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.
When 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, [for example, fluoxetine (Prozac) sertraline (Zoloft), and
paroxetine (Paxil), fluvoxamine (Luvox), amitriptyline (Elavil), imipramine
(Tofranil), desipramine (Norpramin)].
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.
Both diltiazem (Cardizem-CD, Tiazac, Dilacor-XR) and verapamil (Calan-SR,
Isoptin-SR, Verelan, 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, [for example, chlorpromazine (Thorazine),
thioridazine
(Mellaril), trifluoperazine (Stelazine) or with haloperidol
(Haldol)]. Such
reactions have included delirium, seizures, encephalopathy, high fever or
certain neurologic reactions that affect movement of muscles, called
extrapyramidal symptoms.
Lithium can cause goiter or hypothyroidism. The use of lithium with potassium
iodide can increase the likelihood of this adverse reaction.
The use of the beta blocker, propranolol (Inderal), with lithium can lead to
a slow heart rate and dizziness. Other beta blockers, [for example, metoprolol
(Lopressor), atenolol (Tenormin)] also may interact with lithium and be
associated with a slow heart rate.
PREGNANCY: Lithium crosses the placenta and has been associated with
toxicity in the fetus. Children born to women taking lithium during
pregnancy
have an increased risk of goiter and cardiac anomalies. If possible, lithium
should be withheld during the first trimester. Women of childbearing age who may
require lithium should be counseled about becoming pregnant.
NURSING MOTHERS: Lithium is secreted into breast milk. Symptoms of
lithium toxicity, including changes in the electrocardiogram, have been seen in
some breast-fed infants, whose mothers were taking lithium. If possible, women
taking lithium should not breast-feed their infants.
SIDE EFFECTS: The most common side effects that can occur in persons
taking lithium are fine hand tremor, dry mouth, altered taste perception, weight
gain, increased thirst, increased frequency of urination, mild
nausea or
vomiting, impotence, decreased libido, diarrhea, and kidney abnormalities. Many
of the gastrointestinal side effects (nausea, taste alterations, diarrhea) often
disappear with continued therapy. Additionally, they may be less common if
lithium is taken in divided doses with meals. If diarrhea or excessive urination
lead to dehydration, lithium toxicity is possible. Lithium can also cause
changes in the electrocardiogram, low blood pressure, and decreased heart rate.
The following side effects suggest that lithium blood levels may be too high,
and that the dose of lithium may need to be reduced (after confirmation by
measurement of lithium levels in blood):
loss of appetite,
visual impairment,
tiredness; muscle weakness,
muscle fasciculations (twitches),
tremor,
unsteady gait,
confusion, seizure,
arrhythmias,
slurred speech,
coma.
About 1 in every 25 persons who receives lithium develops a goiter (an
enlarged thyroid gland). Hypothyroidism (low thyroid hormone levels) has been
reported. Signs of hypothyroidism may include:
Acne is a localized skin inflammation as a result of overactivity of oil glands at the
base of hair follicles. This inflammation, depending on its location, can take the form
of a superficial pustule (contains pus), a pimple, a deeper cyst, congested pores, whiteheads, or blackheads. Treatments vary depending on the severity of the acne.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Post-traumatic stress disorder (PTSD), a psychiatric condition, can develop after any catastrophic life event. Symptoms include nightmares, flashbacks, sweating, rapid heart rate, detachment, amnesia, sleep problems, irritability, and exaggerated startle response. Treatment may involve psychotherapy, group support, and medication.
Suicide is the process of intentionally ending one's own life. Approximately 1 million people worldwide commit suicide each year, and 10 million to 20 million attempt suicide annually.
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood stabilizer medications, antidepressants, and psychotherapy.
Huntington's disease is the result of degeneration of neurons in areas of the brain. Huntington's disease is an inherited disorder. Early symptoms include mood swings, apathy, depression, and anger uncharacteristic of the individual. Judgement, memory, and other cognitive functions may become impaired. Presymptomatic testing is available for individuals who have a family history of Huntington's disease. Treatment includes medication and therapy for symptoms.
Diabetes insipidus is a condition in which the patient has frequent urination. Symptoms of diabetes insipidus include irritable, listless, fever, vomiting, or diarrhea due to the loss of large volumes of urine. There are three types of diabetes insipidus, central, nephrogenic, dipsogenic, and gestational. Treatment depends upon the type of diabetes insipidus.
Fragile X syndrome is the most common inherited form of mental retardation. It's caused by a mutation on the X chromosome. People with Fragile X syndrome suffer from physical, social, emotional, speech, language, sensory, intelligence, and learning impairments. There is no definitive treatment for Fragile X, though there are ways to minimize the symptoms.
Schizoaffective disorder is a mental illness that features schizophrenia and a mood disorder, either major depression or bipolar disorder. Symptoms include agitation, suicidal thoughts, little need for sleep, delusions, hallucinations, and poor motivation. Treatment may involve psychotherapy, medication, skills training, or hospitalization.
Compulsive gambling is a disorder that affects millions in the U.S. Symptoms and signs include a preoccupation with gambling, lying to family or loved ones to hide gambling, committing crimes to finance gambling, and risking importance relationships and employment due to gambling. Treatment may incorporate participation in Gamblers' Anonymous, psychotherapy, and medications like carbamazepine, topiramate, lithium, naltrexone, antidepressants, clomipramine, and fluvoxamine.
Postpartum depression is a form of depression that occurs within a year after delivery. It is thought that rapid hormone changes after childbirth may lead to depression. Symptoms of postpartum depression include crying a lot, headaches, chest pains, eating too little or too much, sleeping too little or too much, withdrawal from friends and family, and feeling irritable, sad, hopeless, worthless, guilty, and overwhelmed. Treatment typically involves talk therapy and medication.
The term cluster headache is a type of headache that recurs over a period of time. There are episodes that last one to three times a day during a period of time, which may last from 2 weeks to 3 months. There are three main types of treatment abortive medications, preventive medications, or surgery which involves blocking the trigeminal nerve.
Bipolar disorder, or manic-depressive illness, is a disorder that causes unusual and extreme mood changes. Symptoms of bipolar disorder in children and teens include having trouble concentrating, behaving in risky ways and losing interest in activities they once enjoyed. Treatment for bipolar disorder in children and teenagers incorporates psychotherapy and medications.
Taking prescription medications or over-the-counter drugs or supplements should be discussed with your doctor. There are some medications that have been found to cause no problems in pregnancy, however, medications such as Accutane for acne, should never be taken during pregnancy.
Kleine-Levin syndrome is a rare sleep condition, primarily affecting adolescent males. Symptoms of Kleine-Levin syndrome include recurring but reversible periods "episodes" of excessive sleep. There is no definitive treatment for Kleine-Levin syndrome. Medication can be prescribed to treat sleepiness and episodes.
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