Euthyrox 0.175mg (175mcg) Tabs
WARNING: Do not use this drug for weight loss. Severe and sometimes deadly side effects may happen with this drug if it is taken in large doses or with other drugs for weight loss. If you have questions, talk with the doctor. @ COMMON USES: It is used to add thyroid hormone to the body.It is used to manage thyroid cancer.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Thyroid hormone replacement
Pharmacologic Class
Thyroid hormone
Pregnancy Category
Category A
FDA Approved
Jan 1955
DEA Schedule
Not Controlled
Overview
What is this medicine?
Levothyroxine is a medicine that replaces a hormone normally made by your thyroid gland. It's used to treat an underactive thyroid (hypothyroidism) and helps your body's metabolism work properly. It's important to take it exactly as prescribed to feel your best.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely.
Take your medication on an empty stomach, at least 30 to 60 minutes before breakfast.
Some brands of this medication may be more likely to cause choking, gagging, or trouble swallowing. If you're taking one of these products, be sure to take it with a full glass of water. Check with your pharmacist if you're unsure.
If you need to, you can crush your tablet and mix it with 1 or 2 teaspoons (5 or 10 mL) of water. Take your dose right away after mixing, and do not store the mixture for future use.
Important Interactions to Consider
Do not take iron products, antacids that contain aluminum or magnesium, or calcium carbonate within 4 hours before or 4 hours after taking your medication.
If you're taking other medications, they may need to be taken at a different time than your medication. Check with your doctor or pharmacist to determine the best schedule.
Certain foods, such as soybean flour (found in infant formula), may affect how your medication works in your body. Discuss this with your doctor.
If you regularly drink grapefruit juice or eat grapefruit, talk to your doctor about potential interactions.
Using the Correct Form of Your Medication
There are different brands and forms of this medication. Do not switch between different brands or forms without consulting your doctor.
Continue taking your medication as directed by your doctor or healthcare provider, even if you're feeling well.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, away from heat and light. Do not store it in a bathroom.
If your medication comes in a blister pack, do not remove it from the pack until you're ready to take it. Do not store the removed medication for future use.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember.
If it's close to the time for your next dose, skip the missed dose and return to your regular schedule.
Do not take two doses at the same time or take extra doses.
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely.
Take your medication on an empty stomach, at least 30 to 60 minutes before breakfast.
Some brands of this medication may be more likely to cause choking, gagging, or trouble swallowing. If you're taking one of these products, be sure to take it with a full glass of water. Check with your pharmacist if you're unsure.
If you need to, you can crush your tablet and mix it with 1 or 2 teaspoons (5 or 10 mL) of water. Take your dose right away after mixing, and do not store the mixture for future use.
Important Interactions to Consider
Do not take iron products, antacids that contain aluminum or magnesium, or calcium carbonate within 4 hours before or 4 hours after taking your medication.
If you're taking other medications, they may need to be taken at a different time than your medication. Check with your doctor or pharmacist to determine the best schedule.
Certain foods, such as soybean flour (found in infant formula), may affect how your medication works in your body. Discuss this with your doctor.
If you regularly drink grapefruit juice or eat grapefruit, talk to your doctor about potential interactions.
Using the Correct Form of Your Medication
There are different brands and forms of this medication. Do not switch between different brands or forms without consulting your doctor.
Continue taking your medication as directed by your doctor or healthcare provider, even if you're feeling well.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, away from heat and light. Do not store it in a bathroom.
If your medication comes in a blister pack, do not remove it from the pack until you're ready to take it. Do not store the removed medication for future use.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember.
If it's close to the time for your next dose, skip the missed dose and return to your regular schedule.
Do not take two doses at the same time or take extra doses.
Lifestyle & Tips
- Take on an empty stomach, typically 30-60 minutes before breakfast, with a full glass of water.
- Avoid taking with food, calcium, iron, antacids, or other medications within 4 hours (or as advised by your doctor) as they can interfere with absorption.
- Take at the same time each day for consistent absorption.
- Do not switch between different brands or generic versions without consulting your doctor, as formulations can vary and may require dose adjustment.
- Inform your doctor about all other medications, supplements, and over-the-counter products you are taking.
- Regular blood tests (TSH) are essential to ensure the correct dose.
Available Forms & Alternatives
Available Strengths:
- Euthyrox 100mcg Tablets
- Euthyrox 0.125mg (125mcg) Tablets
- Euthyrox 88mcg Tablets
- Euthyrox 0.05mg (50mcg) Tablets
- Euthyrox 0.075mg (75mcg) Tablets
- Euthyrox 0.137mg (137mcg) Tab
- Euthyrox 0.175mg (175mcg) Tabs
- Euthyrox 0.150mg (150mcg) Tab
- Euthyrox 0.025mg (25mcg) Tab
- Euthyrox 0.112mg (112mcg) Tablets
- Euthyrox 0.2mg (200mcg) Tab
- Euthyrox 0.075mg (75mcg) Tablets
- Euthyrox 0.088mg (88mcg) Tablets
- Euthyrox 0.100mg (100mcg) Tablets
Dosing & Administration
Adult Dosing
Standard Dose:
Initial: 1.7 mcg/kg/day orally once daily. Maintenance: 100-125 mcg/day (average).
Dose Range:
25 - 300 mg
Condition-Specific Dosing:
initialHypothyroidism:
1.7 mcg/kg/day orally once daily. Adjust by 12.5-25 mcg increments every 4-6 weeks based on TSH.
cardiacDisease:
Initial: 12.5-25 mcg/day orally once daily. Titrate slowly with 12.5-25 mcg increments every 6-8 weeks.
subclinicalHypothyroidism:
Consider lower doses (e.g., 25-75 mcg/day) based on TSH and symptoms.
Pediatric Dosing
Neonatal:
10-15 mcg/kg/day orally once daily (0-3 months).
Infant:
6-8 mcg/kg/day orally once daily (3-6 months); 5-6 mcg/kg/day (6-12 months).
Child:
4-5 mcg/kg/day orally once daily (1-5 years); 3-4 mcg/kg/day (6-12 years).
Adolescent:
2-3 mcg/kg/day orally once daily (12-17 years, during growth spurt); 1.7 mcg/kg/day (after growth spurt, or if adult height reached).
Dose Adjustments
Renal Impairment:
Mild:
No specific dose adjustment required.
Moderate:
No specific dose adjustment required.
Severe:
No specific dose adjustment required.
Dialysis:
No specific dose adjustment required; not significantly dialyzable.
Hepatic Impairment:
Mild:
No specific dose adjustment required.
Moderate:
No specific dose adjustment required.
Severe:
No specific dose adjustment required.
Pharmacology
Mechanism of Action
Levothyroxine (T4) is a synthetic form of the natural thyroid hormone, thyroxine. It is converted to its active metabolite, liothyronine (T3), in peripheral tissues. T3 then enters the cell nucleus and binds to thyroid hormone receptors, regulating gene expression and controlling numerous metabolic processes, including protein, carbohydrate, and lipid metabolism, and influencing growth and development.
Pharmacokinetics
Absorption:
Bioavailability:
48-79% (average 60-80%)
Tmax:
2-4 hours
FoodEffect:
Decreased absorption with food, especially fiber, calcium, iron, and certain foods (e.g., soybean flour, cottonseed meal, walnuts, dietary fiber). Should be taken on an empty stomach.
Distribution:
Vd:
10-13 L
ProteinBinding:
>99% (primarily to thyroid-binding globulin (TBG), thyroid-binding prealbumin (TBPA), and albumin)
CnssPenetration:
Limited (T3 crosses more readily than T4)
Elimination:
HalfLife:
6-7 days (euthyroid); 9-10 days (hypothyroid); 3-4 days (hyperthyroid)
Clearance:
Approximately 0.05 L/hour
ExcretionRoute:
Primarily renal (approximately 80% as metabolites), with some fecal excretion (approximately 20%).
Unchanged:
<1% (renal)
Pharmacodynamics
OnsetOfAction:
Gradual, typically 3-5 days (due to long half-life and conversion to T3)
PeakEffect:
Approximately 3-4 weeks (time to reach steady state)
DurationOfAction:
Several weeks after discontinuation due to long half-life
Safety & Warnings
Side Effects
Serious Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of high blood pressure, including:
+ Severe headache or dizziness
+ Passing out
+ Changes in eyesight
Chest pain or pressure
Fast or abnormal heartbeat
Shortness of breath
Sudden weight gain or swelling in the arms or legs
Headache
Feeling tired or weak
Changes in appetite
Unintentional weight changes
Diarrhea, stomach cramps, or vomiting
Mood changes, such as feeling irritable, nervous, excitable, anxious, or restless
Shakiness
Trouble sleeping
Sensitivity to heat
Excessive sweating
Fever
Muscle cramps
Muscle weakness
Flushing
Bone pain
Changes in menstrual periods
Additional Side Effects in Children:
Hip or knee pain
Limping
Additional Side Effects in Infants:
Changes in the shape of the head and face
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
Hair loss (usually temporary and resolves on its own within the first few months of treatment)
Reporting Side Effects
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of high blood pressure, including:
+ Severe headache or dizziness
+ Passing out
+ Changes in eyesight
Chest pain or pressure
Fast or abnormal heartbeat
Shortness of breath
Sudden weight gain or swelling in the arms or legs
Headache
Feeling tired or weak
Changes in appetite
Unintentional weight changes
Diarrhea, stomach cramps, or vomiting
Mood changes, such as feeling irritable, nervous, excitable, anxious, or restless
Shakiness
Trouble sleeping
Sensitivity to heat
Excessive sweating
Fever
Muscle cramps
Muscle weakness
Flushing
Bone pain
Changes in menstrual periods
Additional Side Effects in Children:
Hip or knee pain
Limping
Additional Side Effects in Infants:
Changes in the shape of the head and face
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
Hair loss (usually temporary and resolves on its own within the first few months of treatment)
Reporting Side Effects
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Symptoms of too much thyroid hormone (hyperthyroidism): rapid heart rate, palpitations, chest pain, nervousness, irritability, sweating, heat intolerance, unexplained weight loss, diarrhea, tremor, insomnia.
- Symptoms of too little thyroid hormone (hypothyroidism) despite treatment: persistent fatigue, weight gain, cold intolerance, constipation, dry skin, hair loss, depression, memory problems.
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain health conditions, including:
+ An overactive thyroid gland
+ A weak adrenal gland
+ Difficulty swallowing
This list is not exhaustive, and it is crucial to discuss all your health problems with your doctor.
Additionally, provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
Any health problems you have
It is vital to verify that it is safe to take this medication with all your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain health conditions, including:
+ An overactive thyroid gland
+ A weak adrenal gland
+ Difficulty swallowing
This list is not exhaustive, and it is crucial to discuss all your health problems with your doctor.
Additionally, provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
Any health problems you have
It is vital to verify that it is safe to take this medication with all your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor.
Precautions & Cautions
Important Information for Patients Taking This Medication
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. To ensure uninterrupted treatment, do not allow your supply of this medication to run out. You may not experience the full effects of this medication for several weeks.
If you have diabetes (high blood sugar), consult your doctor, as this medication may affect your blood sugar control. Your doctor may need to adjust your diabetes medications. Follow your doctor's instructions for monitoring your blood sugar levels and undergo blood tests as recommended.
When taking this medication, stop using biotin or any products containing biotin at least 2 days before having your thyroid levels checked.
High doses of this medication may increase the risk of osteoporosis (weak bones), particularly after menopause. Discuss your risk factors with your doctor, who can help determine if you are at higher risk of developing osteoporosis.
This medication may affect fertility, potentially leading to difficulties in getting pregnant or fathering a child. If you plan to conceive, consult your doctor before starting treatment.
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
Pregnancy and Breastfeeding
Inform your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. Your doctor will discuss the benefits and risks of this medication for you and your baby.
Special Considerations for Children
If your child is taking this medication and experiences any changes in weight, consult your doctor, as their dose may need to be adjusted. Never give your child more of this medication than prescribed, as this can increase the risk of severe side effects.
In some cases, this medication may affect growth in children and teenagers. Regular growth checks may be necessary. Consult your doctor to discuss any concerns.
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. To ensure uninterrupted treatment, do not allow your supply of this medication to run out. You may not experience the full effects of this medication for several weeks.
If you have diabetes (high blood sugar), consult your doctor, as this medication may affect your blood sugar control. Your doctor may need to adjust your diabetes medications. Follow your doctor's instructions for monitoring your blood sugar levels and undergo blood tests as recommended.
When taking this medication, stop using biotin or any products containing biotin at least 2 days before having your thyroid levels checked.
High doses of this medication may increase the risk of osteoporosis (weak bones), particularly after menopause. Discuss your risk factors with your doctor, who can help determine if you are at higher risk of developing osteoporosis.
This medication may affect fertility, potentially leading to difficulties in getting pregnant or fathering a child. If you plan to conceive, consult your doctor before starting treatment.
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
Pregnancy and Breastfeeding
Inform your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. Your doctor will discuss the benefits and risks of this medication for you and your baby.
Special Considerations for Children
If your child is taking this medication and experiences any changes in weight, consult your doctor, as their dose may need to be adjusted. Never give your child more of this medication than prescribed, as this can increase the risk of severe side effects.
In some cases, this medication may affect growth in children and teenagers. Regular growth checks may be necessary. Consult your doctor to discuss any concerns.
Overdose Information
Overdose Symptoms:
- Palpitations
- Tachycardia (rapid heart rate)
- Arrhythmias
- Chest pain (angina)
- Tremor
- Nervousness
- Irritability
- Insomnia
- Diarrhea
- Weight loss
- Fever
- Heat intolerance
- Seizures (rare)
- Heart failure (in susceptible individuals)
What to Do:
Seek immediate medical attention. Call 911 or your local emergency number. For poison control, call 1-800-222-1222. Management typically involves supportive care, reducing absorption (if recent ingestion), and managing symptoms (e.g., beta-blockers for cardiac effects).
Drug Interactions
Major Interactions
- Amiodarone (can cause hypo- or hyperthyroidism, affecting levothyroxine dose)
- Oral anticoagulants (e.g., Warfarin - increased anticoagulant effect)
- Tyrosine kinase inhibitors (e.g., Sunitinib, Imatinib - can decrease levothyroxine efficacy)
- Orlistat (can decrease levothyroxine absorption)
- Sevelamer (can decrease levothyroxine absorption)
- Sucralfate (can decrease levothyroxine absorption)
Moderate Interactions
- Calcium carbonate/supplements (decreased absorption of levothyroxine)
- Iron supplements (decreased absorption of levothyroxine)
- Antacids (aluminum and magnesium containing - decreased absorption of levothyroxine)
- Proton pump inhibitors (e.g., Omeprazole - can decrease levothyroxine absorption by increasing gastric pH)
- H2 receptor blockers (e.g., Ranitidine - can decrease levothyroxine absorption by increasing gastric pH)
- Bile acid sequestrants (e.g., Cholestyramine, Colestipol - decreased absorption of levothyroxine)
- Soy products (decreased absorption of levothyroxine)
- Fiber supplements (decreased absorption of levothyroxine)
- Rifampin (increased levothyroxine metabolism)
- Phenytoin (increased levothyroxine metabolism, decreased protein binding)
- Carbamazepine (increased levothyroxine metabolism)
- Sertraline (can increase levothyroxine requirements)
- Estrogens (e.g., oral contraceptives, HRT - increase TBG, increasing levothyroxine requirements)
- Androgens (decrease TBG, decreasing levothyroxine requirements)
- Beta-blockers (can inhibit T4 to T3 conversion)
- Corticosteroids (can inhibit T4 to T3 conversion)
- Antidiabetic agents (levothyroxine can increase blood glucose, requiring antidiabetic dose adjustment)
Minor Interactions
- Grapefruit juice (potential minor effect on absorption, but clinical significance is low)
Monitoring
Baseline Monitoring
Thyroid Stimulating Hormone (TSH)
Rationale: Primary indicator of thyroid function and adequacy of levothyroxine replacement.
Timing: Before initiating therapy.
Free Thyroxine (Free T4)
Rationale: Assesses circulating unbound T4 levels, useful in certain conditions (e.g., central hypothyroidism, TSH-secreting pituitary adenoma, or when TSH is unreliable).
Timing: Before initiating therapy.
Clinical Symptoms of Hypothyroidism
Rationale: To establish baseline and track improvement.
Timing: Before initiating therapy.
Routine Monitoring
Thyroid Stimulating Hormone (TSH)
Frequency: Every 4-6 weeks after initiation or dose change, then every 6-12 months once stable.
Target: 0.4-4.0 mIU/L (individualized based on age, comorbidities, and specific conditions like pregnancy or thyroid cancer).
Action Threshold: TSH outside target range; adjust dose.
Free Thyroxine (Free T4)
Frequency: Consider if TSH is suppressed or elevated, or in central hypothyroidism. Less frequent than TSH.
Target: 0.8-1.8 ng/dL (or laboratory reference range).
Action Threshold: Free T4 outside target range; adjust dose.
Clinical Symptoms (e.g., fatigue, weight, mood, skin/hair changes, heart rate)
Frequency: At every visit.
Target: Resolution or improvement of hypothyroid symptoms.
Action Threshold: Persistent or worsening symptoms, or development of hyperthyroid symptoms; evaluate TSH/Free T4 and consider dose adjustment.
Symptom Monitoring
- Fatigue
- Weight changes (gain or loss)
- Cold intolerance
- Constipation
- Dry skin
- Hair loss
- Bradycardia (slow heart rate)
- Depression
- Memory impairment
- Muscle aches
- Nervousness
- Irritability
- Heat intolerance
- Palpitations
- Tremor
- Diarrhea
- Weight loss (unexplained)
- Insomnia
Special Patient Groups
Pregnancy
Levothyroxine requirements often increase during pregnancy due to increased thyroid-binding globulin (TBG) and fetal thyroid hormone needs. It is crucial to maintain euthyroidism to support fetal neurological development. Category A: Studies in pregnant women have not demonstrated a risk to the fetus.
Trimester-Specific Risks:
First Trimester:
Increased dose often needed early in pregnancy. Untreated maternal hypothyroidism in the first trimester is associated with increased risk of miscarriage, preterm birth, and impaired neurocognitive development in the offspring.
Second Trimester:
Dose adjustments continue to be necessary. Monitor TSH every 4-6 weeks.
Third Trimester:
Dose adjustments continue to be necessary. Maintain TSH within trimester-specific reference ranges.
Lactation
Levothyroxine is compatible with breastfeeding. Minimal amounts are excreted into breast milk, and it is not expected to cause adverse effects in breastfed infants. It is considered safe for use during lactation.
Infant Risk:
L1 - Safest (no increase in adverse effects in infants).
Pediatric Use
Dosing is weight-based and critical for normal growth and development, especially neurological development in infants and young children. Underdosing can lead to irreversible cognitive impairment. Overdosing can lead to craniosynostosis in infants and accelerated bone maturation. Close monitoring of TSH and clinical status is essential.
Geriatric Use
Lower initial doses (e.g., 12.5-25 mcg/day) are recommended, especially in patients with underlying cardiovascular disease, due to increased sensitivity to thyroid hormones. Dose titration should be gradual (e.g., every 6-8 weeks) to avoid cardiac complications. Monitor for symptoms of hyperthyroidism.
Clinical Information
Clinical Pearls
- Always take levothyroxine on an empty stomach, 30-60 minutes before breakfast, with water. Consistency in timing is key.
- Separate administration from calcium, iron, antacids, and other interacting medications by at least 4 hours.
- Do not switch between different brands or generic formulations without consulting a healthcare provider, as bioequivalence can vary, potentially requiring dose adjustment.
- TSH is the primary lab test for monitoring, but Free T4 may be useful in specific situations (e.g., central hypothyroidism, TSH suppression).
- Full therapeutic effect and TSH stabilization may take 4-6 weeks after a dose change.
- Patients with pre-existing cardiac disease should start with lower doses and titrate very slowly to avoid exacerbating cardiac symptoms.
- Patients should be educated on symptoms of both hypo- and hyperthyroidism to report any changes promptly.
Alternative Therapies
- Liothyronine (T3, Cytomel): Used in specific cases, often for short-term TSH suppression or in combination with levothyroxine, but has a shorter half-life and more fluctuating levels.
- Desiccated Thyroid Extract (Armour Thyroid, NP Thyroid): Natural thyroid hormone derived from porcine thyroid glands, containing both T4 and T3. Dosing can be less precise due to variable T4/T3 ratios and potency.
- Combination therapy (Levothyroxine + Liothyronine): Used by some practitioners for patients who do not feel well on levothyroxine alone, though evidence for superiority is mixed.
Cost & Coverage
Average Cost:
$10 - $50 per 30 tablets (generic)
Generic Available:
Yes
Insurance Coverage:
Tier 1 (generic) or Tier 2/3 (brand)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the overdose, including the medication taken, the amount, and the time it occurred.