Pharmacy on Web

20 August 2008

 We just received notice from our wholesaler that Goldshield Thyroxine will be available in NZ in early September 2008 as alternative to the current Levothyroxine by GSK, however it is not funded by Pharmac. Currently, some people is experiencing unwanted side effects from the Glaxosmithkline(GSK) manufactured Levothyroxine also known by it's brand name as Eltroxin. Goldshield thyroxine is manufactured in Australia.

The strength available will be identical to the GSK brand, 50mcg and 100mcg. It is a section 29 medicines which means your pharmacist will need a prescription from GP and these details will be recorded by the supplier. We are told that each customer will be restricted to 3 packets regardless of dosage. Each packet contains 28 tablets. Goldshield Thyroxine will not be subsidised by Pharmac. For a 28 tablets of the 50mcg the price will be approximately $30 and $22.50 for the 100mcg. These prices may varied between pharmacies.

Updates:

I would like to know the nearest pharmacy where I can get Goldshield Thyroxine?

Just go to your local pharmacy, they will need a prescription from your GP in order to procur this product for you. The pharmacy will arrange this with the wholesaler to supply you because it is a section 29 medicine. Currently, the stock is not yet available anywhere in New Zealand, so your order will be put on a waiting list. So basically it is a First in First Serve Basis. We understand the demand is quite high and some wholesaler are not taking anymore back orders. Please remember to check with your pharmacy first on the price so that you don't get a shock when you have to pay. Some pharmacy may not be aware that this alternative thyroxine is available.

what is the difference in formulation?

Essentially, the thyroxine has been reformulated please refer to this two articles Eltroxin formulation change – Monitor patients and adjust dosing if necessary26 June 2008 and the national news media coverage.

Will it be available from only certain pharmacies or will they all have it as an option?

Most pharmacies should be able to procure Goldshield Thyroxine for you so check with your local chemist first, they may be restricted if their supplier choose not to stock the product or if the backorder list is full. Stock is not in NZ yet, the date set is September 2008 but delays could happen.

Please email us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it if you require further information on Goldshield Thyroxine. 

23 July 2008

Medsafe today released a statement advising caution in the use of medicines and medical devices containing heparin and low molecular weight heparin.  The key points are:

1.  Detectable levels of over-sulphated chondroitin sulphate (OSCS) have not been found in medicines containing heparin or low molecular weight heparins supplied in New Zealand.

2.  Because of the limitations on the available test methods, the presence of low levels of OSCS in products cannot be completely excluded.

3.  There has been no increase in adverse reaction reports in New Zealand for medicines containing heparin or low molecular weight heparins.

4.  Two types of medical device have been found to contain heparin contaminated with OSCS.  These are:

- an oxygenator used in cardiac surgery, where alternative products should be used if possible

- blood collection containers, where use of the products has been allowed where OCSC levels are below 6%.

5.  Healthcare practitioners are asked to be alert for, and to promptly report, any adverse reactions occurring in patients exposed to medicines or medical devices containing heparin or low molecular weight heparins.

This means there is no reason not to use heparin when clinically indicated, but to be alert for any adverse reaction and to report it promptly.

The full Medsafe alert is on the Pharmaceutical Society members' website www.psnz.org.nz .

Eltroxin formulation change – Monitor patients
and adjust dosing if necessary
26 June 2008

Medsafe is writing to provide information and advice on the change in formulation of Eltroxin (levothyroxine, also known as, thyroxine) tablets which has led to a number of patients reporting problems such as sore eyes, palpitations, and headaches.

In response to these reports, Medsafe has reassessed the change in Eltroxin formulation and can confirm that the new formulation satisfies all quality, safety, and bioequivalence criteria. In addition, all excipients and excipient quantities present in the new formulation are commonly used in medicines.

Treatment of thyroid dysfunction is subject to significant inter-patient variability. Therefore, when patients are changed to new formulations or brands of levothyroxine, thyroid function monitoring is required to ensure the correct dose is being prescribed. Small changes in dosing of levothyroxine can affect serum thyroid hormone levels.

When changing a patient to the new Eltroxin formulation, Medsafe advises that:
Thyroid function should be monitored to ensure each patient is being prescribed the correct dose. This is particularly important for patients who have noticed symptoms since changing to the new formulation. Recent adverse reaction reports have shown raised TSH levels in some patients, confirming the need for monitoring.
When monitoring Thyroid function:
Thyroid Stimulating Hormone (TSH) levels are the best indicator of thyroid function. If there are particular concerns about thyroid function, free T4 and free T3 levels should also be monitored.
Thyroid function tests can be performed at any time of the day.
Due to the long half life of levothyroxine (5 - 7 days), Thyroid function tests should be conducted no earlier than 4 – 6 weeks following a change in dose, or a change in formulation.
Dose adjustments should not usually exceed 50 micrograms per day. Dose adjustments in the elderly, in patients with pre-existing heart disease, or in patients with diabetes should not exceed 50 micrograms on alternate days.
Specialist advice should be sought if dose adjustments are required in children.

Additional factors to consider when prescribing Eltroxin tablets:
Poor patient compliance should be considered as a possible cause of adverse effects. Compliance may be affected by the need to take Eltroxin tablets on an empty stomach, or the need for alternate day dosing in some patients.
Adverse reactions should be reported to the Centre for Adverse Reactions Monitoring (CARM, Box 913, Dunedin. This e-mail address is being protected from spambots. You need JavaScript enabled to view it . Fax 03 479 7150). Please include, where possible, the patient’s TSH, T3, and T4 results, the current dosing regimen, and if and when the patient was changed to th e new formulation.
The Eltroxin data sheet includes dosing guidelines for transferring patients to the new Eltroxin formulation http://www.medsafe.govt.nz/profs/Datasheet/e/Eltroxin(new)tab.htm