Lithium, drug interactions

Stockley IH. Lithium drug interactions. In Stockley IH, ed. Stockley s drug interactions. 6th ed. London Pharmaceutical Press 2002. p. 651-66. 

Marcoux AW. Carbamazepine-lithium drug interaction. ArmPharmacoffter( 99C) 30, 547. 

The most potentially serious drug interactions include the concomitant use of NSAIDs with lithium, warfarin, oral hypoglycemics, high-dose methotrexate, antihypertensives, angiotensin-converting enzyme inhibitors, fi-blockers, and diuretics. 

Several factors predispose to lithium toxicity, including sodium restriction, dehydration, vomiting, diarrhea, drug interactions that decrease lithium clearance, heavy exercise, sauna baths, hot weather, and fever. Patients should be told to maintain adequate sodium and fluid intake and to avoid excessive coffee, tea, cola, and other caffeine-containing beverages and alcohol. 

Carbamazepine is also most beneficial for patients with mixed episodes and rapid cycling. However, many patients find the side effects of carbamazepine more troublesome than those of valproate, and becanse carbamazepine has a penchant for nntoward drug-drug interactions, we reserve the use of carbamazepine for those patients who are unable to tolerate valproate, lithium, and the atypical antipsychotic... 

The following drug interactions were reported for metronidazole, a chemically related nitroimidazole. Therefore, these drug interactions may occur with tinidazole. Drugs that may affect tinidazole include cholestyramine, CYP3A4 inducers and inhibitors and oxytetracycline. Drugs that may be affected by tinidazole include alcohols, anticoagulants, cyclosporine, tacrolimus, disulfiram, fluorouracil, hydantoins, and lithium. 

Nonsteroidal antiinflammatory drugs, interaction with lithium, 36 66 No-phonon transition, 35 324 Norbomadiene complexes with cobalt, 12 286 with copper, 12 328, 330, 331 with gold, 12 348, 349 with group VIB metals, 12 231 with group VnB metals, 12 241 with iron, 12 265 with palladium, 12 314 with platinum, 12 319 with rhodium, 12 300-302 with ruthenium, 12 278, 279 with silver, 12 340-342, 344, 346 Norbomylsiloxane, 42 226, 228 Notch receptor proteins, 46 473, 475 h (N)" oxime complexes, osmium, 37 260 h (N,0) oxime complexes, osmium, 37 260 (NPr ljiFeCfrdto),], magnetization versus temperature, 43 230... 

Ragheb, M. (1990) The clinical significance of lithium-nonsteroidal anti-inflammatory drug interactions. / Clin Psychopharmacol 10 350-354. 

Permanent morphological changes in renal structure have been reported in patients who have experienced lithium toxicity (Markowitz et al. 2000). Case reports of irreversible renal failure as a result of chronic, nontoxic lithium therapy are extremely rare and typically foUow 10 or more years of treatment, during which time the patient s serum creatinine levels have gradually increased (e.g., to 2.0 mg/100 mL Gitlin 1993). To minimize the risk of renal complications, which are rare but potentially serious, we recommend frequent patient education about the risks of toxicity and factors that might make toxicity more likely, such as drug interactions or dehy-... 

Dmg interactions Drug interactions between Neupogen and other drugs have not been fully evaluated. Drugs that may potentiate the release of neutrophils from bone marrow, such as lithium, should be used with caution. 

Failure to account for a critical drug interaction, affecting the renal clearance of lithium, resulted in an otherwise avoidable fatality ( 45). 

Whenever possible, we prefer to treat with a mood stabilizer (e.g., lithium, VPA) alone, because of their specificity for bipolar disorder and to minimize adverse effects. This is particularly true in mild to moderately severe episodes of acute mania. In addition, if the patient can benefit from a single drug during the acute episode, this would support its benefit for maintenance and prophylactic purposes. Further, monotherapy diminishes the chance for potentially significant drug interactions and reduces cost. 

There are several clinically significant drug interactions with lithium, including the following ... 

Other reported potentially significant drug interactions include the combination of verapamil or nifedipine with CBZ, which, at times, can lead to toxicity secondary to increases in CBZ levels, and neurotoxic reactions when verapamil or diltiazem is combined with lithium. 

Drug Interactions Other antihypertensive agents Carbamazepine (vasodilators, ACE inhibitors, Rifampin diuretics, and beta-blockers) Phenobarbital Digoxin Cyclosporine Disopyramide Theophylline Flecainide Inhalation anesthetics Quinidine Neuromuscular blocking agents Cimetidine Lithium ... 

Drug interactions Diuretics Indomethacin Agents increasing serum potassium Lithium Agents causing renin release Agents affecting sympathetic activity ... 

Belmaker, R. H. How does lithium work in manic depression Clinical and psychological correlates of the inositol theory. Ann. Rev. Med. 47 (1996) 47-60. Finley, P. R. Clinical relevance of drug interactions with lithium. Clin. 

Factors that put patients at risk of lithium intoxication are those that increase intake (deliberately or accidentally), reduce excretion (kidney disease, dehydration, low sodium intake, drug interactions), or reduce body water (dehydration secondary to fluid restriction, vomiting, diarrhea, or polyuria) (66). Patients with lithium-induced polyuria are at a particular risk of toxicity if their ability to replace fluids is compromised (for example by anesthesia, over-sedation, CNS trauma). 

In a retrospective study of 114 patients admitted to a toxicological ICU with suspected lithium intoxication, 81 had definite intoxication 78% were deliberate overdoses, and 22% were accidental (due, for example, to renal insufficiency, dehydration, drug interactions, poor compliance, drunkenness). Most were treated conservatively with gastric lavage and forced diuresis hemodialysis was used only in 3-6%. Two of those who took a deliberate overdose and one of those who took an accidental overdose died (535). 

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