{
 "query": "levothyroxine / liothyronine",
 "ingredient": "levothyroxine / liothyronine",
 "slug": "levothyroxine-liothyronine",
 "rxcui": "465675",
 "brands": [
  "Thyrolar"
 ],
 "names": [
  "levothyroxine / liothyronine"
 ],
 "components": [
  {
   "ingredient": "levothyroxine",
   "slug": "levothyroxine",
   "grade": "C",
   "total": 71,
   "scores": {
    "safety": "C",
    "evidence": "D",
    "regulatory": "B",
    "conflict": "B",
    "options": "C"
   },
   "boxed": true,
   "controlled": false,
   "first_approval_fmt": "08/21/2000",
   "first_approval": "20000821"
  },
  {
   "ingredient": "liothyronine",
   "slug": "liothyronine",
   "grade": "C",
   "total": 66,
   "scores": {
    "safety": "C",
    "evidence": "F",
    "regulatory": "A",
    "conflict": "A",
    "options": "C"
   },
   "boxed": true,
   "controlled": false,
   "first_approval_fmt": "05/08/1956",
   "first_approval": "19560508"
  }
 ],
 "classes": [],
 "alternatives": [],
 "label": {},
 "faers": null,
 "faers_base": {
  "total": 20692304,
  "serious_share": 0.5742697381596559,
  "death_share": 0.09102355155810585
 },
 "recalls": [],
 "recall_total": 0,
 "drugsfda": {
  "first_approval": "19560508",
  "first_approval_fmt": "",
  "anda": 10,
  "nda": 0,
  "rems": false,
  "labeling_recent": 0
 },
 "trials": null,
 "pubmed": null,
 "payments": {
  "year": "2024",
  "usd": 0.0,
  "records": 0,
  "by_name": [],
  "names_checked": [
   "levothyroxine / liothyronine",
   "Thyrolar"
  ],
  "source": "bulk-index"
 },
 "partd": null,
 "mdl": [],
 "dsc": [],
 "settlements": [],
 "prescrire": null,
 "eml": null,
 "exposure": null,
 "scores": {
  "safety": {
   "score": 70,
   "letter": "C",
   "why": [
    "Graded by its riskiest ingredient, levothyroxine (70)",
    "Carries an FDA boxed warning, the strongest warning the FDA issues (-30)",
    "1,386 FDA reports naming it as the suspect drug per million Medicare fills, 0.5x the median drug on this site",
    "Death share in reports is near or below the FAERS average (0.8x)"
   ],
   "weight": 0.35
  },
  "evidence": {
   "score": 21,
   "letter": "F",
   "why": [
    "Graded by its riskiest ingredient, liothyronine (21)",
    "28 randomized trials and 4 systematic reviews/meta-analyses indexed in PubMed",
    "No Cochrane review found (-5)",
    "Only 15% of completed registered trials posted results (-15)",
    "'Drug ineffective' is the single most-reported item about this drug in FAERS (-5)"
   ],
   "weight": 0.25
  },
  "regulatory": {
   "score": 80,
   "letter": "B",
   "why": [
    "Graded by its riskiest ingredient, levothyroxine (80)",
    "Recalls since 2016: 0 Class I, 68 Class II, 2 Class III across 20 generic makers (-7)",
    "9 label changes approved since 2021: the safety story is still moving (-8)",
    "Label lists recent major changes to warnings or indications (-5)"
   ],
   "weight": 0.15
  },
  "conflict": {
   "score": 85,
   "letter": "B",
   "why": [
    "Graded by its riskiest ingredient, levothyroxine (85)",
    "Pharma paid doctors $579,638 tied to this drug last year (-15)",
    "Not named in any pending federal MDL"
   ],
   "weight": 0.15
  },
  "options": {
   "score": 70,
   "letter": "C",
   "why": [
    "Graded by its riskiest ingredient, levothyroxine (70)",
    "Generic versions approved (20 applications)",
    "No same-class alternatives found: little leverage to switch (-30)"
   ],
   "weight": 0.1
  }
 },
 "total": 62,
 "grade": "D",
 "questions": [
  "This is a fixed combination of levothyroxine and liothyronine. Why both together, instead of only the one I need?",
  "This drug carries a boxed warning. Which specific risk does it cover, and does it apply to me?",
  "The most-reported problems in FDA's adverse event data are fatigue, nausea, diarrhoea, headache. How would we recognize and handle those?",
  "Off-label use is among the most-reported items for this drug. Is my use on-label, and if not, what evidence supports it?",
  "What result are we expecting, by when, and what is the plan if it does not happen?",
  "If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)",
  "The most-reported problems in FDA's adverse event data are fatigue, headache, nausea. How would we recognize and handle those?"
 ]
}