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Levothyroxine can interact with a wide range of medications and supplements, which may affect how well it works or increase the risk of certain side effects. It is important to always inform your doctor and pharmacist about everything you are taking, including prescription drugs, over-the-counter medicines, vitamins, and herbal products. Some drugs, such as midodrine, are generally not recommended to be used with levothyroxine unless your doctor considers it necessary and makes appropriate adjustments to your dosing schedule.

Other common interactions include antacids that contain aluminum or magnesium, calcium supplements, iron products, and cholesterol-lowering medications like cholestyramine and colesevelam. Medicines that belong to the class of proton pump inhibitors—such as omeprazole, lansoprazole, esomeprazole, pantoprazole, and rabeprazole—may also interact with levothyroxine. Additionally, hormone therapies including various forms of estrogen and certain antibiotics like ciprofloxacin can affect or be affected by levothyroxine.

If you are prescribed any of these medicines or supplements alongside levothyroxine, your doctor may decide to adjust the doses or the timing of when you take each medication to help reduce the potential for interactions. Keeping an updated list of all the products you use and sharing this with your healthcare providers can help prevent unwanted complications and ensure that your treatment remains safe and effective.

Common side effects:

• Hair loss

Less common but important to monitor:

• Increased sweating
• Sensitivity to heat
• Nervousness
• Mood swings
• Tiredness
• Diarrhea
• Shaking or tremors
• Headaches
• Shortness of breath
• Bone pain
• Muscle weakness
• Weight loss
• Excessive hunger
• Vomiting
• Stomach cramps
• Difficulty sleeping

Serious side effects:

• Chest pain
• Fast or irregular heartbeat
• Swelling of the hands, ankles, or feet
• Seizures
• Signs of heart failure (such as trouble breathing, weakness, or extreme tiredness)
• Heart attack (dizziness, anxiety, nausea, cold sweat, pain or tightness in the chest)
• Allergic reaction (rash, itching or swelling especially of the face, tongue, or throat, severe dizziness, or trouble breathing)

Interactions with high risk of serious adverse effects and should be avoided:

• Warfarin (the effects of warfarin may be influenced and require close monitoring of blood clotting).
• Diabetes medications (the effects may be influenced and blood sugar may require closer monitoring).

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Antacids (reduce absorption of levothyroxine).
• Calcium supplements (reduce absorption of levothyroxine).
• Iron supplements (reduce absorption of levothyroxine).
• Cholesterol-lowering medications: colestyramine, Colestipol, Colesevelam (reduce absorption of levothyroxine).
• Sucralfate (reduce absorption of levothyroxine).
• Carbamazepine (can interfere with levothyroxine metabolism/effect).
• Phenytoin (can interfere with levothyroxine metabolism/effect).
• Rifampin (can interfere with levothyroxine metabolism/effect).
• Amiodarone (can interfere with levothyroxine metabolism/effect).

Interactions with low risk that usually do not require a change in therapy:

• Caffeinated beverages (reduce absorption of levothyroxine).
• High-fiber foods (reduce absorption of levothyroxine).
• Soy products (reduce absorption of levothyroxine).
• Calcium-rich foods: milk, cheese, yogurt (reduce absorption of levothyroxine).
• Grapefruit and grapefruit juice (decrease absorption of levothyroxine).
• Kelp supplements (may worsen hypothyroidism; contains iodine).
• Biotin (may interfere with thyroid function tests).