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Digoxin toxicity — GPhC CRA MCQ

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HardCardiovascular TherapeuticsDigoxin toxicityGPhC CRA

A patient taking levothyroxine starts orlistat and calcium carbonate. Her TSH later rises despite reliable levothyroxine use. Which counselling change is most relevant?

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Correct answer: E — Dose separation plus thyroid-function review

Calcium salts reduce levothyroxine absorption and should be separated from it; orlistat can also impair control and warrants closer thyroid-function monitoring. A consistent levothyroxine routine and prescriber review are safer than unsupervised dose changes. The explanation must account for both new medicines rather than attributing the result to non-adherence.

Reference: https://bnf.nice.org.uk/interactions/