Drugs which interact with lithium

When reading the active ingredients list on non-prescription medications or when in doubt about any drug interaction, ask your pharmacist!

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Your Journey Family Members and Caregivers. Your Journey Identity and Cultural Dimensions. Your Journey Frontline Professionals. Get Involved Become a Fundraiser. In addition, lithium has a narrow therapeutic index and minor changes in plasma concentrations can have significant clinical consequences 1.

Drug interactions with lithium mostly occur through the direct effect of other medicines on renal function, notably glomerular filtration rate and sodium absorption 1. Medicines that interact with lithium are summarised in Table 1. Regular monitoring of serum lithium and assessment for signs of lithium toxicity see below should be performed for patients requiring concomitant treatment with lithium and interacting medicines 2—4. The dose of lithium may require adjustment.

In some cases, the concomitant treatment may need to be stopped 2—4. Table 1: Medicines that may interact with lithium adapted from data sheets 2—4. Johnson FN, editor. Lithium therapy monographs. Lithium combination treatment. Basel, Switzerland: Karger, A manual of adverse drug interactions: lithium salts. London, Boston, Durban, Singapore: Wright, —8. The use of lithium in the medically ill.

Gen Hosp Psychiatry ; 83— Foster JR. Use of lithium in elderly psychiatric patients: a review of the literature. Lithium ; 3: 77— Clinical relevance of drug interactions with lithium. Clin Pharmacokinet ; — Harvey NS, Merriman S.

Review of clinically important drug interactions with lithium. Drug Saf ; — Mood stabilizer combinations: a review of safety and efficacy. Am J Psychiatry ; 12— Combining lithium and antidepressants. J Clin Psychopharmacol ; 3: —7. Paroxetine and amitriptyline augmentation of lithium in the treatment of major depression: a double-blind study.

J Clin Psychopharmacol. In press. Nervenarzt ; 46—8. Solomon JG. Seizures during lithium-amitriptyline. Postgrad Med ; —8. Pharmacopsychiatry ; — Lithium long-term treatment — does it act via serotonin? Pharmacopsychiatry ; —7. Bauer M. The combined use of lithium and SSRIs. J Serotonin Res ; 2: 69— CAS Google Scholar. Ohman R, Spigset O. Serotonin syndrome induced by fluvoxamine-lithium interaction.

Pharmacopsychiatry ; —4. Mekler G, Woggon B. A case of serotonin syndrome caused by venlafaxine and lithium. Pharmacopsychiatry ; —3. A double-blind, placebo-controlled study of citalopram with and without lithium in the treatment of therapy-resistant depressive patients: a clinical, pharmacokinetic, and pharmacogenetic investigation.

J Clin Psychopharmacol ; — Pharmacokinetic interaction between lithium and fluoxetine after single and repeated administration in young healthy volunteers. Int J Clin Pharmacol Ther ; —9. Lithium carbonate, haloperidol and irreversible brain damage. JAMA ; —7. Neurotoxicity with combined administration of lithium and a neuroleptic.

Delirium and persistent dyskinesia induced by a lithium-neuroleptic interaction. Concurrent lithium administration results in higher haloperidol levels in brain and plasma of Guinea pigs.

Psychiatry Res ; —6. Lithium and haloperidol incompatibility reviewed. Questions about combined lithium and haloperidol treatment. Am J Psychiatry ; —8. Adverse reactions in treatment with lithium carbonate and haloperidol. JAMA ; —6. Safety of the combination of lithium and neuroleptic drugs. Am J Psychiatry ; —4. See 'Serotonin syndrome' and 'Monoamine-oxidase inhibitor' under Antidepressant drugs in BNF for more information and for specific advice on avoiding monoamine-oxidase inhibitors during and after administration of other serotonergic drugs.

Aceclofenac increases the concentration of lithium. Manufacturer advises monitor and adjust dose. Acetazolamide alters the concentration of lithium. Manufacturer makes no recommendation. Both lithium and almotriptan can increase the risk of serotonin syndrome. Both lithium and amifampridine prolong the QT interval. Most manufacturers advise avoiding the use of two or more drugs that are associated with QT prolongation. Increasing age, female sex, cardiac disease, and some metabolic disturbances notably hypokalaemia predispose to QT prolongation.

Aminophylline is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with lithium. Aminophylline is predicted to decrease the concentration of lithium. Manufacturer advises caution.

Both lithium and amiodarone prolong the QT interval. Both lithium and amisulpride prolong the QT interval. Amitriptyline potentially increases the risk of neurotoxicity when given with lithium.

Amphotericin B. Amphotericin B is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with lithium. Both lithium and anagrelide prolong the QT interval. Both lithium and apalutamide prolong the QT interval. Both lithium and apomorphine prolong the QT interval.

Arsenic trioxide. Both lithium and arsenic trioxide prolong the QT interval. Both lithium and artemether prolong the QT interval. Both lithium and artenimol prolong the QT interval. Azilsartan potentially increases the concentration of lithium. Manufacturer advises monitor concentration and adjust dose. Bambuterol is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with lithium.

Beclometasone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with lithium. Both lithium and bedaquiline prolong the QT interval. Bendroflumethiazide is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with lithium.

Bendroflumethiazide increases the concentration of lithium. Manufacturer advises avoid or adjust dose and monitor concentration. Benzydamine increases the concentration of lithium. Betamethasone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with lithium.

Both lithium and bosutinib prolong the QT interval. Bromfenac increases the concentration of lithium. Budesonide is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with lithium. Bumetanide is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with lithium. Bumetanide increases the concentration of lithium. Bupropion might enhance the risk of serotonin syndrome when given with lithium.

MHRA advises monitor. Both lithium and cabozantinib prolong the QT interval. Calcitonins decrease the concentration of lithium. Manufacturer advises adjust dose. Candesartan potentially increases the concentration of lithium. Captopril is predicted to increase the concentration of lithium. Carbamazepine is predicted to increase the risk of neurotoxicity when given with lithium.

Celecoxib increases the concentration of lithium. Both lithium and ceritinib prolong the QT interval. Chlorothiazide increases the concentration of lithium. Chlorothiazide is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with lithium.

Both lithium and chlorpromazine prolong the QT interval. Chlorpromazine potentially increases the risk of neurotoxicity when given with lithium. Manufacturer advises discontinue if neurotoxicity develops.

Chlortalidone increases the concentration of lithium. Chlortalidone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with lithium. Both lithium and citalopram can increase the risk of serotonin syndrome. Both lithium and citalopram prolong the QT interval. Both lithium and clarithromycin prolong the QT interval.

Both lithium and clomipramine can increase the risk of serotonin syndrome. Both lithium and clomipramine prolong the QT interval. Clomipramine potentially increases the risk of neurotoxicity when given with lithium. Both lithium and crizotinib prolong the QT interval. Both lithium and dapoxetine can increase the risk of serotonin syndrome. Both lithium and dasatinib prolong the QT interval. Deflazacort is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with lithium.

Both lithium and delamanid prolong the QT interval. Demeclocycline is predicted to increase the risk of lithium lithium carbonate , lithium citrate toxicity when given with lithium. Manufacturer advises avoid or adjust dose. Both lithium and desflurane prolong the QT interval.

Dexamethasone is predicted to cause hypokalaemia potentially increasing the risk of torsade de pointes when given with lithium.