Drug interactions
Epinephrine + Levothyroxine
Severity: Moderate
Epinephrine and Levothyroxine: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Thyroid hormones increase adrenergic sensitivity of the cardiovascular system, so the effects of epinephrine on heart rate and rhythm may be enhanced. The risk is greatest in patients with coronary artery disease or over-replaced thyroid status.
What this interaction means in plain words
Epinephrine and Levothyroxine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Epinephrine belongs to Endocrine; Levothyroxine belongs to Endocrine.
Why it happens
Thyroid hormone increases beta-adrenergic receptor responsiveness, producing additive cardiac stimulation with epinephrine.
What to do
Monitor heart rate, blood pressure and ECG when epinephrine is given to patients on levothyroxine, especially those with coronary disease. Use the lowest effective epinephrine dose and avoid thyroid over-replacement.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Levothyroxine
Other interactions of Epinephrine
- Epinephrine + Isocarboxazid Contraindicated
- Epinephrine + Phenelzine Contraindicated
- Epinephrine + Tranylcypromine Contraindicated
- Acebutolol + Epinephrine Major
- Amitriptyline + Epinephrine Major
- Amoxapine + Epinephrine Major
Frequently asked questions
Can I take Epinephrine with Levothyroxine?
MediHelp rates the interaction as moderate. Epinephrine and Levothyroxine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Thyroid hormones increase adrenergic sensitivity of the cardiovascular system, so the effects of epinephrine on heart rate and rhythm may be enhanced. The risk is greatest in patients with coronary artery disease or over-replaced thyroid status.
How serious is the interaction between Epinephrine and Levothyroxine?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor heart rate, blood pressure and ECG when epinephrine is given to patients on levothyroxine, especially those with coronary disease. Use the lowest effective epinephrine dose and avoid thyroid over-replacement.
What other medicines interact with Levothyroxine?
MediHelp also lists interactions of Levothyroxine with, for example, Cholestyramine, Sodium iodide i-131, Tiratricol. The full list is on the Levothyroxine page.
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