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| Interactions: | Acetazolamide Adverse Effect Decreased lithium effectiveness or increased lithium concentrationsClinical Management Monitor therapeutic efficacy of lithium and serum lithium concentrations. Adjustments of the lithium dose may be necessary.
AmilorideAdverse Effect increased lithium concentration and lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Monitor serum lithium levels within the first five to seven days of adding or discontinuing amiloride and periodically thereafter. Changes in the lithium dose may be required with concomitant amiloride therapy.
BenazeprilAdverse Effect Lithium toxicity (weakness, tremor, excessive thirst, confusion) and/or nephrotoxicityClinical Management The combination of lithium and Benazepril should be avoided if possible, though the choice of an alternative antihypertensive agent that does not interact with lithium is limited. If lithium and Benazepril are used concurrently, serum lithium levels should be closely monitored and the patient followed up for any symptoms of lithium toxicity.
Bumetanide Adverse Effect increased lithium concentrations and lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Monitor serum lithium levels within the first five to seven days of adding or discontinuing bumetanide and periodically thereafter.
Bupivacaine Comb.Adverse Effect weakness, dyskinesias, increased extrapyramidal symptoms, encephalopathy, and brain damageClinical Management Monitor patients closely for any signs of toxicity or extrapyramidal symptoms, especially if high doses of antipsychotic drugs and lithium are used.
Bupropion hclAdverse Effect Additive risk of seizures in case of abrupt Lithium withdrawal when the person is undergoing Bupropion HCL treatment Clinical Management: Withdrawal of Lithium and other drugs which lower seizure threshold should be done slowly if the person is under Bupropion HCL treatment.
Calcitonin Adverse Effect decreased lithium concentrations and loss of lithium efficacyClinical Management Lithium levels should be closely monitored in patients receiving calcitonin therapy.
Captopril Adverse Effect Lithium toxicity (weakness, tremor, excessive thirst, confusion) and/or nephrotoxicityClinical Management The combination of lithium and Captopril should be avoided if possible, though the choice of an alternative antihypertensive agent that does not interact with lithium is limited. If lithium and Captopril are used concurrently, serum lithium levels should be closely monitored and the patient followed for any symptoms of lithium toxicity.
CarbamazepineAdverse Effect Additive neurotoxicity (weakness, tremor, nystagmus, asterixis)Clinical Management Monitor for signs of neurotoxicity with concomitant therapy; serum levels have not been useful in predicting this adverse effect. If neurotoxicity occurs, one or both of the agents may need to be discontinued.
Celecoxib Adverse Effect Increased lithium plasma concentrations and an increased risk of lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Closely monitor plasma lithium concentrations when celecoxib therapy is initiated or withdrawn.
ChlorpromazineAdverse Effect Concomitant administration causes extrapyramidal symptoms, disorientation and unconsciousness Clinical Management: Avoid the concomitant administration if possible.
Chlorthalidone Adverse Effect increased lithium concentrations and lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Monitor serum lithium levels within the first five to seven days of adding or discontinuing Chlorthalidone and periodically thereafter. Lower lithium doses may be required with concomitant Chlorthalidone therapy.
Cisplatin Adverse Effect Altered lithium pharmacokineticsClinical Management Due to multiple factors which may influence lithium concentrations during cisplatin therapy, consideration of frequent monitoring of serum lithium levels is advisable.
Clopamide Adverse Effect increased lithium concentrations and lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Monitor serum lithium levels within the first five to seven days of adding or discontinuing Clopamide and periodically thereafter. Lower lithium doses may be required with concomitant Clopamide therapy.
Clozapine Adverse Effect weakness, dyskinesias, increased extrapyramidal symptoms, encephalopathy, and brain damageDiclofenac PrepsAdverse Effect Lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management If a nonsteroidal antiinflammatory agent is used concurrently with lithium, serum lithium levels should be monitored and the patient followed for any symptoms of toxicity. A decrease in the lithium dose may be required.
Diltiazem Adverse Effect Neurotoxicity, psychosisClinical Management With concurrent lithium and calcium channel blocker use, consider monitoring patients for evidence of neurotoxicity. Periodic serum lithium level monitoring might also be considered.
Domperidone - Antispas Adverse Effect weakness, dyskinesias, increased extrapyramidal symptoms, encephalopathy, and brain damageClinical Management Monitor patients closely for any signs of toxicity or extrapyramidal symptoms, especially if high doses of antipsychotic drugs and lithium are used. Serum lithium levels should be monitored periodically. Some clinicians advocate maintaining levels in the low therapeutic range.
Enalapril Adverse Effect Lithium toxicity (weakness, tremor, excessive thirst, confusion) and/or nephrotoxicityClinical Management The combination of lithium and Enalapril should be avoided if possible, though the choice of an alternative antihypertensive agent that does not interact with lithium is limited. If lithium and Enalapril are used concurrently, serum lithium levels should be closely monitored and the patient followed for any symptoms of lithium toxicity.
Filgrastim Adverse Effect Potentiates the release of neutrophils Clinical Management: Administer the drugs with caution.
Fluoxetine Adverse Effect Possible lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Monitor patients on concurrent lithium and fluoxetine therapy for evidence of lithium toxicity (weakness, tremor, excessive thirst, confusion). In addition, monitor patients for signs and symptoms associated with serotonin syndrome (hypertension, hyperthermia, myoclonus, mental status changes).
Flupenthixol DecanoateAdverse Effect weakness, dyskinesias, increased extrapyramidal symptoms, encephalopathy, and brain damage Clinical Management: Monitor patients closely for any signs of toxicity or extrapyramidal symptoms, especially if high doses of antipsychotic drugs and lithium are used.
Fluphenazine Adverse Effect weakness, dyskinesias, increased extrapyramidal symptoms, encephalopathy, and brain damageClinical Management Monitor patients closely for any signs of toxicity or extrapyramidal symptoms, especially if high doses of antipsychotic drugs and lithium are used
FlurbiprofenAdverse Effect Lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Serum lithium levels should be monitored within the first few days if a nonsteroidal antiinflammatory drug is added or discontinued from therapy, and periodically thereafter. Patients should be followed for any symptoms of toxicity; a decrease in the lithium dose is often required with concomitant therapy.
Frusemide Adverse Effect Increased lithium concentrations and lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Monitor serum lithium levels within the first five to seven days of adding or discontinuing furosemide and periodically thereafter. Lower lithium doses may be required with concomitant furosemide therapy.
Haloperidol Adverse Effect weakness, dyskinesias, increased extrapyramidal symptoms, encephalopathy, and brain damageClinical Management Monitor patients closely for any signs of toxicity or extrapyramidal symptoms, especially if high doses of Haloperidol and lithium are used.
Hydrochlorthiazide Hydrochlorthiazide reduces the renal clearance of lithium leading to toxicity
IbuprofenAdverse Effect An increased risk of lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Due to the potential for increased serum lithium levels, patients should be monitored for signs of lithium toxicity and serum levels obtained as indicated. A reduction in lithium dosage may be necessary.
Indapamide Adverse Effect increased lithium concentrations and lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Monitor serum lithium levels within the first five to seven days of adding or discontinuing indapamide and periodically thereafter. Lower lithium doses may be required with concomitant indapamide therapy.
IndomethacinAdverse Effect An increased risk of lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management If a nonsteroidal antiinflammatory agent is used concurrently with lithium, serum lithium levels should be monitored and the patient followed for any symptoms of toxicity. A decrease in the lithium dose may be required.
Ketoprofen Adverse Effect Lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Serum lithium levels should be monitored within the first few days if a nonsteroidal antiinflammatory drug is added or discontinued from therapy, and periodically thereafter. Patients should be followed for any symptoms of toxicity; a decrease in the lithium dose is often required with concomitant therapy.
Ketorolac Adverse Effect Lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Serum lithium levels should be monitored within the first few days if a nonsteroidal antiinflammatory drug is added or discontinued from therapy, and periodically thereafter. Patients should be followed for any symptoms of toxicity; a decrease in the lithium dose is often required with concomitant therapy.
LisinoprilAdverse Effect Lithium toxicity (weakness, tremor, excessive thirst, confusion) and/or nephrotoxicityClinical Management The combination of lithium and Lisinopril should be avoided if possible, though the choice of an alternative antihypertensive agent that does not interact with lithium is limited. If lithium and lisinopril are used concurrently, serum lithium levels should be closely monitored and the patient followed for any symptoms of lithium toxicity.
Losartan Adverse Effect an increased risk of lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Patients prescribed lithium and losartan should be closely monitored for the development of lithium toxicity. Plasma lithium levels should also be followed.
LoxapineAdverse Effect Weakness, dyskinesias, increased extrapyramidal symptoms, encephalopathy, and brain damageClinical Management Monitor patients closely for any signs of toxicity or extrapyramidal symptoms, especially if high doses of Loxapine and lithium are used.
Mefenamic Acid Adverse Effect Lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management If a nonsteroidal antiinflammatory agent is used concurrently with lithium, serum lithium levels should be monitored and the patient followed for any symptoms of toxicity. A decrease in the lithium dose may be required.
MeloxicamAdverse Effect Elevation of plasma lithium levels and reduced renal lithium clearanceClinical Management Clinicians should be aware that mean pre-dose lithium concentration and area under the curve were elevated 21% in those patients treated with meloxicam 15 mg and lithium doses ranging from 804 to 1072 mg twice daily when compared to patients receiving lithium alone. Patients currently taking lithium should be observed closely when meloxicam is introduced or withdrawn.
MethyldopaAdverse Effect An increased risk of lithium toxicity (tremor, weakness, excessive thirst, confusion)Clinical Management Monitor for signs of neurotoxicity with concomitant therapy; serum lithium levels may not necessarily predict this effect. An alternative antihypertensive agent might be considered.
Metronidazole Adverse Effect Elevated lithium plasma levels and lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Monitor for signs of lithium toxicity with concomitant therapy (nausea, diarrhea, polyuria, polydipsia, hand tremor, muscle weakness, confusion, slurred speech, irregular pulse); decreased lithium dosage may be required. Periodic lithium levels might be considered during concurrent therapy with metronidazole. Levels above 1.5 mEq/L are usually associated with some toxicity, while levels above 2 mEq/L result in serious toxicity.
NabumetoneAdverse Effect Lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Serum lithium levels should be monitored within the first few days if a nonsteroidal antiinflammatory drug is added or discontinued from therapy, and periodically thereafter. Patients should be followed for any symptoms of toxicity; a decrease in the lithium dose is often required with concomitant therapy.
Naproxen Adverse Effect Elevated lithium plasma levels and lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management If a nonsteroidal antiinflammatory agent is used concurrently with lithium, serum lithium levels should be monitored and the patient followed for symptoms of toxicity (nausea, diarrhea, polyuria, polydipsia, hand tremor, muscle weakness, confusion, slurred speech, seizures, irregular pulse). A decrease in the lithium dose may be required. Levels above 1.5 mEq/L are usually associated with some toxicity, while those above 2 mEq/L result in serious toxicity.
Nimesulide Adverse Effect Lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Serum lithium levels should be monitored within the first few days if a nonsteroidal antiinflammatory drug is added or discontinued from therapy, and periodically thereafter. Patients should be followed for any symptoms of toxicity; a decrease in the lithium dose is often required with concomitant therapy.
Oxyphenbutazone Adverse Effect Lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Lithium levels should be considered periodically with concomitant phenylbutazone therapy; lower lithium dosage may be required. Patients should be closely followed for any signs of lithium toxicity.
Pancuronium Adverse Effect Prolongation of the neuromuscular blockade
PenfluridolAdverse Effect Weakness, dyskinesias, increased extrapyramidal symptoms, encephalopathy, and brain damageClinical Management Monitor patients closely for any signs of toxicity or extrapyramidal symptoms, especially if high doses of Penfluridol
and lithium are used.
Perindopril Adverse Effect Lithium toxicity (weakness, tremor, excessive thirst, confusion) and/or nephrotoxicityClinical Management The combination of lithium and Perindopril should be avoided if possible, though the choice of an alternative antihypertensive agent that does not interact with lithium is limited. If lithium and Perindopril are used concurrently, serum lithium levels should be closely monitored and the patient followed for any symptoms of lithium toxicity.
PhenylbutazoneAdverse Effect Lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Lithium levels should be considered periodically with concomitant phenylbutazone therapy; lower lithium dosage may be required. Patients should be closely followed for any signs of lithium toxicity.
Pimozide Adverse Effect weakness, dyskinesias, increased extrapyramidal symptoms, encephalopathy, and brain damage
Piroxicam Adverse Effect Lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management If a nonsteroidal antiinflammatory agent is used concurrently with lithium, serum lithium levels should be monitored and the patient followed for any symptoms of toxicity. A decrease in the lithium dose may be required.
Promethazine Adverse Effect Disorientation, unconsciousness & extra-pyramidal symptoms Clinical Management: Avoid the combination if possible.
RamiprilAdverse Effect Lithium toxicity (weakness, tremor, excessive thirst, confusion) and/or nephrotoxicityClinical Management The combination of lithium and Ramipril should be avoided if possible, though the choice of an alternative antihypertensive agent that does not interact with lithium is limited. If lithium and Ramipril are used concurrently, serum lithium levels should be closely monitored and the patient followed for any symptoms of lithium toxicity.
Risperidone Adverse Effect weakness, dyskinesias, increased extrapyramidal symptoms, encephalopathy, and brain damageClinical Management Monitor patients closely for any signs of toxicity or extrapyramidal symptoms, especially if high doses of antipsychotic drugs and lithium are used.
Rofecoxib Adverse Effect Elevation of plasma Lithium levels and a reduction in renal Lithium clearance Clinical Management: Monitor for signs of Lithium toxicity when the drugs are administered concomitantly.
SibutramineAdverse Effect Concomitant administration results in Serotonin syndrome, which is characterized by various fatal reactions Clinical Management: Monitor for the adverse effects and institute supportive therapy. Avoid the concomitant use of these drugs as far as possible.
Sodium Bicarbonate Adverse Effect decreased lithium effectivenessClinical Management Monitor therapeutic efficacy of lithium and serum lithium concentrations; increased lithium dosage may be needed with concomitant urinary alkalinizer therapy.
Spironolactone Adverse Effect increased lithium concentrations and lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Monitor serum lithium levels within the first five to seven days of adding or discontinuing spironolactone and periodically thereafter. Lower lithium doses may be required with concomitant spironolactone therapy.
Succinyl Choline Adverse Effect Prolongation of succinylcholine-induced neuromuscular blockadeClinical Management Caution should be observed when administering succinylcholine to patients undergoing surgery who are stabilized on lithium therapy. Monitor the patient for enhanced neuromuscular blockade.
TenoxicamAdverse Effect Lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Serum lithium levels should be monitored within the first few days if a nonsteroidal antiinflammatory drug is added or discontinued from therapy, and periodically thereafter. Patients should be followed for any symptoms of toxicity; a decrease in the lithium dose is often required with concomitant therapy.
Tetracycline
Adverse Effect Lithium toxicity (drowsiness, slurred speech, tremor, polydipsia)Clinical Management Monitor patient for clinical and laboratory evidence of lithium toxicity, and potential sources of sodium imbalance (diet, adequate fluid intake, diarrhea). Adjust or hold lithium dose as needed.
TheophyllineAdverse Effect Decreased lithium effectivenessClinical Management Monitor therapeutic efficacy of lithium and serum lithium concentrations; increased lithium dosage may be needed with concomitant therapy.
Thioridazine Adverse Effect weakness, dyskinesias, increased extrapyramidal symptoms, encephalopathy, and brain damageClinical Management Monitor patients closely for any signs of toxicity or extrapyramidal symptoms, especially if high doses of antipsychotic drugs and lithium are used.
Triametrene Adverse Effect Concomitant administration causes reduction in renal clearance of Lithium due to diuretic-induced sodium loss and leads to Lithium toxicityClinical Management: Monitor serum Lithium levels and adjust the dosage accordingly.
Trifluoperazine Adverse Effect weakness, dyskinesias, increased extrapyramidal symptoms, encephalopathy, and brain damageClinical Management Monitor patients closely for any signs of toxicity or extrapyramidal symptoms, especially if high doses of antipsychotic drugs and lithium are used.
Valdecoxib Adverse Effect Elevation of plasma Lithium levels and a reduction in renal Lithium clearance Clinical Management: Monitor for signs of Lithium toxicity when the drugs are administered concomitantly.
Verapamil Adverse Effect Loss of mania control, neurotoxicity, bradycardiaClinical Management Serum lithium levels should be monitored periodically. Patients should be followed closely for signs of mania or psychosis, as well as any symptoms of neurotoxicity such as ataxia, tremors, tinnitus, nausea, vomiting or diarrhea.
XipamideAdverse Effect increased lithium concentrations and lithium toxicity (weakness, tremor, excessive thirst, confusion)Clinical Management Monitor serum lithium levels within the first five to seven days of adding or discontinuing thiazides and periodically thereafter. Lower lithium doses may be required with concomitant thiazides therapy. |
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