Levothyroxine Dosing

Levothyroxine is a synthetic T4 hormone used in the treatment of hypothyroidism. Common side effects associated with taking levothyroxine include but are not limited to:

  • Insomnia
  • Weight loss
  • Tremor
  • Upset stomach


Levothyroxine should be taken first thing in the morning, 30 to 60 minutes prior to eating breakfast. It should be taken with a full glass of water to prevent choking and or gagging on the tablet.


This is the ideal dosing for levothyroxine. If you have been taking this medication a different way or time, you should continue to take it in that manner. The most important part of levothyroxine administration is taking it the exact same way and time everyday. Changing administration habits can put your thyroid hormones off and you may require a dosing adjustment.


Omeprazole And Pantoprazole Dosing

Omeprazole and pantoprazole are proton pump inhibitors, most commonly used for gastroesophageal reflux disease (GERD), ulcers, and other gastric hypersecretory conditions.


The most common side effects associated with taking omeprazole include but are not limited to:

  • Headache
  • Vomiting
  • Abdominal pain
  • Diarrhea


Omeprazole and pantoprazole should be given on an empty stomach 60 minutes before the first meal of the day.


Dosing Levothyroxine With Omeprazole Or Pantoprazole

Dosing all of these medications together can be very tricky. The number one concern in dosing these medications is the levothyroxine as it has the narrowest therapeutic index and can be the easiest medication to affect by changing/adding other medications.


If you are already taking your other medications (e.g. metoprolol, Lasix, Plavix, calcium, and other multivitamins) in the morning and are adding on levothyroxine, it may be easiest to indeed take the levothyroxine at night.


As stated above regarding the levothyroxine dosing, the main concern is taking the levothyroxine the exact same way everyday to avoid potential for swings in thyroid hormone levels in the blood. In addition, you generally need to take calcium and other metal containing multivitamins at least two hours before or four hours after taking levothyroxine as they can greatly affect the levels of levothyroxine.


Although levothyroxine is generally dosed in the morning, in your case, taking the other medications in the morning and the levothyroxine at night may be the best scenario medication compliance as well as the best opportunity to avoid interactions between medications. Just be sure to take the levothyroxine consistently at the same time and the same way.