Granny B asked
I had thyroid removed 4 years ago and took levothyroxine in morning and waited 1 hour to eat. But now I need to take my Nexium in the morning as it doesn't help at other times I tried. Now I take levothyroxine when I get up wait 45 minutes and then take Nexium and wait another 45 minutes, then eat breakfast. Am I doing this correctly to get the benefit of both? Thank you for any suggestions.
Answer
It can often be difficult to take levothyroxine (brand names Synthroid, Levoxyl) with other medications due to the specific (and strict) dosing instructions for the medication. When prescribed levothyroxine, it is extremely important that it be taken consistently, the same way every day.
Levothyroxine Dosing Recommendations
Levothyroxine should ideally be dosed as follows:
- Take on an empty stomach with a full glass of water at least 30 to 60 minutes before breakfast. Be sure to take levothyroxine apart from other medications as well as they can decrease absorption. In general, the rate and extent of absorption for levothyroxine is best when administered on an empty stomach.
The reason it is so important to take levothyroxine consistently is to avoid fluctuations in drug absorption, which can make a significant impact on your therapy. Levothyroxine is dosed in micrograms, which is 1/1000th of a milligram. We are talking small doses here. A small change in your dose can make a huge difference in how you feel.
Nexium Dosing Recommendations
Like levothyroxine, Nexium needs to be dosed a specific way for optimal effects. The most common dosing recommendation is as follows:
- Take Nexium on an empty stomach, at least 60 minutes before meals and ideally before the first meal of the day.
The reason it is important to take Nexium (and all PPI medications) before food is because the drug needs time to become absorbed. Unlike antacids like Tums and Rolaids, Nexium doesn't simply neutralize stomach acid, but inhibits, or "shuts off" proton pumps, decreasing acid production. Nexium needs to be absorbed and available at the site of action (i.e. proton pumps) before food is ingested, which activates acid secretion.
Taking Levothyroxine With Nexium
In an ideal scenario:
- Levothyroxine should be taken first thing in the morning, at least 30 minutes before Nexium with a full glass of water. Remember that it is important to take levothyroxine the same way every day.
- After at least 30 minutes from levothyroxine administration, take Nexium.
- Eat your first meal of the day about 60 minutes after taking Nexium for best effects.
Per your inquiry, you are taking your medication correctly, with levothyroxine being dosed first, followed by Nexium, followed by food. Your Nexium may be slightly more effective if you wait 60 minutes instead of 45 minutes to eat, but this may not be that significant for most individuals.
