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.
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.
Apr 16, 2021- Levothyroxine should ideally be taken alone on an empty stomach because it needs to be absorbed consistently to maintain stable thyroid hormone levels.
- If you must take levothyroxine and Lexapro together, talk to your pharmacist or doctor, but whatever routine you choose, take it the same way every day to avoid fluctuations in your thyroid levels.
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 Recommended 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, speak with your prescriber or pharmacist about the best approach for your situation, and whatever routine they recommend, 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 & sources
- Synthroid Prescribing Information — AccessFDA
Glossary — Terms in This Answer
- Hypothyroidism
- A condition where the thyroid gland does not produce enough thyroid hormone.
- Absorption
- The process by which a medication passes from the digestive system into the bloodstream.
- Micrograms
- A unit of measurement equal to one millionth of a gram, used for very small drug doses.
- Thyroid hormone levels
- The amount of hormones produced by the thyroid gland that circulate in the blood.
- TSH
- A hormone produced by the pituitary gland that controls thyroid function and is measured to check thyroid health.
- Dosage
- The specific amount of medication prescribed to be taken at one time.
- Fluctuate
- To change or vary up and down irregularly.
- Bioavailability
- The degree and rate at which a medication becomes available in the body after administration.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
More answers from Brian →