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Lithium - Interactions and Warnings

Patients taking drugs with a narrow therapeutic index such as lithium should be discouraged from using herbal products. All drugs with a narrow therapeutic index may either have increased adverse effects or be less effective when used in conjunction with herbal products.
- Crit Care Nurse 2002 Apr;22(2):22-8, 30, 32; quiz 34-5 -- Herbal remedies: drug-herb interactions. -- Kuhn MA.

The risk of permanent neurotoxic sequelae of lithium is increased by the concomitant use of certain conventional neuroleptics. We report two new cases of lithium neurotoxicity; one received lithium alone, not in combination with a neuroleptic. Both cases showed severe cerebellar atrophy on brain CT and MRI. Additional factors such as dehydration, systemic infection, other medications, or rapid correction of frequently-coexisting hyponatremia may contribute to the risk of lithium neurotoxicity.
- Rev Neurol (Paris) 1998 Jul;154(6-7):546-8 -- Cerebellar degeneration following acute lithium intoxication -- Roy M, Stip E, Black D, Lew V, Langlois R.

Concomitant use of diuretics has long been associated with the development of lithium toxicity, but the risk of significant interactions varies with the site of pharmacological action of the diuretic in the renal tubule. Thiazide diuretics have demonstrated the greatest potential to increase lithium concentrations, with a 25 to 40% increase in concentrations often evident after initiation of therapy. Nonsteroidal anti-inflammatory drugs have also been associated with lithium toxicity. A growing body of evidence also suggests that ACE inhibitors may impair lithium elimination. Antipsychotics, anticonvulsants and calcium antagonists have all be implicated in a sufficient number of case reports to warrant concern. As these medications have all been commonly coadministered with lithium, the relative risk of serious interactions appears to be quite low, but caution is advised.
- Clin Pharmacokinet 1995 Sep;29(3):172-91 -- Clinical relevance of drug interactions with lithium. -- Finley PR, Warner MD, Peabody CA.

Iodide-induced myxedema may also occur in patients receiving drugs which alter thyroid function, such as lithium, phenazone, and sulfisoxazole.
- Med Clin North Am 1975 Sep;59(5):1075-88 -- Adverse effects of iodides on thyroid function. -- Vagenakis AG, Braverman LE.

Lithium can lower levels of inositol in the body.
- J Neural Transm 1998;105(1):31-8 -- Augmentation of lithium's behavioral effect by inositol uptake inhibitors. -- Einat H, Kofman O, Itkin O, Lewitan RJ, Belmaker RH.

last update: November 2008

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