Drug Name
Cytomel (Liothyronine Sodium)
Active Ingredient
Liothyronine Sodium
Cytomel Uses
Replacement or supplemental therapy in hypothyroidism; TSH suppression for treatment or prevention of euthyroid goiters (eg, thyroid nodules, multinodular goiters, enlargement in chronic thyroiditis); diagnostic agent in suppression tests to differentiate suspected hyperthyroidism from euthyroidism; treatment of myxedema coma/precoma (IV)
Contraindication
Acute MI and thyrotoxicosis uncomplicated by hypothyroidism; coexistence of hypothyroidism and hypoadrenalism (Addison disease), unless treatment of hypoadrenalism with adrenocortical steroids precedes initiation of thyroid therapy.
Dosage and Administration
Hypothyroidism
Adults PO 25 mcg/day initially, increase by up to 25 mcg every 1 to 2 wk if needed. Children PO 5 mcg/day initially, increase by 5 mcg/day at 2 wk intervals, if needed.
Congenital Hypothyroidism
Children PO 5 mcg/day initially; increase by 5 mcg/day every 3 to 4 days until desired response achieved. Infants a few mo of age may require only 20 mcg/day for maintenance; at 1 yr, 50 mcg/day may be required; and, above 3 yr, full adult dosage may be required.
Simple (Nontoxic) Goiter
Adults PO 5 mcg/day initially, increase by 5 to 10 mcg every 1 to 2 wk. When 25 mcg/day is reached, increase by 12.5 to 25 mcg every 1 to 2 wk if needed. Children PO 5 mcg/day initially, increase by 5 mcg/day at 2-wk intervals, if needed.
Myxedema
Adults PO 5 mcg/day initially, increase by 5 to 10 mcg every 1 to 2 wk. When 25 mcg/day is reached, increase by 12.5 to 25 mcg every 1 to 2 wk if needed. Children PO 5 mcg/day initially, increase by 5 mcg/day at 2-wk intervals, if needed.
Myxedema Coma/Precoma
Adults IV 25 to 50 mcg initially. In patients with known or suspected CV disease, an initial dose of 10 to 20 mcg is suggested; however, base doses on continuous monitoring of the condition and response to therapy.
TSH Suppression Test
Adults PO 75 to 100 mcg/day for 7 days.
Storage/Stability
Store tablets in tightly closed container at controlled room temperature (59° to 86°F); store injection in refrigerator (36° to 46°F).
Cytomel Possible Side Effects
Exceeding the individual limits of compatibility for liothyronine or taking an overdose, especially, if the dose of Cytomel is increased too quickly at the beginning of the treatment, can cause the following clinical symptoms for a thyroid hyperfunction:
- heart palpitation
- trembling
- irregular heartbeat
- heart oppression
- agitation
- shortness of breath
- excretion of sugar through the urine
- excessive perspiration
- diarrhea
- weight loss
- psychic disorders
Our experience is that most symptoms consist of trembling of hands, nausea, headaches, high perspiration, and increased heartbeat. These negative side effects of Cytomel can often be eliminated by temporarily reducing the daily dosage. Caution, however is advised when taking Cytomel since, especially in the beginning, the Cytomel effect can be quick and sometimes drastic.
Overdosage
Symptoms of hyperthyroidism: Headache, irritability, nervousness, sweating, tachycardia, increased bowel motility, menstrual irregularities, palpitations, vomiting, psychosis, seizure, fever, angina pectoris, CHF, shock, arrhythmias, thyroid storm.
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