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Drug Interactions between CMT and Eskalith-CR

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

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Interactions between your drugs

Moderate

choline salicylate magnesium salicylate

Applies to: CMT (choline salicylate / magnesium salicylate) and CMT (choline salicylate / magnesium salicylate)

GENERALLY AVOID: Concomitant use of more than one salicylate at a time may increase the potential for gastrointestinal adverse effects (e.g., inflammation, pain, bleeding, ulceration) and bruising or bleeding.

MANAGEMENT: Concomitant use of more than one salicylate at a time should generally be avoided. Patients treated with a salicylate should be advised to take it with food and to immediately report signs and symptoms of GI ulceration and bleeding such as severe abdominal pain, dizziness, lightheadedness, and the appearance of black, tarry stools.

References

  1. "Product Information. Pepto-Bismol (bismuth subsalicylate)." Procter and Gamble Pharmaceuticals PROD (2001):
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

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Minor

lithium choline salicylate

Applies to: Eskalith-CR (lithium) and CMT (choline salicylate / magnesium salicylate)

Most studies have shown that aspirin and other salicylates do not significantly affect the serum concentrations of lithium. However, one study reported a 22% reduction in lithium clearance in six healthy female subjects given intravenous sodium salicylate, and another study reported a 32% increase in mean serum lithium level in a healthy subject given aspirin for 5 days. In general, no particular precaution should be necessary when lithium is coadministered with salicylates.

References

  1. Reimann IW, Diener U, Frolich JC "Indomethacin but not aspirin increases plasma lithium ion levels." Arch Gen Psychiatry 40 (1983): 283-6
  2. Ragheb M "The clinical significance of lithium-nonsteroidal anti-inflammatory drug interactions." J Clin Psychopharmacol 10 (1990): 350-4
  3. Johnson AG, Nguyen TV, Day RO "Do nonsteroidal anti-inflammatory drugs affect blood pressure? A meta-analysis." Ann Intern Med 121 (1994): 289-300
  4. 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
View all 4 references

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Minor

lithium magnesium salicylate

Applies to: Eskalith-CR (lithium) and CMT (choline salicylate / magnesium salicylate)

Most studies have shown that aspirin and other salicylates do not significantly affect the serum concentrations of lithium. However, one study reported a 22% reduction in lithium clearance in six healthy female subjects given intravenous sodium salicylate, and another study reported a 32% increase in mean serum lithium level in a healthy subject given aspirin for 5 days. In general, no particular precaution should be necessary when lithium is coadministered with salicylates.

References

  1. Reimann IW, Diener U, Frolich JC "Indomethacin but not aspirin increases plasma lithium ion levels." Arch Gen Psychiatry 40 (1983): 283-6
  2. Ragheb M "The clinical significance of lithium-nonsteroidal anti-inflammatory drug interactions." J Clin Psychopharmacol 10 (1990): 350-4
  3. Johnson AG, Nguyen TV, Day RO "Do nonsteroidal anti-inflammatory drugs affect blood pressure? A meta-analysis." Ann Intern Med 121 (1994): 289-300
  4. 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
View all 4 references

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Drug and food interactions

Moderate

lithium food

Applies to: Eskalith-CR (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

magnesium salicylate food

Applies to: CMT (choline salicylate / magnesium salicylate)

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

References

  1. "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn PROD (2002):

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Moderate

lithium food

Applies to: Eskalith-CR (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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