Carbimazole safety warning (neutropenia and agranulocytosis). Doctors are reminded of the importance of recognising bone marrow suppression induced by carbimazole and the need to stop treatment promptly.
Propylthiouracil - monitor for hepatoxicity severe hepatic reactions have been reported including fatal cases and cases requiring liver transplant. Discontinue if LFTs become significantly deranged. Counsel patients on how to recognise signs of liver failure, e.g. nausea, vomiting, jaundice, dark urine, fatigue abdominal pain and itching and to seek medical advice.
Drug safety update
Hypocalcaemia post thyroidectomy- the regime below has been observed as common practice post total thyroidectomy in patients at TWH:
- If Calcium <2.2 mmol/L, give Adcal 2 tablets QDS
- If Calcium <2.1 mmol/L, give Adcal D3 2 tablets QDS
- If Calcium <2.0 mmol/L, give Alfacalcidol 0.5-2 micrograms
- Check bloods every 2-3 days i.e. day 0, 1, 2, 3 and 5
- If Calcium <1.8 mmol/L, high risk of tetany, patient will require admission for slow IV Calcium gluconate
- If Calcium >2.2 mmol/L, reduce to Adcal 2 tablets BD and continue monitoring.
*Ensure that it is the adjusted Calcium level checked.