children Pseudotumor cerebri and slipped capital femoral epiphysis have been reported in children receiving levothyroxine therapy.

Overtreatment may result in craniosynostosis in infants and premature closure of the epiphyses in children with resultant compromised adult height. Hypersensitivity Reactions Hypersensitivity reactions to inactive ingredients have occurred in patients treated with thyroid hormone products. These include urticaria, pruritus, skin rash, flushing, angioedema, various gastrointestinal symptoms (abdominal pain, nausea, vomiting and diarrhea), fever, arthralgia, serum sickness, and wheezing.

Hypersensitivity to levothyroxine itself is not known to occur.

🔄 Drug Interactions ~2 min read ▾

7 DRUG INTERACTIONS See full prescribing information for drugs that affect thyroid hormone pharmacokinetics and metabolism (e.g., absorption, synthesis, secretion, catabolism, protein binding, and target tissue response) and may alter the therapeutic response to Levothyroxine Sodium Tablets. ()

7.1Drugs Known to Affect Thyroid Hormone Pharmacokinetics Many drugs can exert effects on thyroid hormone pharmacokinetics and metabolism (e.g., absorption, synthesis, secretion, catabolism, protein binding, and target tissue response) and may alter the therapeutic response to Levothyroxine Sodium Tablets (see Tables 2-5 below). Table 2. Drugs That May Decrease T4 Absorption (Hypothyroidism) Potential impact: Concurrent use may reduce the efficacy of Levothyroxine Sodium Tablets by binding and delaying or preventing absorption, potentially resulting in hypothyroidism.

Drug or Drug Class Effect Calcium Carbonate Ferrous Sulfate Calcium carbonate may form an insoluble chelate with levothyroxine, and ferrous sulfate likely forms a ferric-thyroxine complex. Administer Levothyroxine Sodium Tablets at least 4 hours apart from these agents. Orlistat Monitor patients treated concomitantly with orlistat and Levothyroxine Sodium Tablets for changes in thyroid function.

Bile Acid Sequestrants - Colesevelam - Cholestyramine - Colestipol Ion Exchange Resins - Kayexalate - Sevelamer Bile acid sequestrants and ion exchange resins are known to decrease levothyroxine absorption. Administer Levothyroxine Sodium Tablets at least 4 hours prior to these drugs or monitor TSH levels. Other drugs: Proton Pump Inhibitors Sucralfate Antacids - Aluminum & Magnesium Hydroxides - Simethicone Gastric acidity is an essential requirement for adequate absorption of levothyroxine.

Sucralfate, antacids and proton pump inhibitors may cause hypochlorhydria, affect intragastric pH, and reduce levothyroxine absorption. Monitor patients appropriately. Table 3.

Drugs That May Alter T4 and Triiodothyronine (T3) Serum Transport Without Affecting Free Thyroxine (FT4) Concentration (Euthyroidism) Drug or Drug Class Effect Clofibrate Estrogen-containing oral contraceptives Estrogens (oral) Heroin / Methadone 5-Fluorouracil Mitotane Tamoxifen These drugs may increase serum thyroxine-binding globulin (TBG) concentration. Androgens / Anabolic Steroids Asparaginase Glucocorticoids Slow-Release Nicotinic Acid These drugs may decrease serum TBG concentration. Potential impact (below): Administration of these agents with Levothyroxine Sodium Tablets results in an initial transient increase in FT4.

Continued administration results in a decrease in serum T4 and normal FT4 and TSH concentrations. Salicylates (greater than 2 g/day) Salicylates inhibit binding of T4 and T3 to TBG and transthyretin. An initial increase in serum FT4 is followed by return of FT4 to normal levels with sustained therapeutic serum salicylate concentrations, although total T4 levels may decrease by as much as 30%.

Other drugs: Carbamazepine Furosemide (greater than 80 mg IV) Heparin Hydantoins Non-Steroidal Anti-inflammatory Drugs - Fenamates These drugs may cause protein-binding site displacement. Furosemide has been shown to inhibit the protein binding of T4 to TBG and albumin, causing an increase free T4 fraction in serum. Furosemide competes for T4-binding sites on TBG, prealbumin, and albumin, so that a single high dose can acutely lower the total T4 level.

Phenytoin and carbamazepine reduce serum protein binding of levothyroxine, and total and free T4 may be reduced by 20% to 40%, but most patients have normal serum TSH levels and are clinically euthyroid. Closely monitor thyroid hormone parameters. Table 4.

Drugs That May Alter Hepatic Metabolism of T4 (Hypothyroidism) Potential impact: Stimulation of hepatic microsomal drug-metabolizing enzyme activity may cause increased hepatic degradation of levothyroxine, resulting in increased Levothyroxine Sodium Tablets requirements. Drug or Drug Class Effect Phenobar…

🔄 Drug / Laboratory Test Interactions 76 words ▾

7.10Drug-Laboratory Test Interactions Consider changes in TBG concentration when interpreting T4 and T3 values. Measure and evaluate unbound (free) hormone and/or determine the free-T4 index (FT4I) in this circumstance. Pregnancy, infectious hepatitis, estrogens, estrogen-containing oral contraceptives, and acute intermittent porphyria increase TBG concentration.

Nephrosis, severe hypoproteinemia, severe liver disease, acromegaly, androgens, and corticosteroids decrease TBG concentration. Familial hyper- or hypo-thyroxine binding globulinemias have been described, with the incidence of TBG deficiency approximating 1 in 9000.

👥 Use in Specific Populations ~3 min read ▾

8 USE IN SPECIFIC POPULATIONS Pregnancy may require the use of higher doses of Levothyroxine Sodium Tablets. ( 2.3 , 8.1 )

8.1Pregnancy Risk Summary Experience with levothyroxine use in pregnant women, including data from post-marketing studies, have not reported increased rates of major birth defects or miscarriages [see Data]. There are risks to the mother and fetus associated with untreated hypothyroidism in pregnancy. Since TSH levels may increase during pregnancy, TSH should be monitored and Levothyroxine Sodium Tablets dosage adjusted during pregnancy [see Clinical Considerations] .

There are no animal studies conducted with levothyroxine during pregnancy. Levothyroxine Sodium Tablets should not be discontinued during pregnancy and hypothyroidism diagnosed during pregnancy should be promptly treated. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown.

In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively. Clinical Considerations Disease-Associated Maternal and/or Embryo/Fetal Risk Maternal hypothyroidism during pregnancy is associated with a higher rate of complications, including spontaneous abortion, gestational hypertension, pre-eclampsia, stillbirth, and premature delivery. Untreated maternal hypothyroidism may have an adverse effect on fetal neurocognitive development.

Dose Adjustments During Pregnancy and the Postpartum Period Pregnancy may increase Levothyroxine Sodium Tablets requirements. Serum TSH levels should be monitored and the Levothyroxine Sodium Tablets dosage adjusted during pregnancy. Since postpartum TSH levels are similar to preconception values, the Levothyroxine Sodium Tablets dosage should return to the pre-pregnancy dose immediately after delivery [see Dosage and Administration ( 2.3 )].

Data Human Data Levothyroxine is approved for use as a replacement therapy for hypothyroidism. There is a long experience of levothyroxine use in pregnant women, including data from post-marketing studies that have not reported increased rates of fetal malformations, miscarriages or other adverse maternal or fetal outcomes associated with levothyroxine use in pregnant women.

8.2Lactation Risk Summary Limited published studies report that levothyroxine is present in human milk. However, there is insufficient information to determine the effects of levothyroxine on the breastfed infant and no available information on the effects of levothyroxine on milk production. Adequate levothyroxine treatment during lactation may normalize milk production in hypothyroid lactating mothers.

The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for Levothyroxine Sodium Tablets and any potential adverse effects on the breastfed infant from Levothyroxine Sodium Tablets or from the underlying maternal condition.

8.4Pediatric Use The initial dose of Levothyroxine Sodium Tablets varies with age and body weight. Dosing adjustments are based on an assessment of the individual patient's clinical and laboratory parameters [see Dosage and Administration ( 2.3 , 2.4 )] . In children in whom a diagnosis of permanent hypothyroidism has not been established, discontinue Levothyroxine Sodium Tablets administration for a trial period, but only after the child is at least 3 years of age.

Obtain serum T4 and TSH levels at the end of the trial period, and use laboratory test results and clinical assessment to guide diagnosis and treatment, if warranted. Congenital Hypothyroidism [See Dosage and Administration ( 2.3 , 2.4 )] Rapid restoration of normal serum T4 concentrations is essential for preventing the adverse effects of congenital hypothyroidism on intellectual development as well as on overall physical growth and maturation. Therefore, initiate Levothyroxine Sodium Tablets therapy immediately upon diagn…

🤰 Pregnancy ~1 min read ▾

🧒 Pediatric Use ~1 min read ▾

Levothyroxine is generally continued for life in these patients. Closely monitor infants during the first 2 weeks of Levothyroxine Sodium Tablets therapy for cardiac overload, arrhythmias, and aspiration from avid suckling. Closely monitor patients to avoid undertreatment or overtreatment.

Undertreatment may have deleterious effects on intellectual development and linear growth. Overtreatment is associated with craniosynostosis in infants, may adversely affect the tempo of brain maturation, and may accelerate the bone age and result in premature epiphyseal closure and compromised adult stature. Acquired Hypothyroidism in Pediatric Patients Closely monitor patients to avoid undertreatment and overtreatment.

Undertreatment may result in poor school performance due to impaired concentration and slowed mentation and in reduced adult height. Overtreatment may accelerate the bone age and result in premature epiphyseal closure and compromised adult stature. Treated children may manifest a period of catch-up growth, which may be adequate in some cases to normalize adult height.

In children with severe or prolonged hypothyroidism, catch-up growth may not be adequate to normalize adult height.

🧓 Geriatric Use 63 words ▾

8.5Geriatric Use Because of the increased prevalence of cardiovascular disease among the elderly, initiate Levothyroxine Sodium Tablets at less than the full replacement dose [see Warnings and Precautions ( 5.1 ) and Dosage and Administration ( 2.3 )] . Atrial arrhythmias can occur in elderly patients. Atrial fibrillation is the most common of the arrhythmias observed with levothyroxine overtreatment in the elderly.

🆘 Overdosage 117 words ▾

10 OVERDOSAGE The signs and symptoms of overdosage are those of hyperthyroidism [see Warnings and Precautions ( 5 ) and Adverse Reactions ( )] . In addition, confusion and disorientation may occur. Cerebral embolism, shock, coma, and death have been reported.

Seizures occurred in a 3-year-old child ingesting 3.6 mg of levothyroxine. Symptoms may not necessarily be evident or may not appear until several days after ingestion of levothyroxine sodium. Reduce the Levothyroxine Sodium Tablets dose or discontinue temporarily if signs or symptoms of overdosage occur.

Initiate appropriate supportive treatment as dictated by the patient's medical status. For current information on the management of poisoning or overdosage, contact the National Poison Control Center at 1-800-222-1222 or www.poison.org.

🧬 Clinical Pharmacology ~2 min read ▾

12 CLINICAL PHARMACOLOGY

12.1Mechanism of Action Thyroid hormones exert their physiologic actions through control of DNA transcription and protein synthesis. Triiodothyronine (T3) and L-thyroxine (T4) diffuse into the cell nucleus and bind to thyroid receptor proteins attached to DNA. This hormone nuclear receptor complex activates gene transcription and synthesis of messenger RNA and cytoplasmic proteins.

The physiological actions of thyroid hormones are produced predominantly by T3, the majority of which (approximately 80%) is derived from T4 by deiodination in peripheral tissues.

12.2Pharmacodynamics Oral levothyroxine sodium is a synthetic T4 hormone that exerts the same physiologic effect as endogenous T4, thereby maintaining normal T4 levels when a deficiency is present.

12.3Pharmacokinetics Absorption Absorption of orally administered T4 from the gastrointestinal tract ranges from 40% to 80%. The majority of the Levothyroxine Sodium Tablets dose is absorbed from the jejunum and upper ileum. The relative bioavailability of Levothyroxine Sodium Tablets, compared to an equal nominal dose of oral levothyroxine sodium solution, is approximately 94%.

T4 absorption is increased by fasting, and decreased in malabsorption syndromes and by certain foods such as soybeans. Dietary fiber decreases bioavailability of T4. Absorption may also decrease with age.

In addition, many drugs and foods affect T4 absorption [see Drug Interactions ( )] . Distribution Circulating thyroid hormones are greater than 99% bound to plasma proteins, including thyroxine-binding globulin (TBG), thyroxine-binding prealbumin (TBPA), and albumin (TBA), whose capacities and affinities vary for each hormone. The higher affinity of both TBG and TBPA for T4 partially explains the higher serum levels, slower metabolic clearance, and longer half-life of T4 compared to T3.

Protein-bound thyroid hormones exist in reverse equilibrium with small amounts of free hormone. Only unbound hormone is metabolically active. Many drugs and physiologic conditions affect the binding of thyroid hormones to serum proteins [see Drug Interactions ( )] .

Thyroid hormones do not readily cross the placental barrier [see Use in Specific Populations ( 8.1 )] . Elimination Metabolism T4 is slowly eliminated (see Table 7). The major pathway of thyroid hormone metabolism is through sequential deiodination.

Approximately 80% of circulating T3 is derived from peripheral T4 by monodeiodination. The liver is the major site of degradation for both T4 and T3, with T4 deiodination also occurring at a number of additional sites, including the kidney and other tissues. Approximately 80% of the daily dose of T4 is deiodinated to yield equal amounts of T3 and reverse T3 (rT3).

T3 and rT3 are further deiodinated to diiodothyronine. Thyroid hormones are also metabolized via conjugation with glucuronides and sulfates and excreted directly into the bile and gut where they undergo enterohepatic recirculation. Excretion Thyroid hormones are primarily eliminated by the kidneys.

A portion of the conjugated hormone reaches the colon unchanged and is eliminated in the feces. Approximately 20% of T4 is eliminated in the stool. Urinary excretion of T4 decreases with age.

Table 7. Pharmacokinetic Parameters of Thyroid Hormones in Euthyroid Patients Hormone Ratio in Thyroglobulin Biologic Potency t 1/2 (days) Protein Binding (%) Includes TBG, TBPA, and TBA Levothyroxine (T4) 10 - 20 1 6-7 3 to 4 days in hyperthyroidism, 9 to 10 days in hypothyroidism

99.96Liothyronine (T3) 1 4 ≤ 2 99.5

🧬 Mechanism of Action 79 words ▾

The physiological actions of thyroid hormones are produced predominantly by T3, the majority of which (approximately 80%) is derived from T4 by deiodination in peripheral tissues.

📦 How Supplied / Storage and Handling 78 words ▾

16 HOW SUPPLIED/STORAGE AND HANDLING Levothyroxine Sodium Tablets, in the shape of caplet are supplied as follows: Strength (mcg) Color Tablet Markings NDC- bottles of 30 NDC- bottles of 90 NDC- bottles of 100 88 mcg Mint Green "T|4" and "88" 68788-7759-03 68788-7759-09 68788-7759-01 Storage Conditions Store at 25°C (77°F); excursions permitted to 15° C to 30° C (59° F to 86° F) [see USP Controlled Room Temperature]. Levothyroxine Sodium Tablets should be protected from light and moisture.

📦 Storage and Handling 34 words ▾

Storage Conditions Store at 25°C (77°F); excursions permitted to 15° C to 30° C (59° F to 86° F) [see USP Controlled Room Temperature]. Levothyroxine Sodium Tablets should be protected from light and moisture.

📋 Description ~1 min read ▾

11 DESCRIPTION Levothyroxine Sodium Tablets contain the active ingredient, levothyroxine, a synthetic crystalline L-3,3',5,5'- tetraiodothyronine in sodium salt form. Synthetic T4 is identical in chemical structure to the T 4 produced in the human thyroid gland. Levothyroxine (T4) sodium has an empirical formula of C 15 H 10 I 4 NNaO 4 ∙ x H 2 O (where x = 5), molecular weight of 798.86 g/mol (anhydrous), and structural formula as shown: Levothyroxine Sodium Tablets for oral administration are available in the following strengths: 25 mcg, 50 mcg, 75 mcg, 88 mcg, 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, and 300 mcg.

Each levothyroxine sodium tablet contains the inactive ingredients butylatedhydroxy toluene, calcium phosphate dibasic dihydrate, magnesium stearate, microcrystalline cellulose, povidone, sodium starch glycolate, and color additive(s). Table 6 provides a listing of the color additives by tablet strength: Table 6. Levothyroxine Sodium Tablets Color Additives Strength (mcg) Color additive(s) 25 FD&C Yellow No.

6 Aluminum Lake Note – FD&C Yellow No. 6 is orange in color. 50 None 75 FD&C Red No.

40 Aluminum Lake, FD&C Blue No. 2 Aluminum Lake 88 FD&C Blue No. 1 Aluminum Lake, FD&C Yellow No.

6 Aluminum Lake*, D&C Yellow No. 10 Aluminum Lake 100 D&C Yellow No. 10 Aluminum Lake, FD&C Yellow No.

6 Aluminum Lake* 112 D&C Red No. 27 & 30 Aluminum Lake 125 FD&C Yellow No. 6 Aluminum Lake*, FD&C Red No.

40 Aluminum Lake, FD&C Blue No. 1 Aluminum Lake 137 FD&C Blue No. 1 Aluminum Lake 150 FD&C Blue No.

2 Aluminum Lake 175 FD&C Blue No. 1 Aluminum Lake, D&C Red No. 27 & 30 Aluminum Lake 200 FD&C Red No.

40 Aluminum Lake 300 D&C Yellow No. 10 Aluminum Lake, FD&C Yellow No. 6 Aluminum Lake*, FD&C Blue No.

1 Aluminum Lake levothyroxine-structure

💬 Information for Patients ~2 min read ▾

17 PATIENT COUNSELING INFORMATION Inform the patient of the following information to aid in the safe and effective use of Levothyroxine Sodium Tablets: Dosing and Administration • Instruct patients to take Levothyroxine Sodium Tablets only as directed by their healthcare provider. • Instruct patients to take Levothyroxine Sodium Tablets as a single dose, preferably on an empty stomach, one-half to one hour before breakfast. • Inform patients that agents such as iron and calcium supplements and antacids can decrease the absorption of levothyroxine.

Instruct patients not to take Levothyroxine Sodium Tablets within 4 hours of these agents. • Instruct patients to notify their healthcare provider if they are pregnant or breastfeeding or are thinking of becoming pregnant while taking Levothyroxine Sodium Tablets. Important Information • Inform patients that it may take several weeks before they notice an improvement in symptoms. • Inform patients that the levothyroxine in Levothyroxine Sodium Tablets is intended to replace a hormone that is normally produced by the thyroid gland.

Generally, replacement therapy is to be taken for life. • Inform patients that Levothyroxine Sodium Tablets should not be used as a primary or adjunctive therapy in a weight control program. • Instruct patients to notify their healthcare provider if they are taking any other medications, including prescription and over-the-counter preparations. • Instruct patients to notify their physician of any other medical conditions they may have, particularly heart disease, diabetes, clotting disorders, and adrenal or pituitary gland problems, as the dose of medications used to control these other conditions may need to be adjusted while they are taking Levothyroxine Sodium Tablets.

If they have diabetes, instruct patients to monitor their blood and/or urinary glucose levels as directed by their physician and immediately report any changes to their physician. If patients are taking anticoagulants, their clotting status should be checked frequently. • Instruct patients to notify their physician or dentist that they are taking Levothyroxine Sodium Tablets prior to any surgery. Adverse Reactions • Instruct patients to notify their healthcare provider if they experience any of the following symptoms: rapid or irregular heartbeat, chest pain, shortness of breath, leg cramps, headache, nervousness, irritability, sleeplessness, tremors, change in appetite, weight gain or loss, vomiting, diarrhea, excessive sweating, heat intolerance, fever, changes in menstrual periods, hives or skin rash, or any other unusual medical event. • Inform patients that partial hair loss may occur rarely during the first few months of Levothyroxine Sodium Tablets therapy, but this is usually temporary.

Glossary — plain-language definitions of medical terms used in this label:

contraindicated: Should not be used in that situation, because the risk is considered too high.

abdominal pain: Pain, cramping, or discomfort felt anywhere in the belly area.

Absorption: How a medicine moves from where it is taken, such as the stomach or gut, into the bloodstream.

Active ingredient: The part of a medicine that produces its intended effect on the body.

adjunctive therapy: A medicine added alongside a main treatment to help it work better.

adrenal insufficiency: A condition where the adrenal glands do not make enough of certain needed hormones, such as cortisol, a stress hormone.

Adverse Reactions: Unwanted or harmful effects that people experienced while taking a medicine, listed on its official label.

angioedema: Rapid swelling deep under the skin, often around the eyes, lips, tongue, or throat.

anxiety: A feeling of worry, nervousness, or unease, sometimes along with a racing heart or restlessness.

arthralgia: Joint pain.

atrial fibrillation: An irregular, often fast heart rhythm coming from the heart's upper chambers, which can raise the risk of blood clots.

Bioavailability: The share of a dose that actually reaches the bloodstream and is able to have an effect.

bone mineral density: A measurement of the amount of mineral, such as calcium, in your bones, used to estimate how strong they are.

Boxed Warning: The strongest safety warning the FDA can require, set inside a bold black border because the risk it describes can be very serious.

cardiac arrest: A sudden stop of the heart's pumping that cuts off blood flow to the body, which is a medical emergency.

clearance: How quickly the body removes a medicine from the blood, usually through the liver and kidneys.

Clinical Pharmacology: The label section explaining how a medicine works in the body and how the body processes it.

Contraindications: A list of situations or health conditions in which a medicine should not be used because the chance of harm is too high.

diarrhea: Loose, watery bowel movements that happen more often than normal.

displacement: When one medicine knocks another off the blood proteins it was riding on, briefly raising the free, active amount of the second medicine.

Distribution: How a medicine spreads from the blood into the body's tissues and organs after it is absorbed.

Dosage and Administration: The label section explaining how much of a medicine to use and how to take or give it.

Drug Interactions: The label section listing other medicines, foods, or substances that can change how a medicine works or raise the chance of side effects.

dyspnea: The medical word for shortness of breath, or the feeling that you cannot get enough air.

efficacy: How well a treatment works under the controlled conditions of a clinical study.

Elimination: The overall removal of a medicine from the body by breaking it down and passing it out.

embolism: A blockage of a blood vessel by a clot or other material that has traveled from elsewhere in the body.

emotional lability: Rapid, exaggerated mood changes that shift quickly from one feeling to another.

enterohepatic recirculation: A cycle where a medicine passes into the gut with bile, then is reabsorbed back into the blood.

estimated background risk: The normal chance that any pregnancy will have a birth defect or problem, even without taking any medicine.

Excretion: How the body removes a medicine or its leftover pieces, mainly through the urine or stool.

fertility: The natural ability to become pregnant or to father a child.

flushing: Temporary redness and warmth of the skin, often on the face and neck, from widening of small blood vessels.

Full Prescribing Information: The complete, detailed label for a prescription medicine that follows the summary highlights.

Half-life: The time it takes for the amount of medicine in the blood to drop by half.

heart failure: A condition in which the heart cannot pump blood as well as it should, causing tiredness, breathlessness, and swelling.

hepatic metabolism: The breakdown of a medicine by the liver into other substances the body can use or remove.

hepatitis: Inflammation of the liver, which can be caused by infections, alcohol, or certain medicines.

How Supplied/Storage and Handling: The label section describing the forms and strengths a medicine comes in and how to store it properly.

hypersensitivity: An overreaction of the body's defense system to a substance, causing symptoms such as rash, swelling, or trouble breathing.

hypertension: Blood pressure that stays higher than normal, commonly called high blood pressure.

hyperthyroidism: A condition where the thyroid gland makes too much thyroid hormone, which can speed the body up.

hypothyroidism: A condition where the thyroid gland makes too little thyroid hormone, which can slow the body down.

incidence: How often a new event, such as a side effect, happens in a group of people over a set period of time.

Indications and Usage: The label section stating which medical conditions the FDA has officially approved the medicine to treat, prevent, or manage.

insomnia: Trouble falling asleep, staying asleep, or getting restful sleep.

intravenous: Given directly into a vein through a needle or thin tube; often written as IV.

irritability: Getting annoyed, frustrated, or angry more easily than usual.

lactation: The making and release of milk from a mother's breasts after giving birth.

liver function tests: Blood tests that check how well the liver is working and whether it is irritated or damaged.

Mechanism of Action: How a medicine produces its effect in the body, described at the level of cells or body chemistry.

Metabolism: How the body chemically changes a medicine, usually in the liver, into other substances.

myocardial infarction: The medical term for a heart attack, when blood flow to part of the heart muscle is blocked.

narrow therapeutic index: Describes a medicine where the helpful dose and the harmful dose are very close, so small changes in the amount matter a lot.

NDC: A unique number that identifies a specific medicine, its maker, strength, and package size.

Overdosage: The label section describing what can happen if too much of a medicine is taken and how it may be treated.

palpitations: The feeling that your heart is racing, pounding, fluttering, or skipping beats.

Patient Counseling Information: The label section telling health professionals what to explain to patients about using a medicine safely.

Pharmacokinetics: The study of how the body takes in a medicine, spreads it around, breaks it down, and removes it over time.

postpartum: The period of time right after a woman gives birth.

potency: How much of a medicine is needed to produce a given effect; a more potent medicine works at a smaller dose.

Prescribing Information: The official, detailed document approved by the FDA that tells health professionals how to use a prescription medicine.

protein binding: How much of a medicine sticks to proteins in the blood instead of moving freely through the body.

pruritus: Itching of the skin.

receptor: A special docking spot on a cell that a medicine or natural body chemical attaches to in order to trigger an effect.

serum sickness: A delayed reaction, usually one to two weeks after exposure, causing fever, rash, and joint pain as the body reacts to a foreign substance.

spontaneous abortion: The natural loss of a pregnancy in its early stages, also called a miscarriage.

stillbirth: The death of a baby in the womb late in pregnancy or during birth.

suspension: A liquid holding fine drug particles that are mixed in but not fully dissolved, so it must be shaken before use.

tachycardia: A faster-than-normal heart rate, usually over 100 beats per minute.

therapeutic index: A measure of how much room there is between a helpful dose of a medicine and a dose that could be harmful.

titration: Slowly adjusting a medicine's dose up or down in small steps to find the amount that works best with the fewest side effects.

TSH: Thyroid-stimulating hormone, a hormone measured by a blood test to check how well the thyroid gland is working.

urticaria: Raised, itchy welts on the skin, commonly called hives.

Use in Specific Populations: The label section describing how a medicine affects particular groups, such as pregnant people, children, or older adults.

Warnings and Precautions: The label section describing serious risks to know about and safety steps to follow while using a medicine.

wheezing: A high-pitched whistling sound made while breathing, usually when the airways are narrowed.

Source: FDA Structured Product Labeling, mirrored from DailyMed / openFDA. Prefer the government’s original formatting? View this label on DailyMed ↗

← 68788-7757-01 · Preferred 68788-7764-03 · Preferred →

For educational and professional reference only — not medical advice. Pricing reflects published NADAC and CMS ASP (free public data) and may differ from your acquisition cost; always verify before billing or dispensing.

levothyroxine sodium 88 ug Tablet, 60-count

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