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Drug Interactions between Celebrex and Eskalith

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

lithium celecoxib

Applies to: Eskalith (lithium) and Celebrex (celecoxib)

MONITOR CLOSELY: Coadministration with nonsteroidal anti-inflammatory drugs (NSAIDs) may increase serum lithium levels and induce toxicity in some patients. The exact mechanism of interaction is unknown, but is thought to involve inhibition of renal prostaglandin synthesis by NSAIDs, resulting in decreased renal blood flow and lithium excretion. There have been numerous published reports of lithium toxicity, including severe cases, following the introduction of various NSAIDs including diclofenac, ibuprofen, indomethacin, ketorolac, mefenamic acid, piroxicam, and COX-2 inhibitors. However, pharmacokinetic studies have been somewhat inconsistent, with no significant effects reported for benoxaprofen and etodolac, and up to a 58% increase in serum lithium levels reported for indomethacin. Both decreased serum concentrations of lithium and no effect have been reported for sulindac and aspirin. The interaction is apparently subject to marked interpatient variability.

MANAGEMENT: Given the narrow therapeutic index of lithium, caution is advised during coadministration with NSAIDs, particularly in the elderly or patients with other risk factors (e.g., sodium restriction; renal impairment; congestive heart failure; dehydration; concomitant use of diuretics, ACE inhibitors, or angiotensin II receptor antagonists). Patients should have serum lithium levels checked every 4 to 5 days after starting an NSAID until the extent of any potential interaction can be evaluated. A reduction in lithium dosage may be needed in some cases. Renal function should also be monitored regularly. Patients should be advised to seek medical attention if they experience potential signs and symptoms of lithium toxicity such as drowsiness, dizziness, confusion, muscle weakness, vomiting, diarrhea, polydipsia, polyuria, tinnitus, tremor, ataxia, and blurred vision.

References

  1. Ragheb M, Ban TA, Buchanan D, Frolich JC "Interaction of indomethacin and ibuprofen with lithium in manic patients under a steady-state lithium level." J Clin Psychiatry 41 (1980): 397-8
  2. Ragheb M "Ibuprofen can increase serum lithium level in lithium-treated patients." J Clin Psychiatry 48 (1987): 161-3
  3. Herschberg SN, Sierles FS "Indomethacin-induced lithium toxicity." Am Fam Physician 28 (1983): 155-7
  4. Reimann IW, Diener U, Frolich JC "Indomethacin but not aspirin increases plasma lithium ion levels." Arch Gen Psychiatry 40 (1983): 283-6
  5. Ragheb M, Powell AL "Lithium interaction with sulindac and naproxen." J Clin Psychopharmacol 6 (1986): 150-4
  6. Furnell MM, Davies J "The effect of sulindac on lithium therapy." Drug Intell Clin Pharm 19 (1985): 374-6
  7. Reimann IW, Frolich JC "Effects of diclofenac on lithium kinetics." Clin Pharmacol Ther 30 (1981): 348-52
  8. Ragheb M "The clinical significance of lithium-nonsteroidal anti-inflammatory drug interactions." J Clin Psychopharmacol 10 (1990): 350-4
  9. Khan IH "Lithium and non-steroidal anti-inflammatory drugs." Br Med J 302 (1991): 1537-8
  10. Gadallah MF, Feinstein EI, Massry SG "Lithium intoxication: clinical course and therapeutic considerations." Miner Electrolyte Metab 14 (1988): 146-9
  11. Kamlana SH, Kerry RJ, Khan IA "Lithium: some drug interactions." Practitioner 224 (1980): 1291-2
  12. Ragheb M "The interaction of lithium with phenylbutazone in bipolar affective patients." J Clin Psychopharmacol 10 (1990): 149-50
  13. Walbridge DG, Bazire SR "An interaction between lithium carbonate and piroxicam presenting as lithium toxicity." Br J Psychiatry 147 (1985): 206-7
  14. Shelley RK "Lithium toxicity and mefenamic acid: a possible interaction and the role of prostaglandin inhibition." Br J Psychiatry 151 (1987): 847-8
  15. MacDonald J, Neale TJ "Toxic interaction of lithium carbonate and mefenamic acid." Br Med J 297 (1988): 1339
  16. Nadarajah J, Stein GS "Piroxicam induced lithium toxicity." Ann Rheum Dis 44 (1985): 502
  17. Kerry RJ, Owen G, Michaelson S "Possible toxic interaction between lithium and piroxicam." Lancet 1 (1983): 418-9
  18. "Product Information. Eskalith (lithium)." SmithKline Beecham PROD (2002):
  19. Harrison TM, Davies DW, Norris CM "Lithium carbonate and piroxicam." Br J Psychiatry 149 (1986): 124-5
  20. Shelley RK "Lithium and piroxicam." Br J Psychiatry 148: (1986): 343
  21. Langlois R, Paquette D "Increased serum lithium levels due to ketorolac therapy." Can Med Assoc J 150 (1994): 1455-6
  22. Iyer V "Ketorolac (Toradol) induced lithium toxicity." Headache 34 (1994): 442-4
  23. Brouwers JRBJ, Desmet PAGM "Pharmacokinetic-pharmacodynamic drug interactions with nonsteroidal anti-inflammatory drugs." Clin Pharmacokinet 27 (1994): 462-85
  24. Stockley IH "Interactions between lithium and NSAIDs." Can Med Assoc J 152 (1995): 152-3
  25. Finley PR, Warner MD, Peabody CA "Clinical relevance of drug interactions with lithium." Clin Pharmacokinet 29 (1995): 172-91
  26. Hughes BM, Small RE, Brink D, Mckenzie ND "The effect of flurbiprofen on steady-state plasma lithium levels." Pharmacotherapy 17 (1997): 113-20
  27. Chandragiri SS, Pasol E, Gallagher RM "Lithium, ACE inhibitors, NSAIDs, and verapamil - A possible fatal combination." Psychosomatics 39 (1998): 281-2
  28. Turck D, Heinzel G, Luik G "Steady-state pharmacokinetics of lithium in healthy volunteers receiving concomitant meloxicam." Br J Clin Pharmacol 50 (2000): 197-204
  29. Lundmark J, Gunnarsson T, Bengtsson F "A possible interaction between lithium and rofecoxib." Br J Clin Pharmacol 53 (2002): 403-4
  30. Monji A, Maekawa T, Miura T, et al. "Interactions between lithium and non-steroidal antiinflammatory drugs." Clin Neuropharmacol 25 (2002): 241-2
  31. "A life-threatening interaction between lithium and celecoxib." Br J Clin Pharmacol 55 (2003): 413
  32. Gunja N, Graudins A, Dowsett R "Lithium toxicity: a potential interaction with celecoxib." Intern Med J 32(9-10) (2002): 494
  33. Bennett WM "Drug interactions and consequences of sodium restriction." Am J Clin Nutr 65 (1997): S678-81
  34. Alderman CP, Lindsay KS "Increased serum lithium concentration secondary to treatment with tiaprofenic acid and fosinopril." Ann Pharmacother 30 (1996): 1411-3
  35. Phelan KM, Mosholder AD, Lu S "Lithium interaction with the cyclooxygenase 2 inhibitors rofecoxib and celecoxib and other nonsteroidal anti-inflammatory drugs." J Clin Psychiatry 64 (2003): 1328-34
  36. Juurlink DN, Mamdani MM, Kopp A, Rochon PA, Shulman KI, Redelmeier DA "Drug-induced lithium toxicity in the elderly: a population-based study." J Am Geriatr Soc 52 (2004): 794-8
  37. Ratz Bravo AE, Egger SS, Crespo S, Probst WL, Krahenbuhl S "Lithium intoxication as a result of an interaction with rofecoxib." Ann Pharmacother 38 (2004): 1189-93
  38. Wilting I, Movig KL, Moolenaar M, et al. "Drug-drug interactions as a determinant of elevated lithium serum levels in daily clinical practice." Bipolar Disord 7 (2005): 274-80
  39. Chen L, Pym H "Rapid onset of neurological symptoms and lithium toxicity on starting meloxicam." Aust N Z J Psychiatry 44 (2010): 95
  40. De Winter S, Meersseman W, Verelst S, Willems L, Spriet I "Drug-related admissions due to interaction with an old drug, lithium." Acta Clin Belg 68 (2013): 356-8
  41. Finley PR "Drug interactions with lithium: an update." Clin Pharmacokinet 55 (2016): 925-41
  42. Hassan S, Khalid F, Alirhayim Z, Amer S "Lithium toxicity in the setting of nonsteroidal anti-inflammatory medications." Case Rep Nephrol 2013 (2013): epub
  43. Frolich JC, Leftwich R, Ragheb M, Oates JA, Reimann I, Buchanan D "Indomethacin increases plasma lithium." Br Med J 1 (1979): 1115-6
  44. Kelly CB, Cooper SJ "Toxic elevation of serum lithium concentration by non-steroidal anti-inflammatory drugs." Ulster Med J 60 (1991): 240-2
View all 44 references

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Drug and food interactions

Moderate

lithium food

Applies to: Eskalith (lithium)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
View all 4 references

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Moderate

lithium food

Applies to: Eskalith (lithium)

MONITOR: One study has suggested that caffeine withdrawal may significantly increase blood lithium levels. The mechanism may be involve reversal of a caffeine-induced increase in renal lithium excretion.

MANAGEMENT: When caffeine is eliminated from the diet of lithium-treated patients, caution should be exercised. When caffeine consumption is decreased, close observation for evidence of lithium toxicity and worsening of the psychiatric disorder is recommended. Patients should be advised to notify their physician if they experience symptoms of possible lithium toxicity such as drowsiness, dizziness, weakness, ataxia, tremor, vomiting, diarrhea, thirst, blurry vision, tinnitus, or increased urination.

References

  1. Mester R, Toren P, Mizrachi I, Wolmer L, Karni N, Weizman A "Caffeine withdrawal increases lithium blood levels." Biol Psychiatry 37 (1995): 348-50

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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