Lithium calcium channel blockers

CALCIUM CHANNEL BLOCKERS LITHIUM Small number of cases of neurotoxicity when co-administered with diltiazem or verapamil Uncertain, but thought to be due to an additive effect on neurotransmission Monitor closely for side-effects... 

Other agents are also used for the treatment of manic-depressive disorders based on preliminary clinical results (177). The antiepileptic carbamazepine [298-46-4] has been reported in some clinical studies to be therapeutically beneficial in mild-to-moderate manic depression. Carbamazepine treatment is used especially in bipolar patients intolerant to lithium or nonresponders. A majority of Hthium-resistant, rapidly cycling manic-depressive patients were reported in one study to improve on carbamazepine (178). Carbamazepine blocks noradrenaline reuptake and inhibits noradrenaline exocytosis. The main adverse events are those found commonly with antiepileptics, ie, vigilance problems, nystagmus, ataxia, and anemia, in addition to nausea, diarrhea, or constipation. Carbamazepine can be used in combination with lithium. Several clinical studies report that the calcium channel blocker verapamil [52-53-9] registered for angina pectoris and supraventricular arrhythmias, may also be effective in the treatment of acute mania. Its use as a mood stabilizer may be unrelated to its calcium-blocking properties. Verapamil also decreases the activity of several neurotransmitters. Severe manic depression is often treated with antipsychotics or benzodiazepine anxiolytics. 

Uncontrolled hypertension Valvular disorders function sympathomi meti cs) Offending medications (NSAIDs, COX-2 inhibitors, steroids, lithium, (i-blockers, calcium channel blockers, anti-arrhythmics, alcohol, thiazolidinediones)... 

There are several studies that combined lithium with other treatments such as antipsychotics, anticonvulsants (e.g., CBZ, VPA), calcium channel blockers (e.g., verapamil), or BZDs (e.g., lorazepam). Generally, in partial responders, the addition of these medications was beneficial and well tolerated. 

Aryl-1,4-dihydropyridines.2 These compounds are important calcium channel blockers or enhancers depending on the stereochemistry at C4. An enaritio-selective synthesis of the (S)-isomers (blockers) is based on addition of an aryl-lithium to achiral 3-dihydrooxazolyl-5-methoxycarbonylpyridine (2). Thus addition... 

Treatment of tardive dyskinesia is often unsatisfactory, especially in severe cases. A large number of treatments have been proposed (SEDA-20,40), including antiparkinsonian drugs, benzodiazepines, baclofen, hormones, calcium channel blockers, valproate, propranolol, opiates, cyproheptadine, tryptophan, lithium, manganese, niacin, botulinum toxin, ECT, dietary control, and biofeedback training. In an open study, 20 patients (mean age 65 years) with severe unresponsive tardive dyskinesia (mean duration 44 months, mean exposure 52 months) were treated with tetrabenazine (mean dose 58 mg/day) (310). The mean score on the AIMS motor subset, determined from videotapes, improved by 54%. Sedation was the only subjective complaint. 

Use lithium cautiously with calcium channel blockers, which may also increase lithium toxicity... 

Calcium channel blockers Increased or decreased lithium levels. 

Clinically important, potentially hazardous interactions with acetazolamide, aminoglycosides, anticholinesterases, bambuterol, calcium channel blockers, chloroquine, chlorpromazine, clindamycin, d-pencillamine, ecothiophate iodine, enflurane, furosemide, halothane, hexomethonium, isoflurane, ketamine, lidocaine, lincomycin, lithium salts, magnesium salts, mannitol, MAO inhibitors, organophosphates, pancuronium, phenytoin, polymyxins, procainamide, quinidine, sevoflurane, spectinomycin, tetracyclines... 

All anticonvulsants (except gabapentin), atypical antipsychotics, benzodiazepines, and calcium channel blockers require liver metabolism, and dosage adjustments may be needed (e.g., 25-50% reduction of normal doses) Carbamazepine or oxcarbazepine Alternative lamotrigine Acute mania or mixed episode first choice lithium... 

Lithium is frequently combined with both traditional and atypical antipsychotics in euphoric acute mania with psychotic features. Case reports of neurotoxicity (e.g., delirium, cerebellar dysfunction, extrapyramidal symptoms, and severe tremors) have been reported in elderly patients receiving lithium and traditional antipsychotics. Combining lithium with calcium channel blockers is not recommended because of reports of neurotoxicity and severe bradycardia with verapamil and diltiazem. Acute neurotoxicity and delirium have been reported in patients receiving ECT with lithinm (even at reduced dosages) therefore lithium should be withdrawn and discontinued at least 2 days before ECT and should not be resumed until 2 to 3 days after the last treatment. 

Calcium-channel blockers increase the toxicity of lithium, which has calcium antagonist effects itself. 

Verapamil usually increases lithium clearance. Nevertheless, some clinicians consider the combination of lithium and calcium-channel blockers potentially hazardous. 

Wright BA, Jairett DB. Lithium and calcium channel blockers possible neurotoxicity. Biol Psychiatry (1991) 30,635-6. 

Medications P-blockers, calcium channel blockers, antiarrhythmics, chemotherapy, lithium, phenothiazines, cimetidine, tricyclic antidepressants... 

CCAs (channel blockers influx inhibitors) have been used primarily for the treatment of cardiovascular disorders (e.g., supraventricular arrhythmias, angina, and hypertension). Agents such as verapamil exert their effects by modulating the influx of Ca across the cell membrane, thus interfering with calcium-dependent functions. Based partly on the common effects of lithium and this class of drugs (e.g., effects on Ca "" activity), the CCAs have been studied as a potential treatment for mania. Janicak et al. (251) reported the results of a 3-week, double-blind comparison of verapamil versus placebo, which did not demonstrate a beneficial effect for verapamil (up to 480 mg/day) in 33 acutely manic hospitalized patients. 

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