How should levothyroxine be taken and what can affect absorption?

• A. Taken on an empty stomach, typically in the morning; timing with meals, calcium/iron supplements, and certain foods can affect absorption
• B. Taken with meals in the morning
• C. Taken with calcium supplements only
• D. Taken with high-fat foods for better absorption

Answer: (A)

Levothyroxine is best absorbed when the stomach is empty, so timing relative to meals is crucial. Taken in the morning before breakfast with a full glass of water, it should be separate from calcium or iron supplements and from foods that can interfere with absorption, since these can bind the drug and reduce uptake. Some guidance suggests spacing calcium or iron by several hours (often around 4) to minimize interaction. This approach—empty-stomach morning dosing with careful separation from minerals and certain foods—maximizes absorption, which is why it’s the best choice.