Endocrine Abstracts

Background: Recent studies have indicated impairment in levothyroxine absorption when administered simultaneously with iron tablets. This clinical audit aims to prevent the impact of this interaction on our patients to optimize therapeutic outcomes.

Standard: The National Institute for Health and Care Excellence (NICE) guidelines recommend maintaining an interval of at least four hours between levothyroxine and ferrous sulfate tablets on administration. The British National Formulary (BNF) suggests separating the two medications by at least four hours and giving levothyroxine 30-60 minutes before breakfast.

Target: Separating levothyroxine and iron administration by at least 4 hours.

Method: This is a cross-sectional audit that included 50 patients admitted at North Cumbria Integrated Care NHS Trust, taking levothyroxine and iron salt tablets. Data on iron preparation, the timing of administration of the two medications, and the time interval between them were documented and compared to the NICE guidelines.

Results: Out of the 50 patients included, 84% were prescribed levothyroxine and iron at the same time with no interval. Of the 11 patients taking ferrous sulfate and levothyroxine, 10 patients took both without a time interval.

Action plan: 1. A presentation was done to raise awareness of this necessary change. 2. A poster was created to remind clinicians of the time interval on prescribing. 3. The electronic prescription system team was involved to display an alert on the system when the two medications are prescribed simultaneously.

Conclusion: These audit findings highlight the necessity for clinicians to be aware of this interaction and to consider alternative timing strategies according to the guidelines to optimize the efficacy of levothyroxine therapy to ensure the highest standards of patient care.