coffee in a cup, cocoa in your coffee

Levothyroxine (Levoxyl, Synthroid) was prescribed more than any other medication in the US last year. Wouldn’t you think people would be eager to learn the best way to take it? Yet there is surprising controversy over one simple problem: just how bad is it to drink coffee with levothyroxine? One reader took issue with our advice to wait.

How Should You Take Your Levothyroxine?

Q. I read on your website that you should not drink coffee within one hour of taking a thyroid pill. My endocrinologist disagrees with you. He said I can have coffee with levothyroxine, though I still should wait 45 minutes before eating breakfast.

Since I started taking this medication, 15 months ago, my thyroid level has remained the same even though I drink coffee right after taking my pill. Am I just lucky, or is the warning wrong?

The Trouble with Drinking Coffee with Levothyroxine:

A. Years ago, Italian researchers demonstrated that coffee interferes with the absorption of levothyroxine pills such as Synthroid (Benvenga et al Thyroid, March 2008). They also pointed out that bran and other dietary fibers block levothyroxine absorption more completely. So do antacids containing aluminum hydroxide or sucralfate. Calcium carbonate antacids, proton pump inhibitors such as omeprazole (Prilosec) or esomeprazole (Nexium), as well as the osteoporosis drugs raloxifene (Evista) all interfere significantly with levothyroxine absorption (Liwanpo & Hershman, Best Practice & Research. Clinical Endocrinology & Metabolism, Dec. 2009).

If You Insist on Drinking Coffee with Levothyroxine:

A different formulation, Tirosint, isn’t affected by coffee, although it is pricey (Vita et al, Expert Opinion on Drug Delivery, July 2014). A recent review recommends either this soft-gel formulation or an oral liquid levothyroxine for people troubled by malabsorption due to digestive disorders, bariatric surgery or incompatible medications (Fallahi et al, Expert Opinion on Drug Delivery, May 2017).

While it makes sense to avoid foods, drinks and medicines that interfere with levothyroxine absorption, the most important principle for taking this drug is consistency. Taking it exactly the same way every day allows the physician to adjust your dose to your needs.

Learn More:

We discuss exactly how to take your levothyroxine and how to interpret the blood tests that track your treatment progress in our Guide to Thyroid Hormones. Click on the link to purchase it online; it is too long to send in the mail.

You might also wish to listen to our interview with top scientist Dr. Antonio Bianco and patient advocate Mary Shomon. It was Show 1015: Thyroid Mysteries, Controversies and the Latest Research.

If you have found a “best way” to take levothyroxine, let us know about your experience. Share your thoughts below.

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  1. Dorothy
    New Orleans
    Reply

    I am the same as the majority of people who have responded. I take my levothyroxine in the middle of the night with no repercussions.

  2. Kathy
    Vernon, VT
    Reply

    Since I am at ‘that age” where I wake during the night (around 3 am) to use the bathroom, I have my pill in a little paper cup and take it at that time with a large glass of water.

    I don’t have to worry about other meds or coffee at that hour. It has worked for me for years. Try it.

  3. Diane E.
    NC
    Reply

    I got tired of trying to follow the instructions of not eating for an hour after taking my levothyroxine (which I’ve taken for 40 years). I found it rather restrictive. I now take it at night before bed along with my calcium (which you are not supposed to mix with vitamin C – part of my morning vitamins) and my low dose aspirin. It works for me.

  4. Sarah
    Fort Worth, Texas
    Reply

    I too like to drink coffee in the morning but to avoid the morning wait for my coffee, I set out my levothyroxine next to a glass of water and when I wake up in the middle of the night, usually around 2 or 3 a. m., I take the thyroid medicine at that time. I figure that by then my stomach is empty enough to process the medicine and the thyroid medicine can work while I’m sleeping through the remainder of the night.

    Occasionally, I have not awoken in the night and have been guilty of taking the thyroid medicine only 15 minutes before coffee. The middle of the night method does seem to keep my thyroid in order.

  5. Yvonne
    Houston Texas
    Reply

    Any reason thyroid medication can’t be taken at bed time when coffee and food are not an issue?

  6. Leonorah
    Reply

    To avoid any problems when taking my levothyroxine I take it when I get up to go to the bathroom at 3:00 A.M.

  7. CARLIE
    Reply

    What about Armour Thyroid? (And while I’m on the subject, I’ve heard of other, newer “complete” thyroid medications not involving pigs. Please, what are they? THANKS!

  8. Linda
    North Carolina
    Reply

    I was advised quite some time ago by my Nutritionist to take my Levothyroxine at bedtime since I do not eat anything within one hour of going to or one hour after going to bed. I have maintained this protocol for some time now, and it has worked very well for me.

  9. Victoria
    Roanoke, VA
    Reply

    I often wake up one or two hours early before I need to get up. I keep my levothyroxine pill at my bedside and take the pill when I wake up early. Then when it is time to get up, the medication has absorbed and I am ready for morning coffee. Lab results are consistently good.

  10. Rose
    Tampa, Florida
    Reply

    I have been taking Levothyroxine for more than 2 years at bedtime so there is no interaction with any food. My numbers are now normal and I have no side affects.

  11. LKD
    Southern US
    Reply

    This subject came up, again, at my house because two different people taking this drug were given two different instructions on taking it by two different pharmacies. An internet search, which included articles from People’s Pharmacy, is more confusing than not. Articles mention coffee, but what about tea? Caffeine is the morning drug of choice here. Is it the coffee that needs to be avoided or caffeine? “Avoid supplements containing iron and calcium for 4 hours on either side”. So, what about putting milk or cream in coffee an hour later, or having cereal and milk for breakfast? Synthroid’s official site is not helpful on this. Also have found nothing official on the difference between taking this at night or in the morning. Just “take on a regular schedule” which is a challenge also. Drugs should not be this difficult to take correctly, nor should it be so impossible to manage taking more than one.

  12. Richard
    GA
    Reply

    I take Levothyroxine, and I drink coffee every day with no ill effects. The reason coffee doesn’t seem to offset the affects may be because I take the Levothyroxine at 11 pm every night, way past the time of my last cup of coffee which is usually around 3 pm at the latest.

  13. Jacqueline Klucsarits
    Pennsylvania
    Reply

    Because I take a proton inhibitor … and drink coffee in the AM… I have switched to taking levothyrin at bedtime.

  14. Barbara
    Oceanside
    Reply

    I have taken thyroid medication for over forty years. For many years the medicine was Synthroid, and then a pharmacist suggested I take Armour. I take the medicine at night because I rarely forget to take it. When I took it first thing in the morning there were restrictions. To me the most important thing is being consistent. At age 72 Armour is the only prescribed medicine I take. Supplements, being my own advocate, and practicing alternative medicine have made a difference. For many years I have followed the People’s Pharmacy.

  15. Penelope
    Florida
    Reply

    My doctor suggested that taking the thyroid med when I get up in the middle of the night. Then if you have a fiber rich breakfast 2 or 3 hours later there’s less interference. Also I take hibiscus tea as the first beverage, and don’t have coffee until after 10 am as a mid-morning pick me up.This info about coffee’s interference with thyroid medication is new, but makes another reason to have it later in the morning.

  16. tony
    stuart, fl
    Reply

    If you take the med with 10 to 12 ounces of warm water you can probably have coffee within 20 minutes. I have done this for years with myself and clients. However, if you add any form of calcium into the coffee you risk binding the thyroid hormone.

  17. Kathy
    USA
    Reply

    I found that since I get up to urinate in the early morning hours (I am 62) and then go back to sleep, this is the best time to take my thyroid medication. I have also switched from levothyroxine to Armour thyroid this year (thanks to a new doctor) and I think that I am doing pretty well. We will see after my blood test this month. My free T3 and T4 have always been below range, even when my TSH is below 1.0

  18. Margaret R Dalton
    CA
    Reply

    I take Levothyroxine on an empty stomach with a full glass of water and wait an hour before taking another pill for blood pressure or eating/beverages.
    My question is how long after the hour wait before eating any fiber or the other substances mentioned in the article that interfere with Levothyroxine? Thank you.

  19. dzrlib
    usa
    Reply

    I never felt ‘right’ after the Armour Thyroid was first taken off the market. Thankfully, it returned and I immediately switched back to Armour Thyroid and feel much better.

  20. M.
    Durham, NC
    Reply

    I’ve taken Levothyroxine for over 18 years. I take it about 10pm. I also take 25mg Benadryl for sleep and 81 mg aspirin for cardio health. I sit up in bed for 15-30 minutes after taking the pills.
    – my pharmacist told me to just be consistent. My levels are always fine.

  21. Susan B.
    Mckinney, TX
    Reply

    I graze throughout much of the day, so I find that my stomach is not empty much. If I’ll take a chug of water right before I get into bed, I’ll get up about midnight to go to the bathroom, take the pill, then go back to sleep. I used to forget if I took it or not, so I started putting one pill out on the bedside with water, and it let’s me know in the morning I took it, because the bottle is empty. It has worked for me.

  22. joan
    santa monica, ca
    Reply

    I sometimes have to get up really early, so now I take my Thyroid tab whenever I wake up in the night anytime after 3am, that way I don’t have to wait for coffee or breakfast.

  23. Marianne
    Atlanta
    Reply

    You have stated in past articles that it is best to take levothyroxine at bedtime. If that is the best option then drinking coffee should not be a problem unless, of course, you swallow the pill with coffee ;-)

  24. SJ
    Colorado
    Reply

    For info on drug interactions on would not rely on my physician’s knowledge, since most do not study that. However, pharmacists have to know about drug interactions with other drugs and food or drink.

  25. Jerry
    Lewisville
    Reply

    I am 82 years old so I usually get up in the middle of the night for a nature call. I have my synthroid laid out waiting for me. No med conflicts!

  26. Patricia
    IL
    Reply

    My first dose of Levothyroxin was brought to me in the hospital DURING my breakfast meal. Despite that, an hour later I could walk and move 100% better than I had for a year! Also, an hour before my breakfast, I had had 2 cups of black coffee.

  27. Valeri
    Reply

    I take my thyroid med at bedtime so I can drink coffee and eat breakfast as soon as I get up or whenever I want.

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