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In summary we have high quality LT4 products on the US market. Smaller pharmacy operations may be dependent on distributers to supply their generic LT4 and personal experience has lead me to believe that the source of generic LT4 may vary from restocking to restocking while name-brand LT4 remains consistent from refill to refill.
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Similar results may be achieved by using name brand products from refill to refill but leave more flexibility of pharmacy choice for the patient. Chain pharmacies tend to carry the same source of generic throughout their network and with few exceptions, maintain the same source prospectively assuring patients of consistent dosing from refill to refill. As there are several generic LT4s on the US market the source of generic LT4 may be dependent on which pharmacy the patient utilizes. The recommendations of the American Thyroid Association, American Association of Clinical Endocrinologists and The Endocrine society as cited in the Brito report seem more valid than ever, start LT4 therapy with one product and stick with it. This occurs when prescriptions for name-brand products are not protected with language such as "Name-Brand Necessary." Substitution of name-brand products for generics or one generic for another are not addressed in the study of Brito et. I agree with the comment below that this is good news but does not have impact on the clinically important circumstance of retail switching from one product to another as required by most state laws. I am reassured that both generic and name-brand products seem equally effective in achieving initial and relatively short term longitudinal normalization of TSH in patients with primary hypothyroidism. I salute the FDA for regulating the levothyroxine (LT4) market resulting in effective standards of manufacturing, performance and potency in LT4 products on the US market. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.