Liothyronine (Cytomel)

Class

Thyroid hormone, synthetic T3

Mechanism

Synthetic form of triiodothyronine (T3), increases metabolic rate and enhances neurotransmitter sensitivity, potentially accelerating antidepressant effects

FDA-Approved Use

Hypothyroidism

Off-Label Use

Augmentation in treatment-resistant depression

Formulation

Oral tablets, injectable formulations (rarely used)

Titration

Start at 25 mcg p.o. daily; titrate as clinically indicated, typically 25–50 mcg/day for augmentation

Dose Range

25–50 mcg/day for augmentation

Kinetics

Rapid onset of action; half-life approximately 1–2 days; metabolized peripherally

Common AEs

Palpitations, anxiety, tremor, sweating, insomnia

Serious/Rare AEs

Cardiac arrhythmias, exacerbation of underlying cardiac disease

Monitoring

Monitor thyroid function tests including TSH, free T3, and free T4 every 6–12 weeks when initiating or adjusting dose

Black Box Warning

None

Considerations

Use cautiously in elderly patients due to increased risk of cardiac adverse effects; careful monitoring is essential in those with cardiovascular disease or arrhythmias.