ࡱ> GIF[ Sbjbj 4 ΐΐ] 3 kkk8$3O3Q3Q3Q3Q3Q3Q3$528Ju3k ii| u3z3""" RO3" O3""/I"20Lo !?2d;33032H|8"|822|8k2<" " 3 u3u3"3 |8 :  25 May 2009 Geraldine MacGibbon Therapeutics Group Manager PHARMAC PO Box 10-254 Wellington 6143 Email: geraldine.macgibbon@pharmac.govt.nz Dear Ms MacGibbon Feedback: Proposed funding for levothyroxine 25 microgram tablets The Paediatric Society strongly supports the proposed funding of a 25 microgram tablet of levothyroxine. The average full replacement dose of thyroxine is 100 micrograms/m2. Infants under approximately 15 months of age are consistently smaller than 0.5m2. Therefore the 50 microgram tablet is too large to manage the smaller doses. Since these tablets can no longer be split, we are forced to either crush the tablets in a suspension which is unstable and requires weekly preparation, or to devise complex regimes with skipped treatment days. For children up to 3 or 4 years of age incremental dose changes are often required to be given in small steps. Despite a thyroxine half life of 7 days, a 50 microgram per week increase is ideally given as 25 micrograms on Mondays and Thursdays, rather than 50 micrograms on Mondays only. Having the lower strength tablet would allow us to provide more consistent and logical treatment for young children. The replacement of the oral suspension with a 25 microgram tablet will avoid the weekly visit to the pharmacy for replacement suspension and may therefore address some compliance issues. Infants with congenital hypothyroidism will develop intellectual disability without replacement therapy and the availability of the 25 microgram tablet will allow us to provide more optimal therapy for these children. The availability of a funded 25 microgram tablet is endorsed by the Endocrinology Special Interest Group (SIG), the Pharmacist & Therapeutics SIG of The Paediatric Society and the Paediatric Endocrinology Service of Starship Childrens Health (SCH). This letter is endorsed by: Professor Alistair Gunn, Dept of Physiology, University of Auckland. Assoc. Professor Paul Hofman, Paediatric Endocrinology, Liggins Institute, Auckland. Professor Barry Taylor, Women & Childrens Health, University of Otago. Dr Rosemary Marks, Developmental Paediatrician, SCH. Dr Craig Jefferies, Paediatric Endocrinologist, SCH. Libby Martindale, Paediatric Pharmacist, Hawkes Bay Hospital. Dianne Wright, Paediatric Pharmacist, Taranaki Hospital. Brenda Hughes, Paediatric Pharmacist, Auckland City Hospital.     THE PAEDIATRIC SOCIETY OF NEW ZEALAND Secretariat: Email:Denise Tringham P O Box 22 234 Wellington 6441 Tel: (04) 938 4827 Fax: (04) 976 4827 psnz@paradise.net.nz  Health of our children: Wealth of our nation  ;VWZ\]^`acdfgijkijĩzjZzhN5B*CJ(OJQJphhh5B*CJ$OJQJphhN5OJQJ+jhVhV5OJQJUmHnHuhjhUhhh64aJmH sH  h64h64OJQJaJmH sH h64h64aJmH sH h64^JmH sH h6456>*^Jh645>*^Jh64OJQJ h64^JhN "=EScS T =>89:;WXgd64;pZ[\]_`bcefhik !Sn#$If$ x$Ifa$  $Ifdgd64 !OPQRS˺϶϶˲hhhV jhVhVUmHnHuhhNhN5B*CJOJQJphhNB*CJOJQJphhhB*CJOJQJphklkd$$If\u+#4a  $If !Sn#$If  !Sn#$If  !PQRS $ !a$ $ !n#a$ ! 2&P :pN. 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The Paediatric Society believes all children and youth should, by right, attain optimal physical, mental and social health and wellbeing.  By working as a coordinated national network of health professionals the Society dedicates its efforts and resources to making official submissions to both Government and Non-Government organisations on issues that will impact on the health and wellbeing of children and young people.

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