Changes in drug metabolism

In hypothyroidism, there is a general slowing down of most metabolic processes, particularly those of drugs, whose tolerance is therefore reduced ( Nicoloff and LoPresti 1993).

1. Digoxin: the half-life is longer because of a slowing down of the rate of peripheral metabolism and reduced glomerular filtration. A high risk of digoxin intoxication is present in myxedema coma.

2. Diuretics: overdosage is frequent, aggravating hypovolemia in myxedema coma.

3. Tranquilizing agents, sedatives, narcotics, and morphine: these drugs must be prescribed with caution because of the risk of overdose or severe respiratory depression. Sometimes these drugs convert moderate hypothyroidism into myxedema coma.

4. Cortisol: basal plasma cortisol levels may be normal since there is reduction of the secretion rate, endogenous metabolism may be reduced by 50 per cent, and stress response may be inadequate. Cortisol treatment is commonly used in myxedema coma, together with -thyroxine treatment (Bürgj.and.König 19,88).

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