Lithium

Are there any interactions with medications?



Medications for depression (Antidepressant drugs)
Interaction Rating: Major Do not take this combination.

Lithium increases a brain chemical called serotonin. Some medications for depression also increase the brain chemical serotonin. Taking lithium along with these medications for depression might increase serotonin too much and cause serious side effects including heart problems, shivering, and anxiety. Do not take lithium if you are taking medications for depression.

Some of these medications for depression include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), amitriptyline (Elavil), clomipramine (Anafranil), imipramine (Tofranil), and others.



Medications for depression (MAOIs)
Interaction Rating: Major Do not take this combination.

Lithium increases a chemical in the brain. This chemical is called serotonin. Some medications used for depression also increase serotonin. Taking lithium with these medications used for depression might cause there to be too much serotonin. This could cause serious side effects including heart problems, shivering, and anxiety.

Some of these medications used for depression include phenelzine (Nardil), tranylcypromine (Parnate), and others.



Dextromethorphan (Robitussin DM, and others)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Lithium can affect a brain chemical called serotonin. Dextromethorphan (Robitussin DM, others) can also affect serotonin. Taking lithium along with dextromethorphan (Robitussin DM, others) might cause too much serotonin in the brain and serious side effects including heart problems, shivering, and anxiety could result. Do not take lithium if you are taking dextromethorphan (Robitussin DM, and others).



Medications for high blood pressure (ACE inhibitors)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications for high blood pressure can increase lithium levels in the body. Taking lithium along with some medications for high blood pressure might cause too much lithium to be in the body.

Some medications for high blood pressure include captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil, Zestril), ramipril (Altace), and others.



Medications for high blood pressure (Calcium channel blockers)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Lithium is commonly used to help fix chemical imbalances in the brain. Some medications for high blood pressure might increase the side effects of lithium, and decrease the amount of lithium in the body.

Some medications for high blood pressure include nifedipine (Adalat, Procardia), verapamil (Calan, Isoptin, Verelan), diltiazem (Cardizem), isradipine (DynaCirc), felodipine (Plendil), amlodipine (Norvasc), and others.



Medications used to prevent seizures (Anticonvulsants)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Medications used to prevent seizures affect chemicals in the brain. Lithium is commonly used to help fix chemical imbalances in the brain. Taking lithium along with some medications used for seizures might increase the side effects of lithium.

Some medications used to prevent seizures include phenobarbital, primidone (Mysoline), valproic acid (Depakene), gabapentin (Neurontin), carbamazepine (Tegretol), phenytoin (Dilantin), and others.



Meperidine (Demerol)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Lithium increases a chemical in the brain called serotonin. Meperidine (Demerol) can also increase serotonin in the brain. Taking lithium along with meperidine (Demerol) might cause too much serotonin in the brain and serious side effects including heart problems, shivering, and anxiety.



Methyldopa (Aldomet)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Taking methyldopa might increase the effects and side effects of lithium. Do not take lithium if you are taking methyldopa unless prescribed by your healthcare professional.



Methylxanthines
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Taking methylxanthines can increase how quickly the body gets rid of lithium. This could decrease how well lithium works.

Methylxanthines include aminophylline, caffeine, and theophylline.



Muscle relaxants
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Lithium might increase how long muscle relaxants work. Taking lithium along with muscle relaxants might increase the effects and side effects of muscle relaxants.

Some of these muscle relaxants include carisoprodol (Soma), pipecuronium (Arduan), orphenadrine (Banflex, Disipal), cyclobenzaprine, gallamine (Flaxedil), atracurium (Tracrium), pancuronium (Pavulon), succinylcholine (Anectine), and others.



NSAIDs (Nonsteroidal anti-inflammatory drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

NSAIDs are anti-inflammatory medications used for decreasing pain and swelling. NSAIDs might increase lithium levels in the body. Taking lithium along with NSAIDs might increase the risk of lithium side effects. Avoid taking lithium supplements and NSAIDs at the same time.

Some NSAIDs include ibuprofen (Advil, Motrin, Nuprin, others), indomethacin (Indocin), naproxen (Aleve, Anaprox, Naprelan, Naprosyn), piroxicam (Feldene), aspirin, and others.



Phenothiazines
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Taking phenothiazines along with lithium might decrease the effectiveness of lithium. Lithium might also decrease the effectiveness of phenothiazines.

Some phenothiazines include chlorpromazine (Thorazine), fluphenazine (Prolixin), trifluoperazine (Stelazine), thioridazine (Mellaril), and others.



Tramadol (Ultram)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Tramadol (Ultram) can affect a chemical in the brain called serotonin. Lithium can also affect serotonin. Taking lithium along with tramadol (Ultram) might cause too much serotonin in the brain causing confusion, shivering, stiff muscles, and other side effects.



Water pills (Loop diuretics)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some "water pills" can increase how much sodium the body gets rid of in the urine. Decreasing sodium in the body can increase lithium levels in the body and increase the effects and side effects of lithium.



Water pills (Thiazide diuretics)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Taking lithium with some "water pills" can increase the amount of lithium in the body. This can cause serious side effects. Talk to your healthcare provider if you are taking lithium before taking "water pills."

Some types of "water pills" include chlorothiazide (Diuril), hydrochlorothiazide (HydroDiuril, Esidrix), indapamide (Lozol), metolazone (Zaroxolyn), and chlorthalidone (Hygroton).



Pentazocine (Talwin)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Lithium increases a brain chemical called serotonin. Pentazocine (Talwin) also increases serotonin. Taking lithium along with pentazocine (Talwin) might cause too much serotonin in the body. Taking lithium along with pentazocine (Talwin) might cause serious side effects including heart problems, shivering, and anxiety. Do not take lithium supplements if you are taking pentazocine (Talwin).

Dosing considerations for Lithium.

The following doses have been studied in scientific research:

BY MOUTH:
  • For acute manic episodes: 1.8 g or 20-30 mg per kg of lithium carbonate per day in 2-3 divided doses. Some healthcare providers begin therapy at 600-900 mg per day and gradually increase the dose.
  • For bipolar disorder and other psychiatric conditions: The usual adult dose is 900 mg to 1.2 g per day in 2-4 divided doses. 24-32 mEq of lithium citrate solution, given in 2-4 divided doses daily, has also been used. Doses usually should not exceed 2.4 g of lithium carbonate or 65 mEq lithium citrate daily. For children, 15-60 mg per kg (0.4-1.6 mEq per kg) per day in divided doses has been used.
    Lithium may be given as a single daily dose, but is usually given in divided doses to lessen side effects.
    Stopping lithium therapy suddenly increases the chance that symptoms of bipolar disorder will return. The dose of lithium should be reduced gradually over at least 14 days.
There is no recommended dietary allowance (RDA) for lithium. A provisional RDA of 1 mg per day for a 70 kg adult has been suggested.


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