Your first 90 days
Your first 90 days on Signifor or Signifor LAR for Cushing disease
What happens before the first fill, the days that matter, the label's rules and who to call, from the label, the drugmaker's own program and one insurer's written rules.
Signifor lowers ACTH, the pituitary signal that drives cortisol, and its labels pair it with a long list of tests. Blood sugar, liver tests, a heart tracing and blood salts are all checked before the first shot. The first 3 months then bring weekly blood sugar checks and repeat liver tests. This page lays out those weeks for both forms, and it says which facts belong to which form. It draws on the 2 FDA labels, Recordati Rare Diseases' own pages and one insurer's written rules.
What has to happen before the first bottle ships
Neither form has a REMS, so the first dose waits on baseline tests, an insurance approval and either injection teaching or a clinic plan. These are the 12 things in the way, in order.
Blood sugar tests
Signifor can raise blood sugar, and nearly all trial patients had higher readings within the first 2 weeks.
- The Signifor label asks for a fasting blood sugar test and an HbA1c before the first dose.
- It says poorly controlled diabetes should be treated intensively before Signifor starts.Signifor label
Liver blood tests
The Signifor label asks for liver tests before the first dose, as a starting point for later checks.
- In the main Signifor trial, 5% of patients had ALT or AST above 3 times the upper normal limit.Signifor label
An ECG, potassium and magnesium
Signifor can slow the heart rate and lengthen a part of the heartbeat called the QT interval.
- The label recommends a baseline heart tracing, called an ECG, before treatment starts.
- It says low potassium and low magnesium must be corrected before the first dose.Signifor label
A gallbladder ultrasound
Gallstones were reported in 30% of patients in the main Signifor trial.
- The Signifor label asks for a gallbladder ultrasound before the first dose and from time to time during treatment.Signifor label
Pituitary hormone checks
Pasireotide can lower pituitary hormones other than ACTH, such as thyroid-stimulating hormone and growth hormone.
- The Signifor label places pituitary function checks before treatment and periodically during it, as clinically appropriate.
- It says people who had pituitary surgery and pituitary radiation are at particular risk.Signifor label
Signifor LAR has its own baseline list
The Signifor LAR label recommends fasting blood sugar, HbA1c, liver tests, an ECG, potassium and magnesium before the first shot.
- It also recommends pituitary function checks, such as thyroid, adrenal and gonadal hormones, before treatment.
- Its Patient Information says a gallbladder ultrasound should be done before and during treatment.Signifor LAR label
A medicine list
The Medication Guide asks people to tell the doctor about every medicine, vitamin and herbal supplement.
- It singles out heart rhythm medicines, medicines that affect the QT interval, and blood pressure medicines such as beta-blockers or calcium channel blockers.
- It also names medicines that control potassium or magnesium, cyclosporine and bromocriptine.Signifor label
Injection teaching, for Signifor
Signifor comes in glass ampules, and each dose is drawn up with a syringe and needle.
- The Medication Guide says your doctor should show you how to prepare and give a dose first.
- It says not to inject Signifor until you have been shown the right way.Signifor label
A plan for who gives Signifor LAR
The Signifor LAR label says a trained healthcare professional must mix and inject every dose.
- The shot goes into the right or left buttock muscle right after mixing, and never into a vein.
- The kit stays in a refrigerator until shortly before the shot.Signifor LAR label
The insurance approval
Plans such as Cigna require prior authorization before they pay for Signifor.
- Cigna asks for age 18 or older, a prescriber's statement about surgery and an endocrinologist or Cushing syndrome specialist.
- Its first approval for Cushing disease lasts 4 months, with renewals after that.Cigna Signifor policy
The prescription form and R.A.R.E.
The endocrinologist's office faxes one Patient Prescription Form, for either Signifor or Signifor LAR, to the pharmacy named on it, Anovo.
- The form asks the office to attach recent lab results, surgery dates and past medicines.
- For Signifor LAR, it also asks whether a nurse will give the shot at home or a clinic will.Prescription form
Help paying, from Recordati
Recordati Rare Diseases offers a $20 co-pay for qualified patients with commercial insurance, and eligibility rules apply.
- Its R.A.R.E. team also supports prior authorization and appeals and checks insurance benefits.
- The R.A.R.E. phone number is 1-888-855-7273, which Recordati also writes as 1-888-855-RARE.Signifor.com
The days that matter
Counted from the first shot of either form, with weekly blood sugar checks, liver tests, Signifor LAR visits and the monthly Signifor box. Type your first-dose date and the tiles become real dates you can add to your calendar.
The tiles below count days from a first dose. Enter the date of yours, or the date you expect, and each tile becomes a real date on your calendar.
The date stays on your device. It is not sent to Trial Friend or anyone else. The calendar file works with Apple, Google and Outlook calendars.Baseline tests for Signifor
Fasting blood sugar, HbA1c, liver tests, potassium, magnesium, an ECG and a gallbladder ultrasound.
- The Signifor label lists all of these, and it does not set an exact number of days ahead.
Baseline tests for Signifor LAR
The Signifor LAR label recommends fasting blood sugar, HbA1c, liver tests, an ECG, potassium and magnesium before the first shot.
- Its Patient Information adds a gallbladder ultrasound and a blood test of pituitary hormones.
Prescription form to Anovo
The office faxes the Signifor and Signifor LAR Patient Prescription Form straight to Anovo.
- The form says to refax or call if no confirmation fax arrives within 24 hours.
- How long this takes varies by office, pharmacy and insurance plan, so ask the office.
Insurance approval
Cigna, one example, requires prior authorization and approves the first 4 months for Cushing disease.
- Other plans set their own rules and their own timing.
Signifor, first shots
The Signifor label starts at 0.6mg or 0.9mg under the skin twice a day.
- The shots go into the top of the thigh or the belly, with a new spot each time.
Signifor LAR, first shot
The Signifor LAR label starts Cushing disease treatment at 10mg into the buttock muscle.
- A trained healthcare professional mixes the kit and gives the shot right away.
Blood sugar checks on Signifor
The Signifor label asks for blood sugar monitoring every week for the first 2 to 3 months.
- The same weekly checks apply for 2 to 4 weeks after any dose increase.
Blood sugar checks on Signifor LAR
The Signifor LAR label asks for weekly blood sugar monitoring for the first 3 months.
- It asks for the same after a dose increase, for 4 to 6 weeks.
- Its Patient Information says your healthcare provider will tell you how often to check your blood sugar.
First liver test on Signifor
The Signifor label asks for liver tests after 1 to 2 weeks on treatment.
- It then asks for them monthly for 3 months and every 6 months after that.
Blood sugar checks on Signifor, number 2
Blood sugar checks on Signifor LAR, number 2
First liver test on Signifor LAR
The Signifor LAR label asks for liver tests after the first 2 to 3 weeks, then monthly for 3 months.
- After that, it leaves the timing to the doctor's judgment.
Blood sugar checks on Signifor, number 3
Blood sugar checks on Signifor LAR, number 3
ECG for some people on Signifor LAR
Signifor LAR reaches its highest level about 21 days after an injection.
- The label says people at risk of QT prolongation should have the QT interval checked at that point.
Blood sugar checks on Signifor, number 4
Blood sugar checks on Signifor LAR, number 4
Next Signifor LAR shot
The Signifor LAR label gives one shot every 4 weeks, which it also writes as every 28 days.
- A missed dose may be given up to, but no later than, 14 days before the next one.
Signifor refill
Each Signifor box holds 60 single-dose ampules, in 10 packs of 6.
- At one ampule twice a day, a box lasts 30 days.
Blood sugar checks on Signifor, number 5
Blood sugar checks on Signifor LAR, number 5
Monthly liver tests
After the first recheck, the Signifor label asks for liver tests monthly for 3 months.
- For people whose ALT was normal at the start, a result 3 to 5 times the upper normal limit is repeated within a week.
- A result above 5 times the upper normal limit is repeated within 48 hours.
Blood sugar checks on Signifor, number 6
Blood sugar checks on Signifor LAR, number 6
Blood sugar checks on Signifor, number 7
Blood sugar checks on Signifor LAR, number 7
Blood sugar checks on Signifor, number 8
Blood sugar checks on Signifor LAR, number 8
Next Signifor LAR shot, number 2
Signifor response check
The Signifor label says the largest drop in 24-hour urine cortisol is typically seen by 2 months.
- It judges response by urine cortisol, by signs and symptoms, or by both.
Signifor refill, number 2
Blood sugar checks on Signifor, number 9
Blood sugar checks on Signifor LAR, number 9
Blood sugar checks on Signifor, number 10
Blood sugar checks on Signifor LAR, number 10
Monthly liver tests, number 2
Blood sugar checks on Signifor, number 11
Blood sugar checks on Signifor LAR, number 11
Blood sugar checks on Signifor, number 12
Blood sugar checks on Signifor LAR, number 12
Next Signifor LAR shot, number 3
Three months in
The Signifor LAR label keeps the 10mg dose for 4 months before any increase is considered.
- After that, the dose may rise for people whose urine cortisol is not normal and who tolerate it, up to 40mg every 28 days.
Blood sugar checks on Signifor, number 13
Blood sugar checks on Signifor LAR, number 13
Signifor refill, number 3
The label, revision by revision
The FDA lists which sections changed in each revision of a label. These are the revisions the current Signifor label records, dated by the FDA, with a plain note on what each one meant for a patient. Older references and handouts can lag these by months.
Current label dated February 17, 2026, read from the FDA's label database today. Signifor label
- July 2024
The FDA approved a new Signifor LAR warning about fatty stools and poor absorption of dietary fat on July 11, 2024. The agency had asked for this warning on somatostatin analogs as a group.FDA letter
- June 2018
The FDA added Cushing disease to the Signifor LAR label on June 29, 2018. The same approval letter added the 10mg and 30mg strengths.FDA letter
- December 2014
Signifor LAR was first approved on December 15, 2014, according to the FDA's Drugs@FDA record. The record lists 5 strengths today, from 10mg to 60mg.Drugs@FDA record
- December 2012
Signifor injection was first approved on December 14, 2012, for adults with Cushing disease. The use covered people for whom pituitary surgery is not an option or has not been curative. The approval letter required follow-up studies of high blood sugar, liver injury, QT prolongation and adrenal insufficiency.FDA letter
How the label says to take it
The parts of the prescribing information and the patient leaflet that come up in the first 3 months, in plain words.
- Signifor, twice a day under the skin
The Signifor label's dose range is 0.3mg to 0.9mg twice a day.
- The recommended starting dose is 0.6mg or 0.9mg twice a day, and the doctor adjusts it by response and side effects.Signifor label
- How the Signifor dose changes
For people started at 0.6mg twice a day, the label allows a rise to 0.9mg if the lower dose is well tolerated.
- Side effects may call for a temporary dose cut, and the label suggests steps of 0.3mg per injection.Signifor label
- How Signifor response is judged
The label looks for a meaningful drop in 24-hour urine cortisol, improved signs or symptoms, or both.
- It says people should keep receiving Signifor as long as benefit is derived.
- The label does not set a fixed point for stopping, and the endocrinologist makes that call.Signifor label
- Where and how Signifor is injected
The label names the top of the thigh or the belly as injection sites.
- It says not to use the same site for 2 shots in a row, and to avoid skin that is red or irritated.
- Each ampule is for one dose, opened just before use, and any leftover is thrown away.Signifor label
- Check the liquid first
Signifor should be clear and colorless, with no clumps or particles in it.
- The Instructions for Use say not to use an ampule that is cracked or broken, or liquid that looks cloudy.
- They say to take the whole box back to the pharmacy and get a new one.Signifor label
- If you miss a Signifor dose
The label says the next injection is given at the scheduled time.
- It says not to double doses to make up for a missed one.
- The Medication Guide says to tell your doctor right away if you take too much.Signifor label
- Signifor LAR, every 4 weeks
The Signifor LAR label starts Cushing disease treatment at 10mg once every 4 weeks.
- After 4 months at 10mg, the dose may rise for people whose urine cortisol is not normal and who tolerate it.
- The highest dose for Cushing disease is 40mg every 28 days.Signifor LAR label
- When Signifor LAR works too well
Low cortisol or side effects may call for a return to the previous dose, a pause or stopping, the label says.
- For people on 10mg, the label says the dose may be paused or stopped.
- The endocrinologist decides which of these steps applies to you.Signifor LAR label
- Liver conditions and Signifor
With moderate liver impairment, the Signifor label starts at 0.3mg twice a day and caps the dose at 0.6mg twice a day.
- It says to avoid Signifor with severe liver impairment, and mild impairment needs no dose change.
- The label says kidney impairment needs no dose change either.Signifor label
- Liver conditions and Signifor LAR
With moderate liver impairment, the Signifor LAR label starts Cushing disease treatment at 10mg and caps it at 20mg every 4 weeks.
- It says to avoid Signifor LAR with severe liver impairment.Signifor LAR label
- Other medicines
Medicines that prolong the QT interval can add to Signifor's own effect, so the label asks for caution.
- Signifor may lower cyclosporine levels and raise bromocriptine levels, and those doses may need adjusting.
- Beta-blocker and calcium channel blocker doses may also need adjusting because of the slower heart rate.Signifor label
- Pregnancy, fertility and breastfeeding on Signifor
The Medication Guide says Signifor may harm an unborn baby, and to tell the doctor about a pregnancy or plans for one.
- Lower cortisol may improve fertility, so the label asks doctors to discuss the chance of an unintended pregnancy.
- The Medication Guide says you and your doctor should choose between Signifor and breastfeeding, not both.Signifor label
- Pregnancy and breastfeeding on Signifor LAR
The Signifor LAR Patient Information says it is not known if Signifor LAR will harm an unborn baby.
- It says to talk to your healthcare provider about the best way to feed your baby.
- It also says to ask about birth control methods that may be right for you during treatment.Signifor LAR label
- Blood sugar after stopping
Both labels call for closer blood sugar checks after pasireotide is stopped in people who take a blood sugar medicine.
- The labels give the reason as a risk of low blood sugar from those medicines.Signifor label
- Storing Signifor
The Medication Guide says to store Signifor at 68 to 77 degrees Fahrenheit and to keep it out of the light.Signifor label
- Storing Signifor LAR
Signifor LAR kits are kept in a refrigerator at 36 to 46 degrees Fahrenheit and never frozen.
- The kit sits at room temperature for at least 30 minutes before mixing.
- Its Patient Information says not to use a kit left at room temperature for more than 24 hours.Signifor LAR label
- If liver tests rise on Signifor
The label says to interrupt Signifor when a raised ALT result is confirmed or still rising on the repeat test.
- The doctor then looks for the cause, which may or may not be Signifor.
- The label allows a cautious restart only if results return to normal or near normal and another likely cause was found.Signifor label
- If liver tests rise on Signifor LAR
The Signifor LAR label says treatment should be discontinued if signs or symptoms of clinically significant liver impairment develop.
- It says treatment should not be restarted if the liver changes are suspected to be related to Signifor LAR.Signifor LAR label
- No contraindications, no boxed warning
The Signifor label lists no contraindications, and it carries no boxed warning.Signifor label
- The same is true of Signifor LAR
The Signifor LAR label lists no contraindications, and it carries no boxed warning either.Signifor LAR label
What the label says to act on
The symptoms the label singles out, and what it tells patients and prescribers to do about each. If any of these happen, the label's instruction is the one to follow, with your care team.
Signs of low cortisol
Weakness, fatigue, loss of appetite, nausea, vomiting, low blood pressure, low sodium in the blood or low blood sugar.
- The Medication Guide says to tell your doctor right away about any of these.
- It says the doctor may change the dose or ask you to stop.Signifor label
Signs of high blood sugar on Signifor
Excessive thirst, high urine output, increased appetite with weight loss, or tiredness.
- In the main Signifor trial, high blood sugar was reported in 40% of patients and diabetes in 18%.
- The Medication Guide says the doctor may add a blood sugar medicine, change the dose or ask you to stop.Signifor label
High blood sugar and ketoacidosis on Signifor LAR
Feeling very thirsty, urinating more than usual, nausea, vomiting, abdominal pain, increased appetite with weight loss or tiredness.
- Fruity scented breath, trouble breathing and confusion are also on the list.
- The Patient Information says to tell your healthcare provider right away about any of these.
- In the Cushing disease trial, high blood sugar was reported in 47% of patients.Signifor LAR label
Dizziness, weakness or fainting spells
Signifor can slow the heart, which may make you feel weak, dizzy or even faint.
- QT prolongation can cause abnormal heartbeats, dizziness and fainting spells that can be very serious.
- The Medication Guide says to call your doctor right away if you experience such spells.Signifor label
Gallstone symptoms
Sudden pain in your upper right stomach area, or sudden pain in your right shoulder or between your shoulder blades.
- Yellowing of your skin and the whites of your eyes, fever with chills, and nausea are also listed.
- The Medication Guide says to tell your healthcare provider if you get any of these symptoms.Signifor label
Fatty stools
Signifor may make it harder for the body to absorb dietary fats.
- The Medication Guide says to tell your doctor about new or worsening fatty stools or changes in stool color.
- Loose stools, stomach bloating and weight loss are on the same list.Signifor label
Low pituitary hormones on Signifor LAR
Nausea and vomiting, tiredness, dizziness, diarrhea, low blood sugar levels, loss of appetite or weight loss.
- The Signifor LAR Patient Information says to tell your healthcare provider if you get any of these symptoms.
- It also lists weakness, dizziness, and fainting or near fainting spells as heart symptoms to report.Signifor LAR label
Stomach upset in the first month
Diarrhea was reported in 58% of patients and nausea in 52% in the main Signifor trial.
- The label says these began mainly during the first month and required no intervention.
- The Medication Guide says to tell your doctor about any side effect that bothers you or does not go away.Signifor label
Why the pharmacy or the insurer says no, and what fixes it
Most first-fill delays are one of these. Knowing which one tells you who to call.
- Prior authorization pending or deniedCigna asks for age 18 or older and a prescriber's statement that surgery is not an option or was not curative. It also wants an endocrinologist or a physician who specializes in treating Cushing syndrome. The endocrinologist's office sends the request and any records the plan asks for.Cigna Signifor policy
- The first approval ran out after 4 monthsCigna's first approval of Signifor for Cushing disease lasts 4 months. It then approves 1 year when the prescriber says there has been a response and treatment continues to maintain it. The office sends that renewal request before the first approval ends.Cigna Signifor policy
- Signifor LAR is reviewed under a different policyCigna reviews Signifor LAR under its own policy, with a 4-month first approval for Cushing disease as well. That policy approves up to 40mg no more often than once every 28 days. It gives a drop in urine cortisol as an example of a response at renewal.Cigna Signifor LAR policy
- The prescription did not reach the right pharmacyRecordati's form says the referral is valid only if the prescriber faxes it directly to Anovo. The same form covers both Signifor and Signifor LAR prescriptions. Questions about the form or the shipment go to the number on it, 888-855-7273.Prescription form
- Coverage lapses or changes during treatmentRecordati's prescriber page for Signifor LAR lists financial assistance during insurance gaps. It says this helps patients start or remain on therapy if an access or insurance gap arises. The page also lists a Patient Assistance Program for indigent patients.Signifor LAR HCP support
- A copay you cannot payWith commercial insurance, Recordati offers a $20 co-pay for qualified patients, and eligibility rules apply. Its R.A.R.E. team also helps people identify other financial assistance opportunities. Our help paying page lists charity funds that may cover Cushing syndrome costs.Signifor.com
Cigna prior authorization policy, May 1, 2026
- Age 18 or older
- According to the prescriber, the patient is not a candidate for surgery or surgery has not been curative
- Prescribed by or with an endocrinologist or a physician who specializes in treating Cushing syndrome
- To continue, the prescriber says there has been a response and treatment continues to maintain it
Approval length. Approved for 4 months at first for Cushing disease, then for 1 year at a time for people who have responded.
This is Cigna policy IP0482 for Signifor, the twice-a-day form, effective May 1, 2026, after an April 9, 2026 review with no criteria changes. It cites the July 2024 Signifor prescribing information, which matches the current label text. Cigna reviews Signifor LAR under a separate policy, IP0165, with the same Cushing disease criteria except that it sets no minimum age. Other plans set their own criteria and their own approval lengths. It is here as an example of what a plan asks for, not as a rule. Cigna Signifor policy
Who to call, and what they can do
The drugmaker's program handles most of the first-fill problems above. Charity funds and foundation help are on the help paying page.
- A $20 co-pay for qualified patients with commercial insurance, with eligibility requirements, restrictions and limitations
- Support for prior authorization and appeals, and a check of insurance benefits
- Help identifying other financial assistance opportunities
- Patient assistance for eligible patients who lack insurance and meet certain financial requirements
- A dedicated R.A.R.E. Nurse Educator, and extra injection training from a nurse if giving Signifor is difficult
- An optional Patient Liaison for disease education and resources, at no additional cost
- For Signifor LAR, a home injection program where a registered nurse gives the shot, at no cost to you or your insurance provider Signifor LAR patient support
- Financial assistance during insurance gaps, to help patients start or remain on therapy Signifor LAR HCP support
- Syringes, needles, alcohol pads and a sharps container sent with Signifor, unless the prescriber marks no supplies Prescription form
Details as the drugmaker publishes them. Signifor.com
Five questions for the pharmacist or the support line
- Does my Signifor box come with syringes, needles and a sharps container?
- When does my next box of 60 ampules ship, and does a dose change need a new prescription?
- I take these medicines. Do any of them affect my heart rhythm, heart rate, potassium or magnesium?
- Where does my Signifor LAR kit ship, and who keeps it refrigerated until the injection?
- Who do I call at night if I feel faint or think my cortisol is too low?
Questions people ask in the first weeks
What is the difference between Signifor and Signifor LAR?
Signifor is injected under the skin twice a day, and people give it to themselves after being taught. Signifor LAR is injected into the buttock muscle every 4 weeks by a trained healthcare professional. Each form has its own FDA label, doses and test schedule.
What tests come before Signifor?
The Signifor label lists fasting blood sugar, HbA1c, liver tests, potassium, magnesium, an ECG and a gallbladder ultrasound. The Signifor LAR label recommends the same blood tests and ECG, and its Patient Information adds the ultrasound.
How often is blood sugar checked on Signifor?
The Signifor label asks for monitoring every week for the first 2 to 3 months, then periodically. The Signifor LAR label asks for weekly monitoring for the first 3 months. Both labels ask for it again after any dose increase.
What does low cortisol feel like on Signifor?
The Medication Guide lists weakness, fatigue, loss of appetite, nausea, vomiting, low blood pressure, low sodium and low blood sugar. It says to tell your doctor right away, and the doctor may change the dose or ask you to stop.
What if I miss a dose of Signifor or Signifor LAR?
For Signifor, the label says to give the next injection at the scheduled time and not to double doses. For Signifor LAR, a missed dose may be given up to, but no later than, 14 days before the next dose.
Is Signifor approved for every kind of Cushing syndrome?
No, both labels cover Cushing disease, the form caused by a pituitary tumor. They cover people for whom pituitary surgery is not an option or has not been curative. The Signifor label says adults, and neither form is established as safe and effective in children.
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Sources
- SIGNIFOR- pasireotide injection: prescribing information, Medication Guide and Instructions for Use, revised 7/2024, Recordati Rare Diseases, Inc., via DailyMed, February 17, 2026.
- SIGNIFOR LAR- pasireotide kit: prescribing information and Patient Information, revised 7/2024, Recordati Rare Diseases, Inc., via DailyMed, July 16, 2024.
- What is SIGNIFOR and How Does it Work, Recordati Rare Diseases Inc., November 12, 2026.
- Patient - Cushing's Disease - Access and Support - SigniforLar, Recordati Rare Diseases Inc., November 12, 2026.
- HCP - Cushing's Disease - Patient Access and Support - SigniforLar HCP, Recordati Rare Diseases Inc., November 12, 2026.
- Signifor & Signifor LAR (pasireotide) Patient Prescription Form, Signifor.RX.187, effective December 1, 2020, Recordati Rare Diseases Inc. and AnovoRx, December 1, 2020.
- Drug Coverage Policy IP0482, Signifor (Cushing's, Signifor), Cigna, May 1, 2026.
- Drug Coverage Policy IP0165, Signifor LAR (Somatostatin Analogs, Signifor LAR), Cigna, May 1, 2026.
- Drugs@FDA records for NDA 200677, Signifor, and NDA 203255, Signifor LAR Kit, via openFDA, FDA, November 12, 2026.
- NDA 203255/S-011 supplement approval letter, steatorrhea, malabsorption of dietary fat and pancreatic exocrine insufficiency, FDA, July 11, 2024.
- NDA 203255/S-004 supplement approval letter, new indication for Cushing's disease and 10 mg and 30 mg strengths, FDA, June 29, 2018.
- NDA 200677 approval letter, Signifor (pasireotide) injection, for subcutaneous use, FDA, December 14, 2012.
This page explains what the FDA label, the drugmaker's support program and an insurer policy say. It is not medical advice and does not tell anyone to start, stop or change a medicine. Dosing, test timing and restarts after a gap are decisions for the prescribing endocrinologist. Found an error? Use the report link in the footer and it will be checked against the source.