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Exercise caution when administering levothyroxine to patients with cardiovascular disorders and to the elderly in whom there is an increased risk of occult cardiac diseaseIn these patientslevothyroxine therapy should be initiated at lower doses than those recommended in younger individuals or in patients without cardiac diseasesee WARNINGSPRECAUTIONSGeriatric Useand DOSAGE AND ADMINISTRATIONIf cardiac symptoms develop or worsenthe levothyroxine dose should be reduced or withheld for one week and then cautiously restarted at a lower doseOvertreatment with levothyroxine sodium may have adverse cardiovascular effects such as an increase in heart ratecardiac wall thicknessand cardiac contractility and may precipitate angina or arrhythmiasPatients with coronary artery disease who are receiving levothyroxine therapy should be monitored closely during surgical proceduressince the possibility of precipitating cardiac arrhythmias may be greater in those treated with levothyroxineConcomitant administration of levothyroxine and sympathomimetic agents to patients with coronary artery disease may precipitate coronary insufficiency.
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