Additional TSH monitoring required

The MHRA received reports of interactions with ritonavir-containing products and levothyroxine, leading to reduced thyroxine levels. It is now recommended that thyroid-stimulating hormone (TSH) be monitored in patients treated with levothyroxine for at least the first month after starting and ending ritonavir treatment. As with all suspected drug interactions, these must be reported on a Yellow Card.

Risks with using inhalers

The MHRA has received many reports of patients who have inhaled objects into the back of the throat while using pressurised metered dose inhalers (pMDI) resulting in coughing and, in some cases, airway obstruction when objects were aspirated. Patients should be reminded, when removing the mouthpiece cover before use, to check the inside for any loose debris and to shake the inhaler to remove any loose objects. If damage has occurred the mouthpiece cover should be replaced. 

A safety issue has also occurred with Braltus (tiotropium), with the MHRA reporting a risk of inhalation of the capsule when patients place it in the mouthpiece of the inhaler rather than in the chamber. Patients need to be educated on the correct use, ensuring they store the capsules safely and always check the mouthpiece is clear before inhaling.