Do Not Prescribe (DNP), Green
Decision Date:
May 2017


MHRA May 2021- Generic prescribing of levothyroxine remains appropriate for the majority of patients, and the licensing of these generic products is supported by bioequivalence testing.

If a patient reports symptoms after changing their levothyroxine product, consider testing thyroid function. If a patient is persistently symptomatic after switching levothyroxine products, whether they are biochemically euthyroid or have evidence of abnormal thyroid function, consider consistently prescribing a specific levothyroxine product known to be well tolerated by the patient. 

If symptoms or poor control of thyroid function persist despite adhering to a specific product, consider prescribing levothyroxine in an oral solution formulation. Note levothyroxine oral solution is very expensive.

DNP: Intravenous/intramuscular formulation for myxoedema coma and hypothyroidism in patients where oral therapy is not feasible. Await clinician request. (Decision date - March 2023)

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Derby and Derbyshire ICB

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