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Revision as of 07:07, 9 April 2012 editBeetstra (talk | contribs)Edit filter managers, Administrators172,031 edits Saving copy of the {{drugbox}} taken from revid 485784681 of page Liothyronine for the Chem/Drugbox validation project (updated: 'DrugBank', 'ChEMBL', 'ChEBI').  Latest revision as of 01:06, 12 November 2024 edit Citation bot (talk | contribs)Bots5,420,429 edits Added doi-broken-date. | Use this bot. Report bugs. | Suggested by Whywhenwhohow | #UCB_webform 316/617 
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{{Short description|Chemical compound}}
{{ambox | text = This page contains a copy of the infobox ({{tl|drugbox}}) taken from revid of page ] with values updated to verified values.}}
{{About|liothyronine as a medication|the hormone|Triiodothyronine}}
{{Use dmy dates|date=August 2021}}
{{Drugbox {{Drugbox
| Verifiedfields = changed | Verifiedfields = changed
| Watchedfields = changed
| verifiedrevid = 476996931
| verifiedrevid = 486388213
| drug_name = Liothyronine sodium
| image = Liothyronine.svg
| IUPAC_name = sodium (2S)-2-amino-3- propanoate
| alt =
| image = Liotironina sódica.png
| image2 = Liotironina sódica3D.png | image2 = Liotironina sódica3D.png
| alt2 =


<!--Clinical data--> <!-- Clinical data -->
| tradename = Cytomel | tradename = Cytomel, Tertroxin, others
| Drugs.com = {{drugs.com|monograph|liothyronine_sodium}} | Drugs.com = {{drugs.com|monograph|liothyronine_sodium}}
| MedlinePlus = a682462 | MedlinePlus = a682462
| DailyMedID = Liothyronine
| pregnancy_AU = <!-- A / B1 / B2 / B3 / C / D / X --> | pregnancy_AU = <!-- A / B1 / B2 / B3 / C / D / X -->
| pregnancy_US = <!-- A / B / C / D / X -->
| pregnancy_category = | pregnancy_category =
| routes_of_administration = ], ]
| ATC_prefix = H03
| ATC_suffix = AA02
| ATC_supplemental =

| legal_AU = <!-- Unscheduled / S2 / S4 / S8 --> | legal_AU = <!-- Unscheduled / S2 / S4 / S8 -->
| legal_UK = <!-- GSL / P / POM / CD --> | legal_UK = POM
| legal_US = <!-- OTC / Rx-only -->
| legal_status = | legal_status =
| routes_of_administration =


<!--Pharmacokinetic data--> <!-- Pharmacokinetic data -->
| bioavailability = | bioavailability =
| protein_bound = 99.7% | protein_bound = 99.7%
| metabolism = | metabolism =
| elimination_half-life = 2.5 days | elimination_half-life = 2.5 days
| excretion = | excretion =


<!--Identifiers--> <!--Identifiers-->
| CASNo_Ref = {{cascite|$1|??}}
| CAS_number_Ref = {{cascite|correct|??}} | CAS_number_Ref = {{cascite|correct|??}}
| CAS_number = 6893-02-3 | CAS_number = 6893-02-3
| ChEBI_Ref = {{ebicite|changed|EBI}} | ChEBI_Ref = {{ebicite|changed|EBI}}
| ChEBI = <!-- blanked - oldvalue: 6484 --> | ChEBI = 6484
| ATC_prefix = H03
| ATC_suffix = AA02
| ATC_supplemental =
| PubChem = 16218759 | PubChem = 16218759
| IUPHAR_ligand = 2634
| DrugBank_Ref = {{drugbankcite|changed|drugbank}}
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank = DB00279 | DrugBank = DB00279
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}} | ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
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| UNII = 06LU7C9H1V | UNII = 06LU7C9H1V
| ChEMBL_Ref = {{ebicite|changed|EBI}} | ChEMBL_Ref = {{ebicite|changed|EBI}}
| ChEMBL = <!-- blanked - oldvalue: 1201119 --> | ChEMBL = 1201119
| PDB_ligand = T3
| C=15 | H=11 | I=3 | N=1 | Na=1 | O=4

| molecular_weight = 672.96 g/mol
<!-- Chemical data -->
| IUPAC_name = sodium (''S'')-2-amino-3-propanoate
| C=15 | H=11 | I=3 | N=1 | Na=1 | O=4
| smiles = .C(=O)(N)Cc2cc(I)c(Oc1cc(I)c(O)cc1)c(I)c2.O | smiles = .C(=O)(N)Cc2cc(I)c(Oc1cc(I)c(O)cc1)c(I)c2.O
| InChI = 1S/C15H12I3NO4.Na.H2O/c16-9-6-8(1-2-13(9)20)23-14-10(17)3-7(4-11(14)18)5-12(19)15(21)22;;/h1-4,6,12,20H,5,19H2,(H,21,22);;1H2/q;+1;/p-1/t12-;;/m0../s1
| InChIKey = IRGJMZGKFAPCCR-LTCKWSDVSA-M
| StdInChI_Ref = {{stdinchicite|correct|chemspider}} | StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI = 1S/C15H12I3NO4.Na.H2O/c16-9-6-8(1-2-13(9)20)23-14-10(17)3-7(4-11(14)18)5-12(19)15(21)22;;/h1-4,6,12,20H,5,19H2,(H,21,22);;1H2/q;+1;/p-1/t12-;;/m0../s1 | StdInChI = 1S/C15H12I3NO4.Na.H2O/c16-9-6-8(1-2-13(9)20)23-14-10(17)3-7(4-11(14)18)5-12(19)15(21)22;;/h1-4,6,12,20H,5,19H2,(H,21,22);;1H2/q;+1;/p-1/t12-;;/m0../s1
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| StdInChIKey = IRGJMZGKFAPCCR-LTCKWSDVSA-M | StdInChIKey = IRGJMZGKFAPCCR-LTCKWSDVSA-M
}} }}

<!-- Definition and medical uses -->
'''Liothyronine''' is a manufactured form of the ] ] (T<sub>3</sub>).<ref name=AHFS2019/> It is most commonly used to treat ] and ].<ref name=AHFS2019/> It can be taken by mouth or by ].<ref name=AHFS2019>{{cite web |title=Liothyronine Sodium Monograph for Professionals |url=https://www.drugs.com/monograph/liothyronine-sodium.html |website=Drugs.com |access-date=27 February 2019 }}</ref>

<!-- Side effects and mechanism -->
Side effects may occur from excessive doses.<ref name=AHFS2019/> This may include weight loss, fever, headache, anxiety, trouble sleeping, ]s, and ].<ref name=AHFS2019/> Use in ] and ] is generally safe.<ref name=BNF76/><ref name=AHFS2019/> Regular blood tests are recommended to verify the appropriateness of the dose being taken.<ref name=AHFS2019/>

<!-- History and culture -->
Liothyronine was approved for medical use in 1956.<ref name=AHFS2019/> It is available as a ].<ref name=BNF76>{{cite book|title=British National Formulary: BNF 76|date=2018|publisher=Pharmaceutical Press|isbn=9780857113382|pages=757|edition=76}}</ref> In 2022, it was the 204th most commonly prescribed medication in the United States, with more than 1{{nbsp}}million prescriptions.<ref name="Top 300 of 2022">{{cite web | title=The Top 300 of 2022 | url=https://clincalc.com/DrugStats/Top300Drugs.aspx | website=ClinCalc | access-date=30 August 2024 | archive-date=30 August 2024 | archive-url=https://web.archive.org/web/20240830202410/https://clincalc.com/DrugStats/Top300Drugs.aspx | url-status=live }}</ref><ref>{{cite web | title = Liothyronine Drug Usage Statistics, United States, 2013 - 2022 | website = ClinCalc | url = https://clincalc.com/DrugStats/Drugs/Liothyronine | access-date = 30 August 2024 }}</ref>

==Medical uses==
Liothyronine may be used when there is an impaired conversion of ] to ] in peripheral tissues.<ref name=AHFS2019/> The dose of liothyronine for hypothyroidism is a lower amount than ] due it being a higher concentrated synthetic medication.<ref name="AHFS2019" /> About 25&nbsp;μg of liothyronine is equivalent to 100&nbsp;μg of levothyroxine.<ref name=BNF76/>

In thyroid cancer or ], ablation therapy with radioactive iodine (]) can be used to remove trace thyroid tissue that may remain after ] (surgical excision of the gland). For <sup>131</sup>I therapy to be effective, the trace thyroid tissue must be avid to iodine, which is achieved by elevating the person's ] levels.<ref name="ATA-cancer">{{cite web|title=Thyroid Cancer (Papillary and Follicular)|url=http://www.thyroid.org/thyroid-cancer/|website=American Thyroid Association|access-date=25 December 2016}}</ref> For patients taking levothyroxine, TSH may be boosted by discontinuing levothyroxine for 3–6 weeks.<ref name="ATA-cancer"/> This long period of hormone withdrawal is required because of levothyroxine's relatively long ], and may result in symptoms of hypothyroidism in the patient. The shorter half-life of liothyronine permits a withdrawal period of two weeks, which may minimize hypothyroidism symptoms. One protocol is to discontinue levothyroxine, then prescribe liothyronine while the T<sub>4</sub> levels are falling, and finally stop the liothyronine two weeks before the radioactive iodine treatment.<ref name="ATA-cancer"/>

Liothyronine may also be used for ] because of its quicker onset of action when compared to levothyroxine.<ref name=Klubo>{{cite journal | vauthors = Klubo-Gwiezdzinska J, Wartofsky L | title = Thyroid emergencies | journal = The Medical Clinics of North America | volume = 96 | issue = 2 | pages = 385–403 | date = March 2012 | pmid = 22443982 | doi = 10.1016/j.mcna.2012.01.015 }}</ref> Use for the treatment of ] is not recommended.<ref name=AHFS2019/>

===Depression===
Adding liothyronine to ] appears useful, especially in women.<ref>{{cite journal | vauthors = Altshuler LL, Bauer M, Frye MA, Gitlin MJ, Mintz J, Szuba MP, Leight KL, Whybrow PC | display-authors = 6 | title = Does thyroid supplementation accelerate tricyclic antidepressant response? A review and meta-analysis of the literature | journal = The American Journal of Psychiatry | volume = 158 | issue = 10 | pages = 1617–22 | date = October 2001 | pmid = 11578993 | doi = 10.1176/appi.ajp.158.10.1617 }}</ref> An algorithm developed from the STAR*D trial recommends liothyronine as an option when people have failed two antidepressant medications.<ref>{{cite journal | vauthors = Gaynes BN, Rush AJ, Trivedi MH, Wisniewski SR, Spencer D, Fava M | title = The STAR*D study: treating depression in the real world | journal = Cleveland Clinic Journal of Medicine | volume = 75 | issue = 1 | pages = 57–66 | date = January 2008 | pmid = 18236731 | doi = 10.3949/ccjm.75.1.57 | doi-broken-date = 12 November 2024 }}</ref>

===Pregnancy===
Thyroid hormone is minimally transferred to the fetus or placenta, however as of October 2014, studies have not shown any adverse effects to the fetus. Hypothyroid mothers should continue to take thyroid hormone replacement therapy throughout pregnancy to avoid adverse events.<ref name="Lexi">"Liothyronine (Lexi-Drugs)". LexiComp. Retrieved 29 October 2014.</ref><ref>{{cite journal | vauthors = Montalvo JM, Wahner HW, Mayberry WE, Lum RK | title = Serum triiodothyronine, total thyroxine, and thyroxine to triiodothyronine ratios in paired maternal-cord sera and at one week and one month of age | journal = Pediatric Research | volume = 7 | issue = 8 | pages = 706–11 | date = August 1973 | pmid = 4200034 | doi = 10.1203/00006450-197308000-00006 | doi-access = free }}</ref>

===Nursing===
Breastmilk contains a low amount of thyroid hormone, so it is important to exercise caution when breastfeeding while taking liothyronine.<ref name="Lexi"/>

===Elderly===
Older people should be started on lower doses of liothyronine.<ref name="Drug Info">, retrieved on 29-October-2014</ref> Plasma T<sub>3</sub> concentrations in this population are decreased by 25% to 40%.<ref name="Lexi"/> TSH must be routinely monitored since there is a risk of ], ] and excessive bone loss from inadequate or abnormal thyroid replacement.<ref name="Lexi"/>

==Contraindications==
Any person with a hypersensitivity to liothyronine sodium or any active ingredient of the formulation should not be on this medication. If there is uncorrected ] or ], a different approach to therapy must be considered.<ref name="Drug Info"/>

==Side effects==
Liothyronine may cause a number of side effects, mostly similar to symptoms of ], which include:<ref>MedlinePlus. Last accessed 14 July 2007.</ref>
* weight loss
* tremor
* headache
* upset stomach
* vomiting
* diarrhea
* stomach cramps
* nervousness
* irritability
* insomnia
* excessive sweating
* increased appetite
* fever
* changes in menstrual cycle
* sensitivity to heat

===Boxed warning===
The package insert contains the following ], as do all thyroid hormones:<ref name="Drug Info"/>

<blockquote>
Drugs with thyroid hormone activity, alone or together with other therapeutic agents, have been used for the treatment of obesity. In euthyroid patients, doses within the range of daily hormonal requirements are ineffective for weight reduction. Larger doses may produce serious or even life-threatening manifestations of toxicity, particularly when given in association with ]s such as those used for their anorectic effects.</blockquote>

==Pharmacology==
Liothyronine is the most potent form of thyroid hormone. As a ] of ] (T<sub>3</sub>), it is chemically similar and pharmacologically equivalent to T<sub>3</sub>. As such, it acts on the body to increase the basal metabolic rate, affect protein synthesis and increase the body's sensitivity to catecholamines (such as adrenaline) by ]. As monotherapy or in combination therapy with ]s, liothyronine may also enhance generation of new neurons in the ].<ref name="AJP">{{cite journal | vauthors = Rosenthal LJ, Goldner WS, O'Reardon JP | title = T3 augmentation in major depressive disorder: safety considerations | journal = The American Journal of Psychiatry | volume = 168 | issue = 10 | pages = 1035–40 | date = October 2011 | pmid = 21969047 | doi = 10.1176/appi.ajp.2011.10030402 }}</ref> The thyroid hormones are essential to proper development and differentiation of all cells of the human body. These hormones also regulate protein, fat, and carbohydrate metabolism, affecting how human cells use energetic compounds.

In comparison to ] (T<sub>4</sub>), liothyronine has a faster onset of action as well as a shorter ], which may be due to less ] to ] and ].

==Society and culture==
=== Economics ===
The British ] launched an investigation into the alleged "excessive and unfair pricing" of liothyronine tablets in 2017. It alleged that ] overcharged the NHS from before 2007 to July 2017. The price of a pack increased by almost 1,600% from £4.46 before it was debranded in 2007 to £258.19 by July 2017.<ref>{{cite news |title=CMA investigates 1,600% price increase of liothyronine over eight-year period |url=https://www.pharmaceutical-journal.com/20206079.article |access-date=17 March 2019 |publisher=Pharmaceutical Journal |date=31 January 2019 |archive-date=30 December 2019 |archive-url=https://web.archive.org/web/20191230163626/https://www.pharmaceutical-journal.com/20206079.article |url-status=dead }}</ref>

== References ==
{{reflist}}

{{Thyroid therapy}}
{{Thyroid hormone receptor modulators}}
{{Portal bar | Medicine}}

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