Methimazole

Thyroid Crisis, Goiter

Drug Status

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Government Approvals

US(FDA)

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WHO Essential Medicine

YES

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Known Teratogen

Possible

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Pharmaceutical Class

Thyroid Hormone Synthesis Inhibitor

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Controlled Drug Substance

NO

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Drug Ingredient

Methimazole

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Summary

  • Methimazole is used to treat an overactive thyroid, also known as hyperthyroidism. This condition can be caused by Graves' disease or toxic multinodular goiter, which are disorders where the thyroid gland produces too much thyroid hormone.

  • Methimazole works by stopping your body from making too much thyroid hormone. It doesn't get rid of thyroid hormone that's already in your body, it only prevents your body from making more.

  • Methimazole is usually taken three times a day with food. Adults start with 15mg daily for mild cases, increasing to 30-40mg for moderate and 60mg for severe cases. The usual daily range is 5-15mg.

  • The most common side effect of Methimazole is an upset stomach. Less common but serious side effects include problems with blood cell production, fever, liver inflammation, and inflammation of blood vessels.

  • Methimazole can harm a developing baby during the first three months of pregnancy. It can also cause a dangerously low white blood cell count and damage the liver. Don't take it if you're allergic to it.

Indications and Purpose

What is Methimazole used for?

Methimazole is a medication used to treat an overactive thyroid (hyperthyroidism). This condition can be caused by Graves' disease or toxic multinodular goiter. These are thyroid disorders where the thyroid gland produces too much thyroid hormone. If surgery or radioactive iodine (a type of radiation treatment) aren't suitable options, methimazole helps control the overactive thyroid. It also helps to reduce symptoms before surgery or radioactive iodine treatment is done. Essentially, it helps to calm down an overactive thyroid gland.

How does Methimazole work?

Methimazole is a medication used to treat an overactive thyroid (hyperthyroidism). It works by stopping your body from making too much thyroid hormone. The medicine is swallowed and absorbed into your body through your gut. Your liver processes it, and it's then removed from your body through your urine. Importantly, methimazole doesn't get rid of thyroid hormone that's already in your body; it only prevents your body from making more. Hyperthyroidism is a condition where the thyroid gland produces excessive amounts of hormones, leading to symptoms like rapid heartbeat, weight loss, and nervousness. Therefore, methimazole helps control these symptoms by reducing the production of these excess hormones.

Is Methimazole effective?

Yes, Methimazole is highly effective in controlling hyperthyroidism. Clinical studies show significant improvement in symptoms and hormone levels in the majority of patients. Its success depends on adherence to the prescribed regimen and regular monitoring.

How does one know if Methimazole is working?

Methimazole's effectiveness is tracked by blood tests measuring TSH (thyroid-stimulating hormone) and free T4 (free thyroxine, a thyroid hormone). These ensure the thyroid is functioning normally (euthyroid). Liver health is also checked via blood tests (bilirubin, alkaline phosphatase, ALT, and AST – liver enzymes). If ALT or AST levels are more than three times higher than normal, methimazole should be stopped. Regular doctor and lab visits are essential for monitoring. Essentially, the medicine's effect on the thyroid and liver is carefully watched to prevent problems.

Directions for Use

What is the usual dose of Methimazole?

Adults start with 15mg daily for mild cases, increasing to 30-40mg for moderate, and 60mg for severe cases. The usual daily range is 5-15mg.Children's starting dose is calculated based on their weight: 0.4 milligrams (mg) of methimazole per kilogram (kg) of body weight, given in three separate doses. For example, a 20kg child would start with 8mg/day (0.4mg/kg 20kg = 8mg). The maintenance dose (the amount needed once the thyroid is under control) is about half the initial dose. A kilogram (kg) is a unit of weight approximately equal to 2.2 pounds. 

How do I take Methimazole?

Methimazole tablets are usually taken three times a day, about every eight hours, with food. There are no special dietary rules. If you miss a dose, take it as soon as you remember, unless it's almost time for your next dose. Never take two doses at once to make up for a missed one. Methimazole is a medication.

For how long do I take Methimazole?

The duration of treatment varies but typically lasts 12–18 months, depending on the severity of hyperthyroidism and response to therapy. Your doctor will regularly assess your thyroid function and adjust the dosage as needed.

How long does it take for Methimazole to start working?

Methimazole starts reducing thyroid hormone levels within 1–2 weeks, but full effects may take 4–8 weeks. Regular blood tests will monitor your thyroid hormone levels during this period.

How should I store Methimazole?

Methimazole storage instructions: Store methimazole at room temperature, away from heat and dampness (like a bathroom). Keep it in its original, tightly sealed container, out of reach of children. Disposal: The best way to dispose of leftover methimazole is through a drug take-back program. These programs are often run by pharmacies or local government agencies. Check with your pharmacist or local waste/recycling department to find one near you. If a take-back program isn't available, the FDA website offers safe disposal alternatives. Never flush medicine down the toilet. *Methimazole:* A medication used to treat certain thyroid conditions.

Warnings and Precautions

Who should avoid taking Methimazole?

Methimazole is a medication with several important warnings. Don't take it if you're allergic to it. It can harm a developing baby during the first three months of pregnancy, possibly causing birth defects. A very serious side effect is agranulocytosis (a dangerously low white blood cell count), indicated by fever or sore throat. **Report these symptoms to your doctor immediately.** Methimazole can also damage the liver (hepatotoxicity), so liver function tests may be needed. Rarely, it can cause vasculitis (inflammation of blood vessels), which can be severe. Keep methimazole out of reach of children. Always talk to your doctor about any concerns or side effects.

Can I take Methimazole with other prescription drugs?

Methimazole may interact with anticoagulants (e.g., warfarin), increasing bleeding risk, and beta-blockers, requiring dose adjustments. Always inform your doctor about all medications you take to avoid interactions.

Can I take Methimazole with vitamins or supplements?

Methimazole users should tell their doctor about all other medicines, vitamins, and supplements they're taking. This is because methimazole can interact with other substances. The doctor might need to change the methimazole dose or watch for any side effects. "Interact" means that one medicine can affect how another works, sometimes making it stronger or weaker, or causing new problems. "Side effects" are unwanted effects of a medicine, like nausea or rash. It's important to be completely honest with your doctor about everything you're taking to ensure your safety and the best treatment outcome.

Can Methimazole be taken safely while pregnant?

Methimazole use during pregnancy is risky. This medicine crosses the placenta and can harm the developing baby, potentially causing birth defects like skin problems (aplasia cutis), facial abnormalities (craniofacial), digestive system issues (gastrointestinal), and omphalocele (a belly button defect). The baby might also develop a goiter (enlarged thyroid gland) or cretinism (severe mental and physical retardation). The risk is greatest in the first three months of pregnancy. Doctors should use the lowest possible dose. Other medicines may be better, especially early in pregnancy. Careful monitoring of the mother's and baby's thyroid function is vital. The doctor might reduce the dose or stop it before the baby is born.

Can Methimazole be taken safely while breastfeeding?

Methimazole passes into breast milk, but studies haven't shown any harm to babies who are breastfed while their mothers take it. However, because it's a medication that affects the thyroid (a gland that controls metabolism), a doctor will want to regularly check the baby's thyroid function with blood tests. These checks are typically done weekly or every two weeks to make sure the baby's thyroid is working correctly. This monitoring is a precaution, not an indication that there's necessarily a problem. The frequency of monitoring will depend on the baby's individual situation and doctor's recommendation.

Is Methimazole safe for the elderly?

Methimazole can be safely used in elderly patients, but they may require lower doses and close monitoring due to a higher risk of side effects, such as liver dysfunction or blood disorders.

Is it safe to exercise while taking Methimazole?

Exercise is safe and beneficial for most patients. However, if you experience fatigue or other symptoms of hyperthyroidism, consult your doctor before starting a new exercise routine.

Is it safe to drink alcohol while taking Methimazole?

Alcohol in moderation is generally safe, but excessive drinking may worsen liver function and interact with the medication. Consult your doctor for personalized advice.