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A patient drops off a prescription for Synthroid. The pharmacy is out of stock of the brand name, but the generic levothyroxine is in stock.

A patient drops off a prescription for Synthroid. The pharmacy is out of stock of the brand name, but the generic levothyroxine is in stock. The physician signed the "May substitute" line. The patient has been on the brand for several years. What are some concerns about switching to the generic? What other examples exist of narrow therapeutic index medications?

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