BNF:

6.2.1

Status:

Do Not Prescribe (DNP), Red, Amber

Decision Date:

June 2018

Comments

AMBER: (Liothyronine in combination with levothyroxine shared care agreement) For existing patients following review of benefit by an NHS Endocrinologist Specialist and the treatment dose have been stabilised for 3 months.

RED:

• when used as monotherapy,
• or for resistant depression,
• or in doses which exceed 60mcg per day.

DO NOT PRESCRIBE (DNP): not to be initiated in new patients.  If there is an exceptional clinical need, such as difficulty in tolerating or absorbing levothyroxine, then a request to prescribe must be made via the IFR process and the request should be made by an NHS endocrinologist. Quality of life and other symptoms relating to patients lack of well-being on levothyroxine monotherapy will not pass the test of exceptionality and these patients should not be referred with the expectation that an IFR will be submitted. They can however still be referred to an endocrinologist for further evaluation of their symptoms to exclude other underlying medical conditions as well as optimisation of levothyroxine therapy

See Liothyronine position statement for further information.

Red Drug Classifications

• 1: Requiring specialist assessment to enable patient selection, initiation and ongoing treating

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