Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Nonsteroidal anti-inflammatory drugs (NSAIDs),
[Voltaren, Cataflam, Arthrotec],
ketorolac [Toradol]), reduce the kidney's ability to eliminate lithium and lead to elevated levels of lithium in the blood andside effects from lithium. Blood concentrations of lithium may need to be measured for 4 to 7 days after an NSAID is either added or stopped during lithium therapy.
sulindac (Clinoril) do not appear to affect lithium concentrations in the blood.
Diuretics (water pills) should be used cautiously in patients receiving lithium. Diuretics that act at the distal renal tubule,
triamterene [Dyrenium; Dyazide, Maxzide]), can increase blood concentrations of lithium. Diuretics that act at the proximal tubule,
acetazolamide [Diamox]), are more likely to reduce blood concentrations of lithium. Diuretics such as
furosemide (Lasix) and
bumetanide (Bumex) may have no affect on lithium concentrations in blood.
[Altace]), may increase the risk of developing lithium toxicity by increasing the amount of lithium that is reabsorbed into the body in the tubules of the kidney and thereby reducing the excretion of lithium.
carbamazepine (Tegretol) and lithium are used together, some patients may experience side effects, including
dizziness, lethargy, and tremor. Central nervous system side effects also may occur when lithium is used with antidepressants,
[Norpramin]). Combining lithium with monoamine oxidase inhibitor (MAOI) class of antidepressants
(for example, isocarboxazid [Marplan], phenelzine [Nardil], tranylcypromine [Parnate],
[Eldepryl], and procarbazine [Matulane]) or other drugs that inhibit monoamine oxidase
linezolid [Zyvox]) may lead to serious reactions.
Medications which cause the urine to become alkaline (the opposite of acidic) can increase the amount of lithium that is lost into the urine. This results in lower blood concentrations of lithium and reduces the effects of lithium. Such drugs include potassium acetate,
potassium citrate (Urocit-K),
sodium bicarbonate, and sodium citrate (Bicitra,
Cytra-2, Liqui-Citra, Oracit, Shohl's).
Caffeine appears to reduce serum lithium concentrations, and side effects of lithium have increased in frequency when
caffeine is consumed.
Tiazac, Dilacor-XR) and
Covera-HS) have been reported to have variable effects on lithium levels in blood. In some patients there may be decreased lithium blood levels and in others lithium toxicity.
Methyldopa (Aldomet) may increase the likelihood of lithium toxicity.
Various reactions have resulted when lithium is administered with phenothiazines,
thioridazine [Mellaril], trifluoperazine
[Stelazine] or with
[Haldol]). Such reactions have included
fever or certain neurologic reactions that affect movement of muscles, called extrapyramidal symptoms.