Package Leaflet: Information for the User

Levotiroxina Sanofi 50 microgram tablets

Levotiroxine sodium

Read this leaflet carefully before you start to take this medicine because it contains important information for you.

• Keep this leaflet, as you may need to read it again.
• If you have any questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not give it to others even if they have the same symptoms as you, as it may harm them.
• If you experience any side effects, consult your doctor or pharmacist, even if they are not listed in this leaflet.Seesection4.

Levotiroxina Sanofi 50 micrograms is a medication that contains levotiroxine, a thyroid hormone, as the active substance. It has the same effect as the hormone that is produced naturally. Levotiroxina Sanofi is used to replace the thyroid hormone that is lacking or/and to alleviate the poor functioning of the thyroid gland.

Levotiroxina Sanofi is used:

• to replace the hormone deficiency in all forms of hypothyroidism (underactive thyroid),

• to prevent the reappearance of new goiters (increase in thyroid) after thyroid surgery in patients with normal thyroid function (depending on thyroid function after surgery),
• to treat benign goiter (benign stroma) in patients with normal thyroid function,
• as supplementary therapy for hyperthyroidism (overactive thyroid) in patients who are receiving thyroid-suppressive agents (anti-thyroid medication), after achieving a normal metabolic status,
• for malignant thyroid tumors, especially after surgery to suppress the growth of a new tumor and as a supplement in the absence of thyroid hormone.

Do not takeLevotiroxina Sanofi

• if you are hypersensitive (allergic) to levothyroxine sodium or to any of the other components of this medication (listed in section 6),
• if you have any of the following conditions or any of the conditions listed below:
• • untreated hyperactive thyroid,
  • untreated adrenal insufficiency (poor adrenal function),
  • untreated poor pituitary function, if this has resulted in adrenal insufficiency (poor adrenal function) that requires treatment,
  • acute myocardial infarction,
  • acute inflammation of the heart muscle (myocarditis),
  • acute inflammation of all layers of the heart (pancarditis).

If you are pregnant, do not take Levotiroxina Sanofi at the same time as another medication for hyperactive thyroid (designated as thyrostatic agents) (see section “Pregnancy, lactation and fertility”).

Medical condition reviews

Before starting treatment with Levotiroxina Sanofi, the following conditions or disorders must be ruled out or treated:

• coronary disease,
• chest pain with a feeling of oppression (angina pectoris),
• high blood pressure,
• poor pituitary function and/or poor adrenal function,
• areas in the thyroid gland that produce uncontrolled amounts of thyroid hormone (thyroid autonomy).

Warnings and precautions

Consult your doctor or pharmacist before starting to take Levotiroxina Sanofi.

Be especially careful with Levotiroxina Sanofi

• if you have already had a heart attack, or if you have coronary disease, heart failure, arrhythmias or chronic cardiomyopathy (non-acute inflammation of the heart muscle), or if you have had a long-standing hypothyroid condition. In these cases, high levels of hormone in the blood must be avoided. Your thyroid hormone levels must therefore be monitored more frequently. Consult your doctor if you experience milder signs of hyperactive thyroid as a result of Levotiroxina Sanofi administration (see section 4. “Possible side effects”).
• if you have a hypothyroid condition due to pituitary gland disease. In this case, you may also have poor adrenal function, which must be treated first by your doctor (treatment with hydrocortisone). This can trigger an acute adrenal crisis without proper treatment.
• if you suspect that you have areas in the thyroid gland that produce uncontrolled amounts of thyroid hormone. Before starting treatment, this must be investigated with further thyroid function tests.
• if you are a postmenopausal woman, and have a high risk of osteoporosis, your doctor must monitor your thyroid functionmore frequently. This isto avoid high levels of thyroid hormone in the blood and to ensure that the lowest required dose is administered.
• if you have diabetes. See the information in the section “Other medications andLevotiroxina Sanofi”.
• if you are being treated with certain anticoagulants (blood-thinning medications, such as dicumarol) or medications that can affect thyroid function (e.g. amiodarone, tyrosine kinase inhibitors [for cancer treatment], salicylates and furosemide at high doses). See the information in the section “Other medications andLevotiroxina Sanofi”.

• if you are being treated with a premature low-birth-weight baby. Extreme caution must be exercised when starting treatment with levothyroxine, as it may cause circulatory collapse due to immature adrenal function (see section 4. “Possible side effects”).Thyroid hormone levels will be monitored periodically when starting levothyroxine treatment in premature babies with very low birth weight, as it may cause a rapid drop in blood pressure (known as circulatory collapse).

• if you have a history of epilepsy, as the risk of seizures increases when levothyroxine is administered.
• if you experience an allergic reaction (see section Possible side effects). Contact your doctor or healthcare professional immediately or go to the nearest hospital emergency room immediately.
• if you are to undergo laboratory tests to control your thyroid hormone levels, you must inform your doctor or laboratory personnel that you are taking or have recently taken biotin (also known as vitamin H, vitamin B7 or vitamin B8). Biotin may affect the results of laboratory tests. Depending on the test, the results may be falsely elevated or falsely reduced due to biotin. Your doctor may instruct you to stop taking biotin before the tests are performed. You should also be aware that other products you may be taking, such as multivitamin preparations or hair, skin and nail supplements, may also contain biotin. This could affect the results of laboratory tests. Inform your doctor or laboratory personnel if you are taking these products (note the information in the section “Other medications andLevotiroxina Sanofi”).

Off-label use (outside indication)

Do not take Levotiroxina Sanofi to lose weight. If your blood thyroid hormone levels are within the normal range, an additional dose of thyroid hormone will not cause weight loss. Severe or even life-threatening side effects may occur if you take additional thyroid hormones or increase your dose without consulting your doctor, especially in combination with certain weight-reducing products.

Changing treatment

Thyroid imbalance may occur if you need to change your medication to another product containing levothyroxine. Consult your doctor if you have any doubts about how to change your medication. Close monitoring (clinical and laboratory parameters) is required during the transition period. Inform your doctor if you experience any side effects, as this may indicate that your dose needs to be adjusted up or down.

Geriatric patients

In elderly patients, a more careful dose adjustment (especially if they have heart problems) and more frequent medical reviews are required.

Other medications andLevotiroxina Sanofi

Inform your doctor or pharmacist if you are taking/using, have taken/used recently or may need to take/use any other medication.

Levotiroxina Sanofi affects the effects of the following agents and groups of medications:

• Antidiabetic medications (medications that reduce blood sugar levels) (such as metformin, glimepiride and glibenclamide, as well as insulin):

If you have diabetes, you must regularly monitor your blood sugar levels, especially when starting and stopping thyroid hormone treatment.

Your doctor may need to adjust the dose of your antidiabetic medication, as levothyroxine may reduce the effect of medications that reduce blood sugar levels.

• Anticoagulant medications that prevent blood clotting - designated as anticoagulants (cumarin derivatives):

In combination with Levotiroxina Sanofi and coumarin derivatives (e.g. dicumarol), you must regularly review your blood coagulation. Your doctor may need to reduce the dose of your anticoagulant medications, as levothyroxine may increase their effect.

The effect of Levotiroxina Sanofi is influenced by other medications, as indicated below:

• Ion exchange resins:

After taking Levotiroxina Sanofi, wait 4 – 5 hours before taking medications used to reduce blood lipid levels (e.g. cholestyramine, cholestipol) or eliminate high potassium or phosphate levels in the blood (calcium and sodium sulfate polystyrene sulfonic acid, sevelamer). Otherwise, these medications will block the absorption of levothyroxine in the intestine and make it less effective.

• Bile acid sequestrants:

Colesevelam (a medication used to reduce elevated blood lipid levels) binds to levothyroxine and reduces its absorption in the intestine. Therefore, Levotiroxina Sanofi must be taken at least 4 hours before colesevelam.

• Medications containing aluminum used to bind stomach acid, medications containing iron, calcium carbonate, proton pump inhibitors:

• TakeLevotiroxina Sanofi at least 2hours before taking medications containing aluminum, used to bind stomach acid (antacids, sucralfate), medications containing iron or calcium carbonate. Otherwise, these medications may reduce the absorption of levothyroxine in the intestine and make it less effective.
• Proton pump inhibitors (e.g. omeprazole, esomeprazole, pantoprazole, rabeprazole and lansoprazole) are used to reduce stomach acid production, which may reduce intestinal levothyroxine absorption and make it less effective. If you are taking levothyroxine at the same time as receiving a proton pump inhibitor, your doctor may need to monitor your thyroid function and may need to adjust the dose of Levotiroxina Sanofi.

• Propylthiouracil, glucocorticoids, beta-blockers (especially propranolol):

Propylthiouracil (used for hyperactive thyroid), glucocorticoids (adrenocortical hormones, “cortisone”) and beta-blockers (used to reduce heart rate and blood pressure) block the conversion of levothyroxine to triiodothyronine, the active form, and may therefore make Levotiroxina Sanofi less effective.

• Amiodarone, contrast agents containing iodine:

Amiodarone (used for arrhythmias) and contrast agents containing iodine (some agents used for X-ray diagnosis) may, due to their high iodine content, trigger both hyperactive and hypothyroid thyroid function. You must be especially careful in the case of nodular goiter, where there may be undetected areas in the thyroid gland producing uncontrolled amounts of thyroid hormone (autonomies). Amiodarone blocks the conversion of levothyroxine to triiodothyronine, the active form, and may therefore affect the effect of Levotiroxina Sanofi. Your doctor may adjust the dose of Levotiroxina Sanofi.

• Tyrosine kinase inhibitors (for cancer treatment):

If you are using levothyroxine at the same time as tyrosine kinase inhibitors (e.g. imatinib, sunitinib, sorafenib or motesanib), your doctor must carefully monitor your symptoms and thyroid function. There may be some loss of levothyroxine effect. Your doctor may adjust the dose of Levotiroxina Sanofi.

• The following medications may affect the effect of Levotiroxina Sanofi:
• • salicylates, especially at doses greater than 2.0 g/day (medications that reduce fever and relieve pain),
  • dicumarol (an anticoagulant),
  • high doses of furosemide (250 mg) (used to increase urine excretion),
  • clofibrate (used to reduce elevated blood lipid levels).
• Anticonceptives or hormone replacement therapy:

If you are taking anticonceptives containing estrogens (“the pill”) or receiving hormone replacement therapy after menopause, you may have an increased need for levothyroxine.

• Sertraline; chloroquine/proguanil:

Sertraline (an antidepressant) and chloroquine/proguanil (used for malaria and rheumatic disease) reduce the effectiveness of levothyroxine.

• Rifampicin, carbamazepine,phenytoin, barbiturates, products containing St. John's Wort:

Rifampicin (an antibiotic), carbamazepine (used for seizures), phenytoin (used for seizures and arrhythmias), barbiturates (used for seizures, anesthesia; certain sleeping pills) and products containing St. John's Wort may weaken the effect of levothyroxine.

• Protease inhibitors (used for HIV infection):

If you are using levothyroxine at the same time as protease inhibitors (lopinavir, ritonavir), your doctor must carefully monitor your symptoms and thyroid function. There may be some loss of levothyroxine effect when administered at the same time as lopinavir/ritonavir.

• If you are taking levothyroxine at the same time as semaglutide (an antidiabetic medication), this may affect your levothyroxine levels and your doctor may need to monitor your thyroid function and adjust the dose of Levotiroxina Sanofi.
• If you are taking or have recently taken biotin, inform your doctor or laboratory personnel when they are to perform laboratory tests to control your thyroid hormone levels. Biotin may affect the results of laboratory tests (see “Warnings and precautions”).
• Orlistat – used to treat obesity.

Levotiroxina Sanofi with food and beverages

If your diet contains soy, your doctor will monitor your thyroid hormone levels in the blood more frequently. Your doctor may need to adjust the dose of Levotiroxina Sanofi during and after this diet (unusually, high doses may be required), as soy products may affect levothyroxine absorption in the intestine and make it less effective.

Do not take Levotiroxina Sanofi with coffee, as it may reduce levothyroxine absorption in the intestine and make it less effective. After taking Levotiroxina Sanofi, wait at least 30 minutes to 1 hour before taking coffee. It is recommended that patients with a coffee habit and taking levothyroxine do not change their “coffee habit” without their doctor monitoring and monitoring their levothyroxine levels.

Pregnancy, lactation and fertility

If you are pregnant or breastfeeding, or if you think you may be pregnant, consult your doctor or pharmacist before taking this medication.

Correct thyroid hormone treatment is particularly important during pregnancy and lactation to ensure optimal health for the mother and the fetus. Therefore, regular monitoring under the supervision of your doctor is required. Despite its extensive use during pregnancy, there have been no adverse effects on pregnancy or the health of the fetus or newborn due to levothyroxine.

Thyroid function should be reviewed during and after pregnancy. Your doctor may need to adjust the dose, as you may have an increased need for thyroid hormone due to the increase in blood estrogen levels during pregnancy.

During pregnancy, do not take Levotiroxina Sanofi at the same time as antithyroid medications (also designated as thyrostatic agents), as this will result in the need for a higher dose of the thyrostatic agent. Antithyroid medications (unlike levothyroxine) can enter the bloodstream of the fetus through the placenta and cause hypothyroid thyroid function in the fetus. If you have hyperactive thyroid, your doctor should treat you during pregnancy only with low doses of thyrostatic agents.

If you are breastfeeding, continue taking levothyroxine as recommended by your doctor.

Even at high doses of levothyroxine treatment, the amount oflevothyroxinethat passes into breast milk during lactation is very low and harmless.

It is likely that hypothyroidism or hyperthyroidism will have an effect on fertility. When treating patients with hypothyroidism, the dose of Levotiroxina Sanofi should be adjusted based on laboratory test results, as an insufficient dose may not improve hypothyroidism and an excessive dose may cause hyperthyroidism.

Driving and operating machinery

No studies have been conducted to investigate the effects of Levotiroxina Sanofi on the ability to drive vehicles and operate machinery.

Levotiroxina Sanofi contains sodium

This medication contains less than 23 mg of sodium (1 mmol) per tablet; this is, essentially “sodium-free”.

Follow exactly the administration instructions of this medication as indicated by your doctor. In case of doubt, consult your doctor again.

Your doctor will determine the daily dose you need, based on the follow-up of your exams.

Dose

There are available tablets with different concentrations of active substance (25, 50, 75, 100, 125, 150, 175, and 200 micrograms of levotiroxine sodium), for individualized treatments. This means that you will only need to take a single tablet daily in most cases.

To start treatment, to increase the dose in adults, and to treat children, your doctor may prescribe tablets with a lower amount of active substance.

Depending on the symptoms, your doctor will be guided by the following recommendations:

• For treating hypothyroidism, adults will start taking 25 - 50 micrograms of levotiroxine sodium per day (equivalent to half - 1 tablet of Levotiroxine Sanofi 50 micrograms). This dose can be increased, following the doctor's instructions, by 25 - 50 micrograms of levotiroxine sodium, at intervals of 2 to 4 weeks, up to a daily dose of 100 - 200 micrograms of levotiroxine sodium (equivalent to 2 - 4 tablets of Levotiroxine Sanofi 50 micrograms).
• To prevent new episodes of goiter after the removal of the goiter and to treat benign goiter, 75 - 200 micrograms of levotiroxine sodium per day (equivalent to 1 and a half - 4 tablets of Levotiroxine Sanofi 50 micrograms) will be taken.
• As supplementary treatment in the treatment of hyperactive thyroid with thyroid-stimulating agents, 50 - 100 micrograms of levotiroxine sodium per day (equivalent to 1 - 2 tablets of Levotiroxine Sanofi 50 micrograms) will be taken.
• After thyroid surgery due to malignant thyroid tumor, the daily dose is 150 - 300 micrograms of levotiroxine sodium.

In some cases, a lower dose of thyroid hormone may be sufficient.

Administration Form

The total daily dose must be taken in the morning with an empty stomach, at least half an hour before breakfast. The tablets should be swallowed whole (without chewing) with plenty of liquid, preferably with a glass of water.

The active substance is absorbed better with an empty stomach than before or after a meal.

Children will receive the total daily dose at least half an hour before the first meal of the day. They can also take the tablet dissolved in a little water (10 - 15 ml) and the fine dispersion resulting from it (which must be prepared just for each dose), will be administered with a little more liquid (5 - 10 ml).

Use in Children

In the long-term treatment of congenital hypothyroidism and hereditary hypothyroidism (inactive thyroid), the daily dose is generally 100 to 150 micrograms of levotiroxine sodium per square meter of body surface.

In neonates and infants with congenital hypothyroidism (inactive thyroid), rapid hormone substitution is especially important to achieve normal mental and physical development.

For this type of inactive thyroid, the recommended daily dose is 10 - 15 micrograms of levotiroxine sodium per kilogram of body weight, during the first 3 months of treatment. From then on, your doctor will adjust the required dose individually, according to the follow-up of controls (including blood levels of thyroid hormone).

In children with acquired hypothyroidism (inactive thyroid), the recommended dose of levotiroxine sodium is 12.5 - 50 micrograms per day, at the start of treatment. Your doctor will gradually increase the dose every 2 to 4 weeks, until reaching the required dose for long-term treatment. During this time, your doctor should be guided particularly by the levels of thyroid hormone in the blood.

Older patients, patients with coronary disease, patients with severe or long-standing hypothyroidism (inactive thyroid)

In older patients, in patients with coronary disease, and in patients with severe or long-standing hypothyroidism (inactive thyroid), special care should be taken when starting treatment with thyroid hormones (a low initial dose, which is gradually increased and at prolonged intervals, with frequent monitoring of thyroid hormone).

Patients with low body weight and patients with a large goiter

Experience shows that a low dose is sufficient even in patients with low body weight and in patients with a large goiter.

Treatment Duration

• In most cases, Levotiroxine Sanofi should be taken for a long period in cases of inactive thyroid, after goiter or after thyroid removal, and to prevent the growth of a new goiter after goiter removal.
• When used as supplementary therapy to treat hyperactive thyroid, Levotiroxine Sanofi 50 micrograms should be taken for the same time as thyroid-stimulating agents (antithyroid medications).
• To treat benign goiter in patients with normal thyroid function, a treatment period of between 6 months and 2 years is necessary. If treatment with Levotiroxine Sanofi has not achieved the desired result in due time, your doctor should consider other therapeutic options.

If you take more Levotiroxine Sanofi than you should

The signs of overdose are described in section 4. "Possible adverse effects". Consult your doctor immediately if these symptoms appear.

In case of overdose or accidental ingestion, consult the Toxicological Information Service, phone 91 562.04.20, indicating the medication and the amount ingested.

If you forgot to take Levotiroxine Sanofi

If you have taken too little or if you have forgotten a dose, do not take a double dose to compensate for the missed dose. Continue taking your tablets according to your regular treatment.

If you interrupt treatment with Levotiroxine Sanofi

To ensure the success of your treatment, you must take Levotiroxine Sanofi regularly at the prescribed dose. Do not change, suspend, or interrupt treatment with Levotiroxine Sanofi on your own too soon, as symptoms may reappear.

If you have any other doubts about the use of this medication, ask your doctor or pharmacist.

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Like all medicines, this medicine can cause side effects, although not everyone will experience them.

Hypersensitivity to the active ingredient or to other components of Levotiroxina Sanofi

In case of hypersensitivity to levotiroxine or to any of the other components of Levotiroxina Sanofi,allergic reactions of the skin and respiratory tract (either immediately or after several days of medication administration) may occur, which can be life-threatening. Symptoms may include skin rash, itching, difficulty breathing, shortness of breath, facial swelling, lips, throat, or tongue. Contact your doctor or healthcare professional immediately or go to the nearest hospital emergency room immediately.

Intolerance to thedosage, overdose

If the dosage is not tolerated in individual cases, or in the case of an overdose, typical symptoms of hyperactive thyroid (hyperthyroidism) may appear, especially if the dose is increased too quickly at the beginning of treatment.

Very common side effects(may affect more than 1 in 10 patients)

• palpitations
• insomnia
• headache

Common side effects(may affect up to 1 in 10 patients)

• rapid heartbeat (tachycardia)
• nervousness

Rare side effects(may affect up to 1 in 1,000 patients)

• increase in pressure in the brain (especially in children)

Other side effects of unknown frequency(cannot be estimated from available data)

• hypersensitivity
• cardiac rhythm disorders
• chest pain with pressure (angina pectoris symptoms)
• allergic skin reactions (e.g.angioedema [difficulty breathing, or facial swelling, lips, throat, or tongue],skin rash, urticaria)
• inner restlessness
• muscle weakness and muscle cramps
• bone fragility (osteoporosis) at high doses of levotiroxine, especially in postmenopausal women, mainly when treated for a long period
• sensation of heat
• menstrual disorders
• diarrhea
• vomiting
• nausea
• weight loss
• tremor
• excessive sweating
• fever
• circulatory collapse in premature infants with low birth weight (see section 2. “Warnings and precautions”).

Inform your doctor if any side effects occur.He will decide whether to reduce the daily dose or interrupt the medication for a few days. As soon as the side effect disappears, treatment can be resumed with a cautious dose.

Reporting of side effects

If you experience any type of side effect, consult your doctor or pharmacist, even if it is a possible side effect that does not appear in this prospectus. You can also report them directly through the Spanish System for the Pharmacovigilance of Medicines for Human Use:https://www.notificaram.es.By reporting side effects, you can contribute to providing more information on the safety of this medicine.

Keep this medication out of the sight and reach of children.

Do not use this medication after the expiration date that appears on the packaging after CAD. The expiration date is the last day of the month indicated.

Do not store at a temperature above 25°C.

Medications should not be disposed of through drains or in the trash. Dispose of the packaging and medications you no longer need at the SIGRE collection point at the pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and medications you no longer need. By doing so, you will help protect the environment.

Composition of Levotiroxina Sanofi 50 micrograms tablets

• The active ingredient is levothyroxine sodium. Each tablet contains 50 micrograms of levothyroxine sodium.
• The other components are:cornstarch, pregelatinized cornstarch, microcrystalline cellulose, sodium carbonate, sodium thiosulfate (F.E.), anhydrous colloidal silica, and hydrogenated ricin oil.

Appearance of the product and content of the container

Levotiroxina Sanofi 50 micrograms are round, white, scored tablets on one face and with the inscription “2L” on both faces.

The tablets can be divided into two equal halves.

Levotiroxina Sanofi 50 micrograms is available in containers of 28 (calendar pack), 50, 84 (calendar pack), 98 (calendar pack), 100, and 500 tablets (10 x 50 tablets).

Only some container sizes may be commercially marketed.

Holder of the marketing authorization

sanofi-aventis, S.A.

C/ Rosselló i Porcel, 21

08016 Barcelona

Spain

Responsible for manufacturing

sanofi-aventis, S.A.

Ctra C35 La Batlloria a Hostalric, km 63.09

Riells i Viabrea, 17404 - Girona

Spain

or

Sanofi-Aventis Deutschland GmbH

Industriepark Hoechst-Brüningstrasse 50

65926 Frankfurt am Main

Germany

This medicine is authorized in the member states of the European Economic Area with the following names:

Germany:L-Thyroxin Winthrop50 µg Tablets

Spain:Levotiroxina Sanofi 50 micrograms tablets

France:L-Thyroxin Henning 50 micrograms scored tablet

Date of the last review of this leaflet:March 2023

Detailed information about this medicine is available on the website of the Spanish Agency for Medicines and Medical Devices (AEMPS)http://www.aemps.gob.es/