How should I schedule levothyroxine 50 µg each morning, memantine 5 mg three times daily, magnesium glycinate 200 mg twice daily, iron polysaccharide complex 150 mg daily, vitamin D3 50 000 IU weekly, a daily multivitamin with minerals, creatine 5 g daily, pumpkin‑seed‑oil 1 capsule twice daily, and progesterone 100 mg every other night at bedtime?

Optimal Medication Scheduling for This Regimen

Take levothyroxine 50 mcg immediately upon waking on an empty stomach, wait at least 4 hours before taking calcium-containing supplements (multivitamin with minerals and magnesium), take iron separately from both levothyroxine and calcium by at least 4 hours, and schedule memantine three times daily with meals to optimize absorption and minimize drug-nutrient interactions.

Morning Dosing (Upon Waking)

• Synthroid (levothyroxine) 50 mcg: Take immediately upon waking with water on an empty stomach 1
• Wait at least 30-60 minutes before eating or drinking anything other than water 1
• Critical timing: Levothyroxine must be separated from calcium-containing supplements by at least 4 hours to prevent malabsorption 2

Mid-Morning (4+ hours after levothyroxine)

• Iron polysaccharide complex 150 mg: Take in the morning away from meals and coffee to maximize absorption 3
• Consider taking with vitamin C-rich beverage (orange juice) to increase iron absorption by approximately 30% 3
• Do not take with coffee, which decreases iron absorption by 54% 3
• Do not take with calcium or magnesium, as calcium inhibits iron absorption 3

Midday Dosing (With Lunch)

• Memantine 5 mg (first of three daily doses) 4
• Creatine 5 g: Can be taken at any time of day 4
• Pumpkin seed oil 1 capsule (first of two daily doses)

Afternoon Dosing (With Snack or Early Dinner)

• Memantine 5 mg (second dose)
• Multivitamin with minerals: Take at least 4 hours after levothyroxine 2
• Magnesium glycinate 200 mg (first of two daily doses): Take at least 4 hours after levothyroxine 2
• Vitamin D3 50,000 units: Take once weekly on a designated day (e.g., every Sunday) 4

Evening Dosing (With Dinner)

• Memantine 5 mg (third dose)
• Pumpkin seed oil 1 capsule (second dose)
• Magnesium glycinate 200 mg (second dose)

Bedtime Dosing (Every Other Night)

• Progesterone 100 mg: Take every other night at bedtime as prescribed

Critical Drug-Nutrient Interaction Considerations

Levothyroxine Spacing Requirements

• Calcium and iron are the most problematic: Both significantly reduce levothyroxine absorption and must be separated by at least 4 hours 1, 2
• Coffee also reduces levothyroxine absorption, so avoid taking levothyroxine with morning coffee 1
• The multivitamin contains minerals (likely including calcium and iron) that will interfere with levothyroxine if taken together 1

Iron Absorption Optimization

• Morning administration (rather than afternoon) increases iron absorption by approximately 37% due to lower hepcidin levels 3
• Taking iron with breakfast or coffee decreases absorption by 66%, even in the presence of vitamin C 3
• Taking iron with orange juice alone (containing ~90 mg vitamin C) results in a 4-fold increase in absorption compared to taking with coffee or breakfast 3
• Practical recommendation: Take iron mid-morning with orange juice, separated from both breakfast and the calcium-containing supplements 3

Calcium and Magnesium Considerations

• These supplements should be taken together in the afternoon/evening, well separated from both levothyroxine and iron 2
• Calcium citrate (if that's the form in your multivitamin) can be taken with or without food 4

Common Pitfalls to Avoid

1. Taking levothyroxine with the multivitamin: This is the most common error and can reduce levothyroxine efficacy by 30-50% 1
2. Taking iron with coffee or meals: This reduces iron absorption by more than half 3
3. Taking calcium and iron together: Calcium inhibits iron absorption 3
4. Inconsistent timing: Levothyroxine absorption varies significantly based on timing and food intake, so maintain consistent scheduling 1

Alternative Bedtime Levothyroxine Option

• If the morning regimen proves too complex, levothyroxine can be taken at bedtime (at least 4 hours after the last meal) with equal efficacy 1
• This would simplify the morning routine and eliminate the need to wait before breakfast 1
• However, you would need to ensure the evening calcium/magnesium doses are taken earlier (at least 4 hours before bedtime) 2