Levothyroxine Treatment Options: Tirosint® and Tirosint®-SOL

If you’re like the majority of people with hypothyroidism, you take a thyroid hormone replacement drug called levothyroxine. That’s the generic name, but you’re probably more familiar with the well-known brands of levothyroxine tablets, including Synthroid, Levoxyl, and Unithroid. There’s also a newer brand on the market called Euthyrox. Many generic versions of levothyroxine tablets are also on the market.

As part of my ongoing Levothyroxine Deep Dive educational effort for thyroid patients, I’ve been exploring hypothyroidism treatment options. I’ve discovered two important facts:

1. Many patients are unhappy with their treatment, and the majority of patients are not well-controlled on levothyroxine tablets, and
2. Many patients — and in some cases, their doctors — are still unfamiliar with or misinformed about levothyroxine options beyond tablets, namely, Tirosint capsules and Tirosint-SOL oral solution.

Tirosint and Tirosint-SOL are different because their active ingredient, levothyroxine, comes in a liquid — not a tablet — form. Tirosint capsules are packaged in individual dose blister packs. Tirosint-SOL oral solution is the only FDA-approved liquid levothyroxine that comes in precise, single-dose packaging.

Besides being liquid versus tablets, Tirosint and Tirosint-SOL are unique in other ways.

No Dyes or Coatings: Most levothyroxine tablets contain various dyes and coatings, which in some patients are known to cause reactions or sensitivity, or reduce the medication’s absorption and effectiveness. Tirosint and Tirosint-SOL contain no dyes or coatings.

Few Excipients: All levothyroxine tablets contain a fairly long list of fillers, binders, and other ingredients, known as “excipients.” Some of these excipients — like lactose, iodine, gluten, and acacia — reduce the effectiveness of levothyroxine tablets if you have allergies or sensitivities to these ingredients. The only excipients in Tirosint and Tirosint-SOL are water, glycerin, and glycerol, which aren’t known to cause problems in most patients.

Resistant to Food, Drinks, Supplements and Medications: Your absorption of levothyroxine tablets is negatively affected by food, beverages, supplements, and medications — for example, coffee, milk, high-fiber foods, calcium and iron supplements, antacids, and proton pump inhibitor drugs like Prevacid. Digestive and gastrointestinal conditions that change stomach acids or impair absorption — like ulcers, irritable bowel disease, Crohn’s disease, and celiac disease — can also interfere with your full absorption of levothyroxine tablets. Research has demonstrated, however, that Tirosint and Tirosint-SOL are highly resistant to most effects of foods, drinks, supplements, and medications, resulting in more successful and speedy resolution of hypothyroidism compared to tablets.

Tirosint-SOL is Fast and Effective: Tirosint-SOL oral solution is a favorite of some endocrinologists when they want to treat your hypothyroidism as quickly as possible, and bypass any obstacles to absorption found with tablets. Because Tirosint-SOL is administered as a flavorless liquid, it bypasses the usual disintegration process of a tablet or even a capsule coating, and is rapidly absorbed.

Tirosint-SOL Means No Pills to Swallow: Tirosint-SOL is easy to take, and is administered by mouth using the ampule, or can be added to water. It’s the easiest and most precise treatment choice for babies and children taking levothyroxine, and patients who don’t swallow pills or capsules.

Consistent and Potent: All forms of levothyroxine are required to fall within the FDA-mandated range of 95–105% of stated potency. This means that from refill to refill of levothyroxine tablets, you can be exposed to medications with varying potencies. This makes careful control of your hypothyroidism difficult, and can be the reason why your thyroid test levels are fluctuating. While meeting the FDA requirements, Tirosint and Tirosint-SOL, aim for consistent potency near 100% of the stated dosage, making it easier to carefully and accurately treat hypothyroidism within a narrow range. This is especially important if you’re a thyroid cancer survivor or you’re hypothyroid and pregnant.

Easy-to-Use, Precise, Individual-Dose Packaging: Tirosint-SOL is the only FDA-approved liquid levothyroxine available in individual-dose packaging. Each dose is packaged in its own easy-to-use ampule, and precise and effective treatment is simplified by Tirosint-SOL’s 12 different dosage sizes: 13 mcg, 25 mcg, 50 mcg, 75 mcg, 88 mcg, 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, and 200 mcg.

The Three Key Tirosint / Tirosint-SOL Challenges

Apart from the lack of awareness of Tirosint and Tirosint-SOL as options, there are three main challenges you may face in getting Tirosint and Tirosint-SOL.

1. Availability

While the number of patients taking Tirosint or Tirosint-SOL is steadily increasing, not all pharmacies stock all dosages. As a result, you may find it hard to get your prescription filled. Many pharmacies still have to special order Tirosint or Tirosint-SOL to fill prescriptions, or simply tell patients “we don’t have it.”

2. Substitution

There are pharmacies that choose not to stock brand-name Tirosint and Tirosint-SOL, or don’t dispense it because they receive financial incentives for dispensing levothyroxine tablets instead. These situations create the second challenge: pharmacies that try to substitute other forms of levothyroxine, such as tablets, or generic forms of levothyroxine. (This is why it’s especially important to request your doctor specify that your prescription is “Dispense as Written” — or DAW — to prevent pharmacy substitution.)

3. Cost

Cost is a challenge, because the retail list price for Tirosint and Tirosint-SOL is typically around $150 a month, two to three times the price of Synthroid, and more than ten times the cost of generic levothyroxine tablets. Tirosint and Tirosint-SOL are not consistently covered by all health insurers. Even if your insurer covers Tirosint and Tirosint-SOL, they may be wrongly classified as specialty drugs, and you could face high insurance copays of $50 to $100 or more per month.

Some patients who have heard of Tirosint or Tirosint-SOL assume they can’t afford it, so they don’t even explore the option of taking it. I’ve also heard many patients say that they asked their doctor to prescribe Tirosint or Tirosint-SOL, but the doctor’s response was, “it’s too expensive, and you can’t afford it.” Patients have also reported an inability to fill their prescriptions for Tirosint or Tirosint-SOL because the retail or copay cost was prohibitive.

If any of these challenges sound familiar, there are solutions.

A Solution to the Challenges: Tirosint Direct

IBSA, the manufacturer of Tirosint and Tirosint-SOL, has created the Tirosint Direct Program available so patients can more easily and affordably get treatment. You can access the program by having your doctor fax or electronically transmit your prescription to one of the participating pharmacies. Tirosint Direct mail order pharmacies always have all doses on hand, and never make substitutions, ensuring that you always get real Tirosint or Tirosint-SOL quickly.

The participating pharmacies then fully negotiate any needed prior authorizations with your doctor and health insurance.

Next, the pharmacy applies all available discounts, including IBSA’s copay coupons, to get you the best possible out-of-pocket cost. If you have insurance, you’ll most likely pay $25 a month or less.

If you’re uninsured — or Tirosint and Tirosint-SOL aren’t covered by your insurer — you’ll be able to get your medication at a discounted cash price as low as $40 a month (for a three-month supply), or $50 month-by-month, as of spring 2021.

Finally, once your order is processed, it ships immediately, and usually arrives in your mailbox within two to three days. Many patients report that from start to finish, the Tirosint Direct process was quicker than getting a prescription for Tirosint or Tirosint-SOL filled at a local pharmacy, and some patients saved as much as $100 a month on their prescriptions.

The Bottom Line

If you are starting levothyroxine treatment for hypothyroidism, Tirosint or Tirosint-SOL may be the most effective choice to help you bypass any allergies, sensitivities, or potential interference, and get a precise, consistent dosage. And if you’re already taking levothyroxine tablets, and are not getting optimal treatment that resolves your symptoms, or you require tight control of your thyroid levels, you may have better results and symptom relief when taking Tirosint or Tirosint-SOL. You can avoid pharmacy availability and substitution problems, and ensure you pay the lowest out-of-pocket price, by using the Tirosint Direct Program to fill your prescription.

More Information

More information about Tirosint and Tirosint-SOL is available at www.Tirosint.com and www.TirosintSOL.com.

You can access cost savings at the Tirosint Direct Program at: www.Tirosint.com/direct.

You can find the Levothyroxine Deep Dive educational program online at www.mary-shomon.com/dive.