Lithium Carbonate interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

  What to do: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

  4 sources

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):

Conditions

Conditions in which Lithium Carbonate needs care, as documented in this source.

• Dehydration

  Major

  Lithium reduces the ability of the kidney to concentrate urine and produces a mild diabetes insipidus and polyuria. Therefore, patients with preexisting dehydration are more prone to lithium retention and toxicity. Therapy with lithium should be administered cautiously in dehydrated patients and may need to be discontinued until improvement in hydration status. Careful monitoring of lithium levels are recommended. Patients with sweating, diarrhea or concomitant infection with fever may need a temporary reduction or cessation of medication.

  3 sources

  1. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  2. "Product Information. Lithobid (lithium)." Ciba-Geigy Pharmaceuticals (2002):
  3. Martinez EJ, Sinnott JT, 4th Rodriguez-Paz G, Oehler RL "Lithium-induced nephrogenic diabetes insipidus treated with indomethacin." South Med J 86 (1993): 971-3

• Dementia

  Major

  Older patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death; although the causes were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. A causal relationship with antipsychotic use has not been established. In controlled trials in older patients with dementia-related psychosis, patients randomized to risperidone, aripiprazole, and olanzapine had higher incidence of cerebrovascular adverse events (e.g., stroke, transient ischemic attack), including fatalities, compared to patients treated with placebo. These agents are not approved for the treatment of patients with dementia-related psychosis.

  14 sources

  1. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals (2001):
  2. "Product Information. Risperdal (risperidone)." Janssen Pharmaceuticals (2001):
  3. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company (2001):
  4. "Product Information. Seroquel (quetiapine)." Astra-Zeneca Pharmaceuticals (2001):
  5. "Product Information. Geodon (ziprasidone)." Pfizer U.S. Pharmaceuticals (2001):
  6. "Product Information. Abilify (aripiprazole)." Bristol-Myers Squibb (2002):
  7. "Product Information. Invega (paliperidone)." Janssen Pharmaceuticals (2007):
  8. "Product Information. Fanapt (iloperidone)." Vanda Pharmaceuticals Inc (2009):

  Show all 14 sourcesShow fewer sources

  9. "Product Information. Saphris (asenapine)." Schering-Plough Corporation (2009):
  10. "Product Information. Latuda (lurasidone)." Sunovion Pharmaceuticals Inc (2010):
  11. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
  12. "Product Information. Vraylar (cariprazine)." Actavis Pharma, Inc. (2015):
  13. "Product Information. Nuplazid (pimavanserin)." Accelis Pharma (2016):
  14. "Product Information. Caplyta (lumateperone)." Intra-Cellular Therapies, Inc. (2022):

• Diarrhea

  Major

  The risk for lithium toxicity may be increased in patients with diarrhea and excessive sweating. Dehydration and sodium depletion may occur in these patients leading to lithium retention and toxicity. The use of lithium may need to be reduced or suspended until the condition resolves. Supplemental fluid and salt may need to be administered. Monitoring serum lithium levels is recommended.

  2 sources

  1. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  2. "Product Information. Lithobid (lithium)." Ciba-Geigy Pharmaceuticals (2002):

• Epilepsy

  Major

  Antipsychotics can lower the seizure threshold and trigger seizures in a dose-dependent manner. Seizures have been reported in patients receiving antipsychotic therapy and may occur in epileptic patients even with maintenance of routine anticonvulsant treatment. Therapy with antipsychotics should be administered cautiously in patients with a history of seizures or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism. High dosages should be avoided if possible.

  7 sources

  1. Markowitz J, Brown R "Seizures with neuroleptics and antidepressants." Gen Hosp Psychiatry 9 (1987): 135-41
  2. Lowry MR, Dunner FJ "Seizures during tricyclic therapy." Am J Psychiatry 137 (1980): 1461-2
  3. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical (2002):
  4. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  5. "Product Information. Moban (molindone)." Gate Pharmaceuticals (2001):
  6. "Product Information. Orap (pimozide)." Gate Pharmaceuticals
  7. "Product Information. Loxitane C (loxapine)." Apothecon Inc (2022):

• Heart Diseases

  Major

  Lithium should generally not be given to patients with significant cardiovascular disease since the risk of lithium toxicity is high in these patients. Additionally, there have been postmarketing reports of a possible association between lithium therapy and the unmasking of Brugada Syndrome, a disorder characterized by abnormal EKG findings and a risk of sudden death. Lithium should be avoided in patients with this diagnosis or suspicion of it, or that have risk factors, which include unexplained syncope, family history of this syndrome, or family history of unexplained sudden death before the age of 45 years. Therapy with lithium should be administered with extreme caution in patients with preexisting cardiac disease. Consultation with a cardiologist is highly recommended and cardiac monitoring should be completed before and during treatment.

  2 sources

  1. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  2. "Product Information. Lithobid (lithium)." Ciba-Geigy Pharmaceuticals (2002):

• Hypothyroidism

  Major

  The use of lithium has been associated with hypothyroidism in 5% to 15% of patient as it blocks the release of thyroxine (T4) and triiodothyronine (T3) mediated by thyrotropin. Therapy with lithium should be administered cautiously in patients with preexisting hypothyroidism. Careful monitoring of the thyroid function is recommended and supplemental thyroid treatment may be required.

  2 sources

  1. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  2. "Product Information. Lithobid (lithium)." Ciba-Geigy Pharmaceuticals (2002):

• Kidney Diseases

  Major

  Lithium is primarily eliminated by the kidneys and should generally not be administered to patients with significant renal dysfunction. Additionally, morphological changes with glomerular and interstitial fibrosis and nephron atrophy have been reported in patients on chronic lithium therapy, although the association has not been clearly established. Kidney function should be assessed in patients prior to starting therapy, during and thereafter and routine urinalysis and renal function tests are recommended. Progressive or sudden changes in renal function indicate the need for reevaluation of treatment. Monitoring lithium serum levels is also recommended.

  3 sources

  1. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  2. "Product Information. Lithobid (lithium)." Ciba-Geigy Pharmaceuticals (2002):
  3. Braden GL. Lithium induced renal diseases. In: Greenberg A, ed. "Primer on Kidney Diseases." San Diego, CA: Academic Press Inc. (1994): 173-4

• Neuroleptic Malignant Syndrome

  Major

  Neuroleptic Malignant Syndrome (NMS), a potentially fatal symptom complex, has been reported in association with the use of antipsychotic drugs. The diagnostic evaluation is complicated and the management requires immediate discontinuation of the antipsychotic therapy and intensive symptomatic treatment and medical monitoring. If a patient that has recovered from NMS requires antipsychotic drug treatment again, the reintroduction of therapy should be carefully considered as NMS recurrences have been reported.

  5 sources

  1. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical (2002):
  2. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  3. "Product Information. Moban (molindone)." Gate Pharmaceuticals (2001):
  4. "Product Information. Orap (pimozide)." Gate Pharmaceuticals
  5. "Product Information. Adasuve (loxapine)." Teva Pharmaceuticals USA (2015):

• Water Intoxication

  Major

  Lithium decreases sodium reabsorption by the renal tubules which could lead to sodium depletion. Therapy with lithium should be administered cautiously in patients with preexisting sodium depletion as the risk of lithium toxicity is increased. Lower dosages may be required. Patients should maintain a normal diet, including salt, and an adequate fluid intake. Monitoring lithium serum concentrations is recommended.

  7 sources

  1. Hurtig DL, Dyson WL "Lithium toxicity enhanced by diuresis." N Engl J Med 290 (1974): 748-9
  2. Hansen HE, Hestbech J, Olsen S, Amdisen A "Renal function and renal pathology in patients with lithium-induced impairment of renal concentrating ability." Dial Transplant Nephrol 14 (1977): 518-27
  3. Reisberg B, Gershon S "Side effects associated with lithium therapy." Arch Gen Psychiatry 36 (1979): 879-87
  4. Depner TA "Nephrotic syndrome secondary to lithium therapy." Nephron 30 (1982): 286-9
  5. Wood IK, Parmalee DX, Foreman JW "Lithium-induced nephrotic syndrome." Am J Psychiatry 146 (1989): 84-7
  6. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  7. "Product Information. Lithobid (lithium)." Ciba-Geigy Pharmaceuticals (2002):

• Fever

  Moderate

  Patients with fever may have a lower tolerance to lithium due to increased fluid and sodium loss. Lithium dosage may need to be reduced or suspended in such patients. Monitoring lithium serum levels is recommended.

  2 sources

  1. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  2. "Product Information. Lithobid (lithium)." Ciba-Geigy Pharmaceuticals (2002):

• Hyperprolactinemia

  Moderate

  Antipsychotic drugs can elevate serum prolactin concentrations, and this elevation persists during chronic administration. This should be considered if therapy will be prescribed in patients with previously detected breast cancer as one-third of human breast cancers are prolactin-dependent in vitro. Associated disturbances such as galactorrhea, amenorrhea, gynecomastia, and impotence have been reported. Appropriate laboratory testing and follow-up is advised.

  5 sources

  1. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical (2002):
  2. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  3. "Product Information. Moban (molindone)." Gate Pharmaceuticals (2001):
  4. "Product Information. Orap (pimozide)." Gate Pharmaceuticals
  5. "Product Information. Adasuve (loxapine)." Teva Pharmaceuticals USA (2015):

• Neutropenia

  Moderate

  The use of antipsychotics has been associated with events of leukopenia, neutropenia and agranulocytosis. Possible risk factors include preexisting low white blood cell count, and history of drug induced leukopenia/neutropenia. Patients with these risk factors should have complete blood count monitored frequently during the first few months of therapy. Patients should also be monitored for any signs or symptoms of infection. Treatment should be discontinued in any patient who develops a sore throat, fever, stomatitis, or other signs of infection along with a low WBC count or severe neutropenia (ANC < 1000/mm3).

  5 sources

  1. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical (2002):
  2. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  3. "Product Information. Moban (molindone)." Gate Pharmaceuticals (2001):
  4. "Product Information. Orap (pimozide)." Gate Pharmaceuticals
  5. "Product Information. Adasuve (loxapine)." Teva Pharmaceuticals USA (2015):