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The Medicines and Healthcare products Regulatory Agency (MHRA) has issued a new prescribing advice for patients who experience symptoms on switching between levothyroxine products.

A small proportion of patients treated with levothyroxine report symptoms, often consistent with thyroid dysfunction, when their levothyroxine tablets are changed to a different product.

“If a patient reports persistent symptoms when switching between different levothyroxine products, prescribers should consider consistently prescribing a specific levothyroxine product known to be well tolerated by the patient,” the MHRA said.

“If symptoms or poor control of thyroid function persist (despite adhering to a specific product), prescribers should consider prescribing an oral solution formulation of levothyroxine,” it added.

Following latest advice, community pharmacy teams may expect to receive requests from patients or prescribers for a specific brand name or make of levothyroxine to be supplied against a prescription.

“If a specific levothyroxine product known to be well tolerated by the patient is required, prescribers must ensure the correct product description is selected using their prescribing systems. In EPS, if a specific brand name or supplier of the product is selected, this will appear in the prescription drug name field,” the MHRA pointed out.

If an electronic prescription annotated with additional or supplementary product information is received by a pharmacy, the Pharmaceutical Services Negotiating Committee (PSNC) has strongly recommended to have such prescriptions appropriately rewritten or re-issued by the prescriber before dispensing to ensure that it can be accurately priced by the NHSBSA.

“This is because reimbursement of products ordered using EPS is based on the prescribed product code; any supplementary (free-typed) product information included in the EPS dosage instructions field is not visible to the NHSBSA during prescription pricing,” the pharmacy regulator said.

Paper prescriptions with items where prescribers have included supplementary product information should be endorsed by the pharmacy as required and submitted for payment within the relevant red separators.

If levothyroxine is prescribed generically, it is reimbursed according to the prices published in Part VIII of the applicable Drug Tariff. “However, a prescription requesting levothyroxine by a specific brand name or supplier name is reimbursed according to the NHS list price published in the NHS dictionary of medicines and devices (dm+d). If no price is indicated against the product listing in the dm+d, payment for the non-Part VIII product is based on the dispenser’s endorsement,” the PSNC added.

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