Drug General Information (ID: DDICMK03GR)
Drug Name			Pantoprazole		Drug Info		Liothyronine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiulcer Agents				Hormone Replacement Agents
Structure

Mechanism of Pantoprazole-Liothyronine Interaction (Severity Level: Moderate)
Altered gastric pH Click to Show/Hide Mechanism Graph
Drug Name		Pantoprazole				Liothyronine
Mechanism		Gastric alkalinizer				Gastric pH sensitive
Key Mechanism Factor 1
		Factor Name		Gastric pH
		Factor Description		The normal pH range of gastric acid is between 1.5 and 3.5 and is highly acidic, consisting mainly of hydrochloric acid. Changes in the pH of the stomach can alter the absorption of drugs.
Mechanism Description		Decreased absorption of Liothyronine due to altered gastric pH caused by Pantoprazole

Recommended Action
Management		Caution is advised if levothyroxine is used concomitantly with proton pump inhibitors. Consider the alteration in gastric pH caused by the PPI. Some authorities recommend separating administration of PPI and levothyroxine by several hours, however there are no studies showing improved absorption when PPIs are administered separately from levothyroxine. If concomitant administration is necessary, consider monitoring TSH level and watching for clinical evidence of reduced levothyroxine effects. Patients should be advised to contact their physician if they experience symptoms of hypothyroidism, such as fatigue, cold intolerance, constipation, unexplained weight gain, depression, joint or muscle pain, thinning hair or hair loss, dry skin, hoarseness, and abnormal menstrual periods.

References
1	Cerner Multum, Inc. "Australian Product Information.".
2	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
3	Product Information. Synthroid (levothyroxine). Abbott Pharmaceutical, Abbott Park, IL.