Can Eltroxin (thyroxine) tablets be crushed and mixed with expressed breast milk for administration to a newborn baby?

Administration of Eltroxin (Levothyroxine) to Newborns

Yes, Eltroxin tablets can be crushed and mixed with a small amount of expressed breast milk for administration to newborns, but the crushed powder should NOT be given directly into the mouth without liquid. The tablet must be dissolved in liquid to ensure proper absorption and prevent choking.

Recommended Administration Method

The safest approach is to crush the tablet and mix it with a small amount (5-10 mL) of expressed breast milk, then administer this mixture immediately to the infant using a spoon, syringe, or dropper. 1

Step-by-Step Administration Protocol

• Crush the tablet into a fine powder using a pill crusher or between two spoons 2
• Mix immediately with a small volume (5-10 mL) of freshly expressed breast milk 1
• Administer the entire mixture within 15-30 minutes to ensure the infant receives the full dose 2
• Use a spoon, oral syringe, or dropper to deliver the mixture directly into the infant's mouth 1
• Follow with additional breastfeeding or expressed milk to ensure the infant swallows all medication 1

Critical Timing Considerations

Levothyroxine should be given consistently at the same time each day, ideally 30 minutes before a feeding when possible, to optimize absorption. 2 However, in newborns where feeding schedules are frequent and unpredictable, consistency of timing is more important than the fasting state.

• Administer the medication at approximately the same time daily to maintain stable thyroid hormone levels 2
• If mixing with breast milk, use only a small volume to ensure the infant consumes the entire dose 1
• Do not add medication to a full bottle of milk, as the infant may not finish it and will receive an incomplete dose 2

Important Caveats and Pitfalls

What NOT to Do

Never give crushed powder directly into the infant's mouth without liquid, as this poses a choking hazard and results in poor absorption. 2

• Do not mix levothyroxine with formula containing soy protein, as soy can significantly reduce absorption 2
• Avoid mixing with large volumes of milk that the infant may not completely consume 1
• Do not prepare the mixture in advance and store it; levothyroxine stability in breast milk decreases over time 2

Monitoring Requirements

All newborns receiving levothyroxine require close monitoring of thyroid function tests and growth parameters. 1

• Monitor TSH and free T4 levels at regular intervals as directed by pediatric endocrinology 1
• Observe for signs of under-treatment (lethargy, poor feeding, constipation) or over-treatment (irritability, tachycardia, poor weight gain) 1
• Ensure consistent administration technique to avoid dose variability 2

Alternative Administration Options

If the infant refuses the breast milk mixture, consider these alternatives:

• Small amount of water (5 mL) can be used instead of breast milk, though breast milk is preferred for newborns 2
• Oral syringe administration may be more reliable than spoon-feeding for ensuring complete dose delivery 1
• If using applesauce or other acidic purees (as mentioned for enzyme administration in other contexts), this is NOT recommended for levothyroxine in newborns, as food interactions may affect absorption 1, 2

Breastfeeding Continuation

Mothers taking levothyroxine can and should continue breastfeeding without interruption. 3 Levothyroxine passes into breast milk in minimal amounts that do not affect the infant's thyroid function or interfere with the infant's own levothyroxine therapy 3, 4. The infant's prescribed dose is calculated independently of any maternal medication transfer 3.