Can You Take Levothyroxine And Lexapro Together?

In our latest question and answer, the pharmacist discusses whether or not you can take Lexapro and levothyroxine together.

Question

I am on Lexapro and levothyroxine and take the Lexapro at bedtime and the levothyroxine whenever I wake up during the night. Can both pills be taken at bedtime together? Thank you.

Asked by Pat On Apr 16, 2021

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Apr 17, 2021
Last updated Mar 28, 2024

Key points

  • Levothyroxine is recommended to be taken on an empty stomach, one-half to one hour before breakfast, or other medications
  • If for whatever reason, you cannot separate levothyroxine from other medications, like Lexapro, it is important to take it consistently, in the same manner, every day to avoid fluctuating thyroid levels and the need for constant dosage adjustments

Answer

In general, levothyroxine, a medication used for the treatment of hypothyroidism, should be taken with 8 ounces of water, on an empty stomach (i.e. with no food), and with no other medications. So, if possible, you should not take it at the same time as Lexapro (escitalopram).

The prescribing information for Synthroid, a brand name version of levothyroxine, states the following in regard to administration:

Administer SYNTHROID [levothyroxine] as a single daily dose, on an empty stomach, one-half to one hour before breakfast.  

Why Levothyroxine Is Recommend To Be Taken By Itself

This recommendation for levothyroxine is in place because some foods can significantly decrease the absorption of the drug, which can affect your thyroid hormone levels.

We have to remember that levothyroxine is dosed in micrograms, not milligrams (one microgram is 1/1000th of a milligram), which is a very small amount. Even small changes in absorption can make a big impact on your hormone levels.

There are even some drugs and foods that are recommended to be separated by at least four hours from levothyroxine. These include:

  • Calcium carbonate
  • Fiber products
  • Ferrous sulfate
  • Walnuts
  • Soybean flour
  • Cottonseed meal

I won't go over all of the potential interacting drugs and foods, as there are many, but I imagine you understand the point. Levothyroxine is best taken by itself.

Consistency In Administration Is Key

If for whatever reason, you cannot avoid taking levothyroxine by itself, consistency is key. Take it the same way every day. I cannot stress this enough. If you take it the same way every day, at least you will likely have a consistent effect, and your thyroid levels won't significantly fluctuate.

However, if you take it inconsistently, say with Lexapro one day, and the next day without, your thyroid levels (or whatever your doctor is measuring, like TSH) will likely fluctuate, and your dosage may need to be adjusted far more often than you would like because the amount of drug you are absorbing is changing.

References

  • Synthroid Prescribing Information, AccessFDA

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at [email protected]! You can also connect with Dr. Brian Staiger on LinkedIn.

Recent Questions