impact of food on drugs, coffee with synthroid

How do you take your Synthroid, the levothyroxine medication used to treat an underactive thyroid gland? Usually, people are urged to take it first thing in the morning. Ideally, it is taken at least half an hour to an hour before eating or drinking anything else. That’s because quite a few things interfere with Synthroid absorption. But not everyone is willing to give up morning coffee with Synthroid. What else can you do?

Is It Essential to Take Synthroid in the Morning?

Q. I was told to take my Synthroid before breakfast. Some of my favorite healthy breakfast choices have a lot of fiber, like oatmeal and granola and walnuts. I read that fiber can interfere with Synthroid absorption.

When I discovered coffee also was prohibited for at least an hour after taking the pill, that did it! No more morning Synthroid for me. Why don’t doctors know these things?

Alternate Dosing Avoids Coffee with Synthroid:

A. That is a good question. The FDA includes a warning about fiber reducing levothyroxine (Synthroid) absorption in its prescribing information available to every doctor.

Quite a few foods can affect Synthroid absorption. Coffee and soybeans can significantly reduce the amount of levothyroxine that is absorbed, while vitamin C increases absorption (Skelin et al, Clinical Therapeutics, Feb. 2017). If you like a latte, or put milk on your bran flakes, the plot thickens. Cow’s milk also interferes with optimal levothyroxine absorption (Chon, Endocrine Society, April 1, 2017).

Taking Synthroid at Bedtime:

Many people have concluded, just as you did, that no coffee in the morning is a non-starter. Instead, they take their Synthroid in the evening. That eliminates the problem of coffee with Synthroid and works just as well, if not better (Bolk et al, Archives of Internal Medicine, Dec. 13, 2010).

You can learn more about the pros and cons of levothyroxine and the best ways to take it from our Guide to Thyroid Hormones. 

Update:

A previous version of this article was entitled “No Coffee with Synthroid Means the Morning Dose Is No Good.” We have changed the title to “Drinking Coffee with Synthroid Means the Morning Dose Is No Good,” because the previous title was confusing.

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  1. lou
    Reply

    For those who want to take synthroid at bedtime, it still needs to be on an empty stomach. Meaning no snacking between evening meal and bedtime!
    And calcium needs to be taken about 6 hours after synthroid tablets.

  2. Judith
    North Carolina
    Reply

    Take your medication during the night when you go to the bathroom (I take mine around 4-4:30 a.m.). No problem drinking coffee, taking nutrients or eating what I want at breakfast. Works great!

  3. Daisy Mae
    Reply

    I have found the best time to take my levothyroxine is at about 3am when I am taking my nightly stroll to the bathroom. It doesn’t conflict with any pills taken during the day or with anything I may have swallowed just before bedtime.

  4. Karen
    28731
    Reply

    I take my synthroid, with decaf coffee, every morning when I wake up. I have Hashimoto, so I assume my thyroid continues to fail with time. However, I have been stable for over a year now on the same dose, so if coffee does interfere, it can’t be enough to make a difference to me! And that prompts a question: Is it the caffeine that interferes?

  5. Deborah
    North Carolina
    Reply

    I always followed the recommended time before eat. But after reading one of your articles, I also learned it was recommended to wait before drinking coffee I was in shock! So now, like Debbie, I take my Synthroid during the wee hours of the morning. Then I can have my morning coffee straightaway.

  6. BonnieK
    Illinois
    Reply

    I have taken synthroid for 15 years in the morning and never miss my morning coffee. Given that my dose is obvious adjusted for the coffee I do not have any problems. The only things that affected my tsk numbers were a 42 pound intentional weight loss, cancer and being hit by a car. Have no thyroid so maybe it is different for those who still have some thyroid hormone.

  7. cliff
    Youston
    Reply

    I generally take my synthroid 1 to 1.5 hours before breakfast and have done well for years. occasionally I wait only 0.5 hours

  8. Abigail
    Reply

    It is very helpful to me that your articles include the medical / scientific sources of information. My doctor appreciated the information in this article about foods that interfere with the uptake or absorption of thyroid medications.

  9. Elizabeth
    wisconsin
    Reply

    After reading about issues with coffee and it’s effectiveness, I am switching tonight to taking my levothyroxine at bed time. I was told it wasn’t a problem to have with coffee, so I set up my whole routine around that advice. I have been taking meds for about 3 months and I even though my numbers are great to the doctor, I am so out of wack: hair loss, major weight gain, foggy mind, no energy what so ever! I can not give up my coffee because that seems to be the only thing to get me moving in the morning. It will be a new routine for me, but I sure hope I see a big change, I will let you know.

  10. Jeanne
    Florida
    Reply

    I started taking Synthroid in my fifties and too busy to think about details, just took it as I headed for work. I am 85, and just learned Synthroid rules…makes me wonder what difference does it make?

    • J. David A
      Springfield, MO, USA
      Reply

      Wilson’s syndrome might interest you. T4 has little activity until decarboxylated and enough made to outnumber the binding molecules. This chemical reaction occurs in the thyroid and in the body. Variations in this process have been ignored by most physicians to this date.

  11. susan
    Massachusetts
    Reply

    is the same true if one takes natural thyroid like Armour or Erfa? Thanks.

  12. Maria
    NJ
    Reply

    Is this drug the same as levoxyl?

  13. Millicent
    Reply

    I HAVE thyroid cancer that has metastizied to the lungs. I am presently taking 200 mg of thyroid to suppress the TSH. Nothing seems to work including 3 ablations. My doctor tried 225 mg of levothyroxin and that was tooooo much for me!!!! So I am back to 200 mg. But I do take the levothyroxin first thing in the morning followed by one cup of caffeine free coffee. Is this a problem? Could this be why my levothyroxin is not working?
    Skip2mloo

  14. Rita
    PA
    Reply

    I take multiple meds that, ideally, all have special administration rules.
    Now, if I need to get up during the night to use the bathroom, I take my Levoxyl with water (which helps my dry mouth). If I don’t get up I take it on arising with black unsweetened coffee. So far my TSH levels have been relatively stable for over 25 years.

  15. Elizabeth
    California
    Reply

    I have no problem taking my synthroid before breakfaszt. I take it as soon as I am awake. Its by my bed. By the time I am dressed and prepare my breakfast, sometimes more than an hour has passed since I’ve taken my meds.

    What I’d like to know is what other meds may interfere with my synthroid as I have other a.m. meds, 2 of which are anticonvulscents, Gabapentin and Lamotrigine. I also take Famotidine (for Pepcid).

  16. Karen
    Wenatchee,WA 98802
    Reply

    If you take Synthroid in the evening wouldn’t other meds that you take at night interfere with its absorption?

  17. L
    Southern US
    Reply

    So, what is the proper/best source for information on taking Synthroid? Two people in my household are taking Synthroid for two different reasons and have different doctors and pharmacies. One was told to take it in the morning, one said it does not matter.

    No mention ever made of coffee though mention has certainly been made of caffeine ingestion in the morning. What are the consequences of taking it just before bedtime? How long must one wait before coffee or breakfast (iron, calcium, and fiber included.)? Half an hour or four?

    What other medications are this fussy about being taken?

  18. Marty
    Seattle, WA
    Reply

    I recently had two wildly different results to TSH tests. For years, I’d been taking L-thyroxin with one other prescription medication and a bunch of supplements with results always within normal range.

    Then, I started taking it first thing in the morning (before coffee). Both odd test results occurred during this later time. We also changed pharmacies and I’m wondering if a different manufacturer’s formulation is causing the different results? I’m going to repeat the TSH test in two or three more weeks to see if one of the earlier results is a fluke. How does L-thyroxin react to wine (glass of wine before bed)?

  19. Suzy
    NC
    Reply

    I take my levothyroxine very early in the morning and wait at least an hour before eating or drinking anything. I am confused though about drinking coffee…I do usually have decaffeinated coffee with breakfast…..does drinking coffee at least an hour after taking the medication have an adverse effect on the effectiveness of the medicine? When, if ever is it o.k. to drink coffee if you are taking levothyroxine?

  20. Judith
    Ca
    Reply

    I have read this does not apply to Tirosint beause of the gel cap~~~

  21. Dotty
    Celebration FL
    Reply

    I’m usually up once a night for potty call. So what I do is place my Synthroid on the top of my pill bottle. I just take it when I get up in the middle of the night. If it’s still there in the morning, I know I must’ve slept great.

  22. Dorothy
    New Orleans, LA
    Reply

    As a senior I get up at least 2-4 times a night to go to the bathroom. In the middle of these trips, I make sure to take my Levothyroxine (usually between 2-4 AM.) My Synthroid problem is solved.

  23. Joan K
    FL
    Reply

    Easy, leave it on your night table or on the bathroom sink. When you get up in the night to urinate take it then. Plenty of time for it to absorb. Of course those of you who are lucky enough to be able to sleep all night will just have to suffer.

  24. Kat
    Florida
    Reply

    I tried taking my levothyroxine at night before bed, but it did not work as well for me, so back to morning. When I was working, I’d take my pill first thing when I got up, then take my breakfast (including coffee) to work with me and eat at my desk while viewing emails. I know some people must eat as soon as they get up in the morning, but that’s never been a problem for me.

  25. bill
    Reply

    Are you just trying to confuse people to sell your health guide?

  26. Cheryl
    Reply

    In my opinion this is important information that should come from the pharmacy that is selling the med. Many years ago I took Synthroid and as recommended I took first thing in the morning, probably with breakfast before I left for work.

  27. CARLIE
    Reply

    How does Armour Thyroid fare regarding coffee, fiber, dairy, etc.?

  28. Sallie
    North Carolina
    Reply

    I have taken Synthroid for 40+ years and even though my test results have always been “in the accepted range”, I continued to have hair loss, brittle nails, dry skin and fatigue. Two years ago a new pharmacist recommended I not take any medications within 3 to 4 hours of taking my Synthroid.

    After I switched to a 10pm pill time because of meals, I no longer have any symptoms. This has been a huge relief for me. I have mentioned my success in omitting these symptoms to friends and they also have switched to a later time to take their Synthroid (Levothyoxine) and have had positive changes in their symptoms. My pharmacist had the answer to a 40 year old problem.

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