Approved Hospital Formulary
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Approved Hospital Formulary
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levothyroxine

levothyroxine
Brand names: Levothroid, Levothyroxine Sodium, Levoxyl, Synthroid
Form Strength
POWDER FOR INJECTION 200 mcg (0.2 mg)
TABLET 25 mcg (0.025 mg); 50 mcg (0.05 mg); 75 mcg (0.075 mg); 88 mcg (0.088 mg); 100 mcg (0.1 mg); 112 mcg (0.112 mg); 125 mcg (0.125 mg); 150 mcg (0.15 mg); 200 mcg (0.2 mg)


Comments:

Processing orders for IV levothyroxine (see restriction criteria):

If you receive an order for IV levothyroxine and the patient has NOT been without PO therapy for 5 days:

  1. If the patient meets one of following (4) clinical criteria listed below, the IV dose may be started immediately (q48 hour interval may not be appropriate-assess on a case-by-case basis)
    1. Presence of clinical hypothyroidism (TSH ≥ 10 uIU/mL, decreased T4 or signs and symptoms of hypothyroidism) who are strict NPO
    2. Myxedema coma
    3. Patients on hypothermia protocol
    4. Potential organ donor status (this will likely be a continuous infusion so the q48h interval will not apply)
  2. Enter the IV dose with interval q48 with a start date as the 6th day without PO therapy.
  3. Enter an open i-Vent for “Chart Order Review- Dose Optimization” with a note to follow along and assess for change to PO per IV to PO policy.
  4. If the patient can change to PO route before the IV dose begins, do all the following:
    1. Interchange to PO
    2. D/C the IV order
    3. Enter an IV to PO i-Vent.
    4. Close the Chart Review i-Vent.

 

If you receive an order for IV levothyroxine and the patient has already been without PO therapy for 5 days or more:

  1. Enter the IV dose with interval q48 hours with a start date of now/today
  2. If the patient meets one of the (4) clinical criteria listed above, the IV dose may be started immediately (q48 hour interval may not be appropriate-assess on a case-by-case basis)

Last updated: Apr. 20, 2022


Pharmacy Phone Numbers
Memorial Pharmacy (Glenwood) 423-495-8380
Memorial Hixson Pharmacy 423-495-7137
Stat 423-495-7470
Outpatient 423-495-8981
Chemo 423-495-7475
Surgery 423-495-8779

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