I've come to accept that some medications need to be taken on an empty stomach while others do better w/(specific) food. For instance, bisphosphonates need to be taken on an empty stomach since they're so poorly absorbed. Calcium is best absorbed in its carbonate form if someone doesn't have their stomach acid suppressed by either an H2 blocker or a proton pump inhibitor. On the other hand, if one needs to take one or both types of those medications, calcium is better absorbed in its citrate form. Likewise, studies have demonstrated that levothyroxine should be taken on an empty stomach to achieve the narrowest thyrotropin range.
But time of day? I always thought that as long as you're consistently taking a medication every 24hrs, then it doesn't really matter if you choose AM or PM. Well, a pilot study of 12 participants published almost 3 years ago demonstrated that timing does matter w/bedtime better than morning for levothyroxine.
And a study published this month corroborates this after the authors elegantly randomized 90 patients already taking levothyroxine to a twice daily regimen, one of which was the real thing and the other a placebo in a double blind fashion (thus, in this cross over design, they acted as their own controls). This continued for 3 months at which time unbeknownst to the patients, their levothyroxine was switched for the placebo & vice versa for another 3 months. Upon analysis, thyrotropin levels were substantially lower (by 1.25mIU/L and both total triiodothyronine and free thyroxine were higher whenever the participants took their levothyroxine in the evening compared to the morning.
What's interesting to note is that lipid values & quality of life scores did not change regardless of the timing of dose administration. Yet, the authors recommended changing dose administration time in an attempt to achieve better (lower) thyroxine numbers w/o any clinical rationale. Remember that we're here to treat the patient, not just the numbers.
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