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Take care when using lithium with other drugs, as clinically relevant interactions may occur

  • Drug Reactions and Interactions
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Abstract

Relatively minor changes in plasma concentrations of lithium can have significant clinical ramifications. Although controlled studies of drug interactions with lithium are limited, accumulated evidence implicates drugs from several classes in the development of lithium toxicity. Consequently, clinicians treating patients with mood disorders need to take a cautious approach when combining lithium with any other medication. This is particularly pertinent in the treatment of elderly patients and those with medical comorbidities.

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References

  1. Finley PR. Drug interactions with lithium: an update. Clin Pharmacokinet. 2016;55:925–41.

    Article  CAS  PubMed  Google Scholar 

  2. Montgomery DB; European College of Neuropsychopharmacology. ECNP Consensus Meeting March 2000 Nice: guidelines for investigating efficacy in bipolar disorder. European College of Neuropsychopharmacology. Eur Neuropsychopharmacol. 2001;11(1):79–88.

    Article  Google Scholar 

  3. Malhi GS, Tanious M, Gershon S. The lithiumeter: a measured approach. Bipolar Disord. 2011;13(3):219–26.

    Article  CAS  PubMed  Google Scholar 

  4. Gelenberg AJ, Kane JM, Keller MB, et al. Comparison of standard and low serum levels of lithium for maintenance treatment of bipolar disorder. N Engl J Med. 1989;321(22):1489–93.

    Article  CAS  PubMed  Google Scholar 

  5. Danielyan A, Kowatch RA. Management options for bipolar disorder in children and adolescents. Pediatr Drugs. 2005;7(5):277–94.

    Article  Google Scholar 

  6. Rej S, Herrmann N, Shulman K. The effects of lithium on renal function in older adults—a systematic review. J Geriatr Psychiatry Neurol. 2012;25(1):51–61.

    Article  PubMed  Google Scholar 

  7. Petersen V, Hvidt S, Thomsen K, et al. Effect of prolonged thiazide treatment on renal lithium clearance. Br Med J. 1974;3(5924):143–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Jefferson JW, Kalin NH. Serum lithium levels and long-term diuretic use. JAMA. 1979;241(11):1134–6.

    Article  CAS  PubMed  Google Scholar 

  9. Crabtree BL, Mack JE, Johnson CD, et al. Comparison of the effects of hydrochlorothiazide and furosemide on lithium disposition. Am J Psychiatry. 1991;148(8):1060–3.

    Article  CAS  PubMed  Google Scholar 

  10. Thomsen K, Schou M. Renal lithium excretion in man. Am J Physiology. 1968;215(4):823–7.

    CAS  Google Scholar 

  11. Kerry RJ, Ludlow JM, Owen G. Diuretics are dangerous with lithium. Br Med J. 1980;281(6236):371.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Baer L, Platman SR, Kassir S, et al. Mechanisms of renal lithium handling and their relationship to mineralcorticoids: a dissociation between sodium and lithium ions. J Psychiatr Res. 1971;8(2):91–105.

    Article  CAS  PubMed  Google Scholar 

  13. Obek A. Mannitol infusions and lithium excretion. Br Med J. 1972;4(5839):550.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Holstad SG, Perry PJ, Kathol RG, et al. The effects of intravenous theophylline infusion versus intravenous sodium bicarbonate infusion on lithium clearance in normal subjects. Psychiatry Res. 1988;25(2):203–11.

    Article  CAS  PubMed  Google Scholar 

  15. Finley PR, O’Brien JG, Coleman RW. Lithium and angiotensin-converting enzyme inhibitors: evaluation of a potential interaction. J Clin Psychopharmacol. 1996;16(1):68–71.

    Article  CAS  PubMed  Google Scholar 

  16. Meyer JM, Dollarhide A, Tuan IL. Lithium toxicity after switch from fosinopril to lisinopril. Int Clin Psychopharmacol. 2005;20(2):115–8.

    Article  PubMed  Google Scholar 

  17. Barthelmebs M, Grima M, Imbs JL. Ramipril-induced decrease in renal lithium excretion in the rat. Br J Pharmacol. 1995;116(4):2161–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Barthelmebs M, Alt-Tebacher M, Madonna O, et al. Absence of a losartan interaction with renal lithium excretion in the rat. Br J Pharmacol. 1995;116(4):2166–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Blanche P, Raynaud E, Kerob D, et al. Lithium intoxication in an elderly patient after combined treatment with losartan. Eur J Clin Pharmacol. 1997;52(6):501.

    Article  CAS  PubMed  Google Scholar 

  20. Leung M, Remick RA. Potential drug interaction between lithium and valsartan. J Clin Psychopharmacol. 2000;20(3):392–3.

    Article  CAS  PubMed  Google Scholar 

  21. Valdiserri EV. A possible interaction between lithium and diltiazem. J Clin Psychiatry. 1985;46(12):540–1.

    CAS  PubMed  Google Scholar 

  22. Kristoff CA, Hayes PE, Barr WH, et al. Effect of ibuprofen on lithium plasma and red blood cell concentrations. Clin Pharm. 1986;5(1):51–5.

    CAS  PubMed  Google Scholar 

  23. Phelan KM, Mosholder AD, Lu S. Lithium interaction with the cyclooxygenase 2 inhibitors rofecoxib and celecoxib and other nonsteroidal anti-imflammatory drugs. J Clin Psychiatry. 2003;64(11):1328–34.

    Article  CAS  PubMed  Google Scholar 

  24. Reimann IW, Diener U, Frölich JC. Indomethacin but not aspirin increases plasma lithium ion levels. Arch Gen Psychiatry. 1983;40(3):283–6.

    Article  CAS  PubMed  Google Scholar 

  25. Türck D, Heinzel G, Luik G. Steady-state pharmacokinetics of lithium in healthy volunteers receiving concomitant meloxicam. Br J Clin Pharmacol. 2000;50(3):197–204.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hawley CJ, Loughlin PJ, Quick SJ, et al. Efficacy, safety and tolerability of combined administration of lithium and selective serotonin reuptake inhibitors: a review of the current evidence. Int Clin Psychopharmacol. 2000;15(4):197–206.

    Article  CAS  PubMed  Google Scholar 

  27. Lawrence KR, Adra M, Gillman PK. Serotonin toxicity associated with the use of linezolid: a review of postmarketing data. Clin Infect Dis. 2006;42(11):1578–83.

    Article  CAS  PubMed  Google Scholar 

  28. Buoli M, Serati M, Altamura AC. Is the combination of a mood stabilizer plus an antipsychotic more effective than monotherapies in the long-term treatment of bipolar disorder? A systematic review. J Affect Disord. 2014;152–154:12–8.

    Article  PubMed  Google Scholar 

  29. Price WA, Zimmer B. Lithium-carbamazepine neurotoxicity in the elderly. J Clin Psychiatry. 1985;44(1):30–1.

    Google Scholar 

  30. Granneman GR, Schneck DW, Cavanaugh JH, et al. Pharmacokinetic interactions and side effects resulting from the concomitant administration of lithium and divalproex sodium. J Clin Psychiatry. 1996;57(5):204–6.

    CAS  PubMed  Google Scholar 

  31. Borden H, Clarke MT, Katz H. The use of pancuronium bromide in patients receiving lithium carbonate. Can Anaesth Soc J. 1974;21(1):79–82.

    Article  CAS  PubMed  Google Scholar 

  32. Hill GE, Wong KC, Hodges MR. Potentiation of succinylcholine neuromuscular blockade by lithium carbonate. Anesthesiology. 1976;44(5):439–42.

    Article  CAS  PubMed  Google Scholar 

  33. Lexi-Interact Data Fields, Lexicomp®. Indianapolis: Wolters-Kluwer Health Clinical Solutions. http://webstore.lexi.com/Information/Product-Information/Lexi-Interact-Fields. Accessed 27 Sep 2016.

  34. Bialer M, Doose DR, Murthy B, et al. Pharmacokinetic interactions of topiramate. Clin Pharmacokinet. 2004;43(12):763–80.

    Article  CAS  PubMed  Google Scholar 

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    The article was adapted from Clinical Pharmacokinetics 2016;55(8):925–41 [1] by salaried employees of Adis/Springer and was not supported by any external funding.

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    Adis Medical Writers. Take care when using lithium with other drugs, as clinically relevant interactions may occur. Drugs Ther Perspect 33, 66–69 (2017). https://doi.org/10.1007/s40267-016-0364-8

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    • DOI: https://doi.org/10.1007/s40267-016-0364-8

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