Lithium fluvoxamine

Clinically important, potentially hazardous interactions with cocaine, fenfluramine, fluoxetine, fluvoxamine, lithium, MAO inhibitors, paroxetine, phenelzine, sertraline, tranylcypromine... 

A falsely elevated imipramine level was recorded when HPLC was used to determine serum imipramine levels in a patient taking imipramine, quetiapine, fluvoxamine, lithium and docusate. The abnormal readings were found to have been caused by a metabolite of quetiapine, and normal readings were obtained by altering the wavelength for detection of imipramine. Nortriptyline levels have been found to be falsely elevated in a patient also taking quetiapine when blood was analysed using fluorescence polarisation immunoassay, but were normal when an HPLC... 

OhmanR, SpigsetO. Serotonin syndrome induced by fluvoxamine-lithium interaction. Phar-macopsychiatry (1993) 26, 263-4. 

Alternatively, the current antidepressant may be augmented (potentiated) by the addition of another agent (e.g., lithium, T3), or an atypical antipsychotic (e.g., risperidone). Risperidone has been shown to be effective in combination with fluvoxamine, paroxetine, or citalopram in treatment-resistant depression. Olanzapine and fluoxetine have been found to be safe and effective in treatment-resistant depression. 

Dick DAT, Naylor GJ, Dick EG Effect of lithium on sodium transport across membranes, in Dthium in Medical Practice. Edited by Johnson EN, Johnson S. Lancaster, England, MTP Press, 1978, pp 183-192 Dick P, Eerrero E A double-blind comparison study of the clinical efficacy of fluvoxamine and chlorimipramine. Br J Chn Pharmacol 15 [suppl 3) 419S-425S, 1983... 

Goodman WK, Price LH, Delgado PL, et al Specificity of serotonin reuptake inhibitors in the treatment of obsessive compulsive disorder comparison of fluvoxamine and desipramine. Arch Gen Psychiatry 47 577-585, 1990b Goodman WK, Rasmussen SA, Foa EB, et al Obsessive compulsive disorder, in Clinical Evaluation of Psychotropic Drugs Principles and Guidance. Edited by Prien RF, Robinson DS. New York, Raven, 1994, pp 431-466 Goodnick P Effects of lithium on indices of 5HT and catecholamines in the clinical content a review. Lithium 1 65-73, 1990... 

Heninger GR, Charney DS, Sternberg DE Lithium carbonate augmentation of antidepressant treatment an effective prescription for treatment-refractory depression. Arch Gen Psychiatry 40 1335-1342, 1983 Henry JA Overdose and safety with fluvoxamine. Int Clin Psychopharmacol 6 [suppl 3) 41-47, 1991... 

McDougle CJ, Price LH, Goodman WK, et al A controlled trial of lithium augmentation in fluvoxamine-refractory obsessive-compulsive disorder lack of efficacy. J Clin Psychopharmacol 11 175-184, 1991... 

In one series of nine patients who received open antipsychotic augmentation of fluvoxamine (with or without lithium), those who had co-morbid tic disorder or schizotypal personality disorder were further benefited. In another nine patients who did not have either of these disorders, only two were helped by antipsychotic augmentation (237). 

MAOIs, TCAs, lithium, clomipramine (alone or with topical steroids), fluoxetine, and fluvoxamine may reduce the frequency and intensity of this disorder ( 210, 226, 255, 256, 257, 258, 259, 260 and 261) however, controlled trials are needed to conclusively establish efficacy. Relapse after initial improvement has also been reported, however. Data also indicate that both trichotillomania and OCD may respond to venlafaxine ( 262, 263). For children, such treatments should be reserved for only those with the more severe, refractory forms. 

McDougle CJ, Goodman WK, Price LH. Lithium augmentation in fluvoxamine-refractory obsessive compulsive disorder. American College Neuropsychopharmacol Panels and Posters, 28th Annual Meeting, Maui, Hawaii, December 12-15, 1989 176. 

Six patients taking a stable dose of fluvoxamine had a minor increase in plasma fluvoxamine concentration (from 67 to 76 ng/ml) 2 weeks after starting to take unspecified doses of lithium this is unlikely to be of clinical significance (181). 

In a systematic review of 32 randomized trials in which 1389 patients took lithium and 2069 took another agent (carbamazepine, divalproex, lamotrigine, or the antidepressants amitriptyline, fluvoxamine, mianserin, and maprotiline), among the seven studies that reported suicides, lithium-treated patients had significantly fewer completed events (242). These included two suicides on lithium (out of 503, 0.4%) and 11 suicides on other agents (two placebo, two amitriptyline, six carbamazepine, and one lamotrigine, out of a total of 601,1.8%) (OR = 0.26 95% Cl = 0.09, 0.77). 

LITHIUM SSRIs Lithium may enhance the pharmacologic effects of SSRIs and potentiate the risk of serotonin syndrome. Excessive somnolence has been reported with fluvoxamine. However, there are reports of both T and l plasma concentrations of lithium. There are reports of lithium toxicity and of serotonergic effects Lithium is a direct stimulant of 5-HT receptors, while SSRIs i the reuptake of 5- HT these are considered to t the effects of serotonin in the brain. Seizures are a neurotoxic effect of lithium and could occur even with plasma lithium concentrations within the normal range. SSRIs and lithium may have additive effects to cause seizures Be aware of the possibility of serotonin syndrome. Also need to monitor lithium levels with appropriate dose adjustments during co-administration > For signs and symptoms of serotonin toxicity, see Clinical Features of Some Adverse Drug Interactions, Serotonin toxicity and serotonin syndrome... 

Activation and agitation may represent the induction of a bipolar state, especially a mixed dysphoric bipolar II condition sometimes associated wdth suicidal ideation, and require the addition of lithium, a mood stabilizer or an atypical antipsychotic, and/or discontinuation of fluvoxamine... 

Quazepam Venlafaxine Amitriptyline Selegiline (deprenyl) Lithium carbonate Lithium carbcxiate controlled release Triazolam Haloperidol Propranolol Clonazepam Chlordiazepoxide Lithium carbonate slow release Lithium carbonate Lithium carbonate Loxapine Maprotiline Fluvoxamine Isocarboxazid... 

Clinically important, potentially hazardous interactions with desvenlafaxine, dextromethorphan, dihydroergotamine, ephedra, ergot, fluoxetine, fluvoxamine, isocarboxazid, linezolid, lithium, MAO inhibitors, meperidine, methysergide, naratriptan, nefazodone, paroxetine, phenelzine, rizatriptan, sertraline, sumatriptan, tranylcypromine, tryptophan, venlafaxine, verapamil, zolmitriptan, zuclopenthixol... 

Established data are lacking. Lithium may enhance the serotonergic effects of fluvoxamine, and a few cases of hyperpyrexia and/or induction of seizure disorder were reported with a combined lithium-fluvoxamine regimen. 

The concurrent use of lithium and SSRIs can be advantageous and uneventful, but various kinds of neurotoxicities have occurred in some patients. Isolated reports describe the development of symptoms similar to those of the serotonin syndrome in patients taking lithium and fluoxetine, fluvoxamine, paroxetine and possibly citalopram. In addition, increases and decreases in serum-lithium levels have been seen with fluoxetine. 

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