A few reports describe reduced levothyroxine effects in patients given alum- inium/magnesium-containing antacids. The efficacy of levothyroxine can also be reduced by the concurrent use of calcium carbonate.
The general importance of the interaction with aluminium/magnesium - containing antacids is not known, but be alert for the need to increase the levothyroxine
dosage in any patient given antacids. With calcium carbonate, the mean reduction in the absorption of levothyroxine is quite small, but some individuals can
experience a clinically important effect. The cautious approach would be to advise all patients to separate the dosages by at least 4 hours.
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