Clinical thyroidology november 2008 volume 20 issue 3

#OFFEE INTERFERES WITH THE INTESTINAL ABSORPTION OF LEVOTHYROXINE "ENVENGA 3 "ARTOLONE , 0APPALARDO -! 2USSO ! ,APA $ 'IORGIANNI ' 3ARACENO '4RIMARCHI & !LTERED INTESTINAL ABSORPTION OF,THYROXINE CAUSED BY COFFEE4HYROID   35--!29
"!#+'2/5.$ -ANY THINGS INTERFERE WITH LEVOTHYROXINE
,4 ABSORPTION SUCH AS IRON BILE ACIDnBINDING RESINS
CHOLESTYRAMINE AND COLESTIPOL OVERTHECOUNTER DRUGSCONTAINING IRON AND CALCIUM GASTRIC CONDITIONS SUCH ASACHLORHYDRIA AND FOOD INGESTION AROUND THE TIME ,4 IS TAKEN 4HE AUTHORS OF THIS STUDY HAVE PREVIOUSLY REPORTEDCASES OF DELAYED INTESTINAL ABSORPTION OF ,4 AND HAVE THUS BEEN MORE THAN USUALLY ATTENTIVE TO THIS PROBLEM ELICITINGDETAILED HISTORIES FROM THEIR PATIENTS ABOUT THE USE OF OTHERDRUGS AND THE DIETARY HABITS PATIENTS FOLLOW WHEN TAKING ,4 0RIMARY PHYSICIANS REFERRED PATIENTS WHO WERE TAKING ,4 FOR REPLACEMENT THERAPY OR TO SUPPRESS SERUM THYROTROPIN43( THAT FAILED TO PRODUCE THE EXPECTED RESULTS 4HEAUTHORS FOUND THAT SEVERAL PATIENTS WERE CONSISTENTLY DRINKINGCOFFEE OR ESPRESSO TO FACILITATE SWALLOWING THEIR ,4 &IGURE 4 ABSORPTION IN THE ACUTE LOADING TEST OF  «G OF ORAL 4 IN FOUR DIFFERENT METHODS OF INGESTION "RAN WAS INGESTED BY ONLY TWO WERE TAKING ,4 WITH WATER FOLLOWED SHORTLY BY DRINKING PATIENTS !5# IS AREA UNDER THE CURVE FOR 4 COFFEE OR ESPRESSO SUGGESTING THAT THIS MIGHT BE THE CAUSE OF WITH CONTROLS DRINKING WATER ALONE WITH ,4 o0 COMPARED WITH -%4(/$3 4HE STUDY SUBJECTS WERE EIGHT PATIENTS ALL OFWHOM WERE WOMEN 4HEIR MEAN ¢3$ AGE WAS ¢YEARS RANGE  TO  AND THEIR SERUM 43( LEVELS WERE¢ M)5, RANGE  TO   4EN HEALTHY VOLUNTEERSFOUR MEN AND SIX WOMEN AGED  TO  YEARS WERE ALSOSTUDIED 0ATIENTS AND VOLUNTEERS UNDERWENT IN VITRO STUDIESOF INTESTINAL ,4 ABSORPTION USING AN ORAL DOSE OF ,4 IN LIEU OF RADIOISOTOPIC TECHNIQUES )NSTEAD OF USING * «G OF ,4 FOR THE TEST WHICH IS THE USUAL DOSE FOR THIS PURPOSE PATIENTSAND VOLUNTEERS WERE GIVEN TWO «G ,4 TABLETS WITH APPROXIMATELY  ML OF WATER TO FACILITATE SWALLOWING WHICHWAS THE BASELINE STUDY ! SECOND TEST SUBSTITUTED ESPRESSOn ML FOR WATER WHILE INGESTING ,4AND A THIRD TEST USED WATER ALONE TO FACILITATE ,4 SWALLOWING FOLLOWED  HOUR LATER BY ESPRESSO 4HE STUDIES WERE REPEATED  TO  WEEKS LATERAND AGAIN AFTER ANOTHER  TO  WEEKS ALTHOUGH IN THE LAST TESTS &IGURE  $ATA FOR  VOLUNTEERS 3EE &IGURE  EXPLANATION 0 ANDo0 FOR RESULT VS WATER ALONE THE SEQUENCE OF WATER AND ESPRESSO WAS RANDOM4O FURTHERTEST THE IN VIVO EFFECTS OF KNOWN INHIBITORS OF ,4 INTESTINAL 2%35,43 4HE MAIN IN VIVO lNDINGS OF INTESTINAL 4 ABSORPTION TWO PATIENTS AND TWO VOLUNTEERS EACH INGESTED ARE SHOWN IN &IGURES  TO  4AKING  «G OF ,4 TWO PACKETS OF BRAN DISSOLVED IN  ML OF WATER WHEN THEY DRINKING ESPRESSO SIGNIlCANTLY LOWERED THE AVERAGE SERUM 4  OR  ML OF ALUMINUM HYDROXIDE PLUS MAGNESIUM HYDROCHLORIDE -AALOX  MINUTES AFTER SWALLOWING  «G  4HE IN VITRO EXPERIMENTS WERE DONE BY COMBINING A  AREA UNDER THE CURVE BUT THIS WAS NOT SIGNIlCANTLY DIFFERENT FROM THAT FOUND IN THE CONTROL OBSERVATIONS $RINKING -AALOX OR WITH SUCRALFATE OR DIETARY lBERS OF BRAN #,).)#!, 4(92/)$/,/'9 L ./6%-"%2  ESPRESSO  HOUR AFTER TAKING ,4 HAD NO SIGNIlCANT EFFECT ON ,4 INTESTINAL ABSORPTION (OWEVER THE DECREASE IN ,4 ABSORPTION WITH SIMULTANEOUS ,4 AND ESPRESSO INGESTION WAS NOT AS GREAT AS WITH ,4 AND BRAN &IGURES  AND  OR ,4 WITH -AALOX &IGURE  4HESE EFFECTS WERE SEEN IN BOTH PATIENTS AND VOLUNTEERS &IGURES  TO  4HE IN VITRO STUDIESTHAT TESTED THE RECOVERY OF 4 FROM A SOLUTION CONTAINING A KNOWN CONCENTRATION OF 4 FOUND THAT ESPRESSO WAS FOLD TO FOLD WEAKER THAN BRAN AND  TO FOLD WEAKER THAN-AALOX IN LOWERING THE 4 CONCENTRATION IN THE SOLUTION #/.#,53)/. $RINKING COFFEE OR ESPRESSO AT THE TIME ,4 IS TAKEN INTERFERES WITH THE INTESTINAL ABSORPTION OF ,4 &IGURE 4 INDEX DATA FOR ONE VOLUNTEER #/--%.4!29
TO REGULAR COFFEE &OR INSTANCE THE EFFECTS OF COFFEE ON THEGASTRIC EPITHELIAL CELLS DIFFER ACCORDING TO DIFFERENT ROASTING 4HIS STUDY CLEARLY SHOWS THAT DRINKING ESPRESSO OR COFFEE METHODS AND DIFFERENT COFFEES AND MAY VARY IN THEIR EFFECT MAY INTERFERE WITH INTESTINAL ABSORPTION OF ,4 IF ONE DRINKS ON THE INTESTINAL MUCOSA    3TILL ALL EIGHT PATIENTS HAD IT WITH OR SHORTLY AFTER LEVOTHYROXINE IS TAKEN 4HIS PATTERN 43( LEVELS IN THE THERAPEUTIC RANGE AFTER BEING INSTRUCTED OF TAKING ESPRESSO OR COFFEE WITH ,4 WAS HIGHLY CONSISTENT TO REFRAIN FROM DRINKING COFFEE AND TO ABSTAIN FROM EATING AMONG THE EIGHT STUDY PATIENTS 4HE EFFECT WAS SIGNIlCANT FOR  MINUTES AFTER TAKING ,4 #OFFEE DOES NOT CHANGE THE BUT IS NOT AS SEVERE AS THAT PRODUCED BY -AALOX OR BY BRAN GASTRIC P( NOR DOES IT IMPAIR GASTRIC EMPTYING AND INTESTINAL INGESTED AT THE TIME ,4 IS TAKEN4HE EFFECT OF ESPRESSO WAS TRANSIT IN NORMAL VOLUNTEERS "ECAUSE THE "ENVENGA STUDY IS OBVIATED BY DRINKING IT  MINUTES AFTER TAKING ,44HE STUDY RETROSPECTIVE IT RELIED ON THE RECOLLECTIONS OF PATIENTS RATHER ALSO SHOWS THAT ESPRESSO SEQUESTERS ,4 IN VITRO ALTHOUGH THAN A SYSTEMATIC RECORDING OF THE TIMING OF MEALS AND COFFEE ONE OF THE VOLUNTEERS HAD AN INCREASE IN THE ABSORPTION OF INGESTION 3TILL THE OBSERVATIONS ARE STRONG ENOUGH AND ,4 WITH COFFEE INGESTION4HE MECHANISM BY WHICH ESPRESSO THE RECOMMENDATIONS ARE SIMPLE ENOUGH TO MERELY WARN DECREASES ,4 ABSORPTION IS UNCERTAIN BUT THE AUTHORS OPINE PATIENTS ABOUT THIS PROBLEM AND TO ADD COFFEE TO THE LIST OF THAT IT ACTS BY SEQUESTERING ,4 RENDERING THE HORMONE LESS THINGS TO BE AVOIDED AT THE TIME THAT ,4 IS TAKEN AVAILABLE FOR UPTAKE BY INTESTINAL EPITHELIUM !LSO ALL THE INVIVO STUDIES WERE DONE WITH ESPRESSO AND NOT COFFEE PER SE RAISING SOME CONCERNS THAT THESE lNDINGS MIGHT NOT APPLY  &IEBICH ",6ALENTE 0 &ERRER-ONTIEL ! ET AL %FFECTS OF COFFEESBEFORE AND AFTER SPECIAL TREATMENT PROCEDURE ON CELL MEMBRANEPOTENTIALS IN STOMACH CELLS -ETHODS &IND %XP #LIN 0HARMACOL  %HRLICH ! "ASSE ( (ENKEL%RNST * ET AL %FFECT OF DIFFERENTLYPROCESSED COFFEE ON THE GASTRIC POTENTIAL DIFFERENCE ANDINTRAGASTRIC P( IN HEALTHY VOLUNTEERS -ETHODS &IND %XP #LIN0HARMACOL  #,).)#!, 4(92/)$/,/'9 L ./6%-"%2 

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