Skip to main content

Drug Interactions between Lithotabs and polythiazide / reserpine

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

Edit list (add/remove drugs)

Interactions between your drugs

Major

lithium polythiazide

Applies to: Lithotabs (lithium) and polythiazide / reserpine

GENERALLY AVOID: Thiazide diuretics may cause a rapid increase in serum lithium levels and potentiate the risk of lithium toxicity. The exact mechanism is unknown but may be related to the sodium loss induced by thiazide diuresis, which produces a compensatory increase in proximal tubular reabsorption of sodium along with lithium. In a study of 22 patients receiving bendroflumethiazide 2.5 mg or hydroflumethiazide 25 mg daily for the treatment of edema, mean renal clearance of a single 600 mg dose of lithium carbonate was reduced by 24% during thiazide diuretic therapy compared to before or after diuretic therapy. A similar reduction in renal lithium clearance has been reported in studies with chlorothiazide. There have also been case reports of patients developing lithium toxicity shortly after initiation of various thiazide diuretics including bendroflumethiazide, chlorothiazide, chlorthalidone, hydrochlorothiazide and indapamide, either alone or in combination with other diuretics. Up to severalfold increases in serum lithium levels have been observed, usually within several days to 2 weeks but occasionally longer. The risk for lithium toxicity may be further increased during concomitant sodium restriction.

MANAGEMENT: Thiazide diuretics should generally not be prescribed to patients receiving lithium unless close monitoring of serum lithium levels and electrolytes can be rendered. Lithium dose reductions may be required. Patients should be advised to notify their physician if they experience potential signs and symptoms of lithium toxicity such as drowsiness, dizziness, muscle weakness, vomiting, diarrhea, thirst, polyuria, tinnitus, tremor, ataxia, and blurred vision. Some investigators have suggested that loop diuretics are safer with lithium than thiazide diuretics, although supporting data are limited.

References

  1. Crabtree BL, Mack JE, Johnson CD, Amyx BC "Comparison of the effects of hydrochlorothiazide and furosemide on lithium disposition." Am J Psychiatry 148 (1991): 1060-3
  2. MacNeil S, Hanson-Nortey E, Paschalis C, et al. "Diuretics during lithium therapy." Lancet 06/07/75 (1975): 1295-6
  3. Boer WH, Koomans HA, Mees EJ "Acute effects of thiazides, with and without carbonic anhydrase inhibiting activity, on lithium and free water clearance in man." Clin Sci 76 (1989): 539-45
  4. Hanna ME, Lobao CB, Stewart JT "Severe lithium toxicity associated with indapamide therapy." J Clin Psychopharmacol 10 (1990): 379-80
  5. Dorevitch A, Baruch E "Lithium toxicity induced by combined amiloride HCl- hydrochlorothiazide administration." Am J Psychiatry 143 (1986): 257-8
  6. Gammon GD, Docherty JP "Thiazide-induced hypercalcemia in a manic-depressive patient." Am J Psychiatry 137 (1980): 1453-5
  7. Levy ST, Forrest JN, Jr Heninger GR "Lithium-induced diabetes insipidus: manic symptoms, brain and electrolyte correlates, and chlorothiazide treatment." Am J Psychiatry 130 (1973): 1014-8
  8. Poust RI, Mallinger AG, Mallinger J, Himmelhoch JM, Neil JF, Hanin I "Effect of chlorothiazide on the pharmacokinetics of lithium in plasma and erythrocytes." Psychopharmacol Commun 2 (1976): 273-84
  9. Solomon JG "Lithium toxicity precipitated by a diuretic." Psychosomatics 21 (1980): 425, 429
  10. Macfie AC "Lithium poisoning precipitated by diuretics." Br Med J 1 (1975): 516
  11. Nurnberger JI Jr "Diuretic-induced lithium toxicity presenting as mania." J Nerv Ment Dis 173 (1985): 316-8
  12. Mehta BR, Robinson BH "Lithium toxicity induced by triamterene-hydrochlorothiazide." Postgrad Med J 56 (1980): 783-4
  13. Hurtig HI, Dyson WL "Lithium toxicity enhanced by diuresis." N Engl J Med 290 (1974): 748-9
  14. Petersen V, Hvidt S, Thomsen K, Schou M "Effect of prolonged thiazide treatment on renal lithium clearance." Br Med J 3 (1974): 143-5
  15. Himmelhoch JM, Poust RI, Mallinger AG, Hanin I, Neil JF "Adjustment of lithium dose during lithium-chlorothiazide therapy." Clin Pharmacol Ther 22 (1977): 225-7
  16. Kerry RJ, Ludlow JM, Owen G "Diuretics are dangerous with lithium." Br Med J 281 (1980): 371
  17. "Product Information. Eskalith (lithium)." SmithKline Beecham PROD (2002):
  18. Aronson JK, Reynolds DJM "ABC of monitoring drug therapy. Lithium." Br Med J 305 (1992): 1273-6
  19. Jefferson JW, Kalin NH "Serum lithium levels and long-term diuretic use." JAMA 241 (1979): 1134-6
  20. Finley PR, Warner MD, Peabody CA "Clinical relevance of drug interactions with lithium." Clin Pharmacokinet 29 (1995): 172-91
  21. Bennett WM "Drug interactions and consequences of sodium restriction." Am J Clin Nutr 65 (1997): S678-81
  22. Vipond AJ, Bakewell S, Telford R, Nicholls AJ "Lithium toxicity." Anaesthesia 51 (1996): 1156-8
View all 22 references

Switch to consumer interaction data

Moderate

lithium reserpine

Applies to: Lithotabs (lithium) and polythiazide / reserpine

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595
View all 8 references

Switch to consumer interaction data

Moderate

reserpine polythiazide

Applies to: polythiazide / reserpine and polythiazide / reserpine

MONITOR: The hypotensive effects of thiazide diuretics and alpha-adrenergic blockers may be additive. Postural hypotension may occur.

MANAGEMENT: Hemodynamic responses should be monitored during coadministration, especially during the first few weeks of therapy. Patients should be advised to take the alpha-blocker at bedtime and to notify their physician if they experience dizziness or syncope while awake.

References

  1. Achari R, Laddu A "Terazosin: a new alpha adrenoceptor blocking drug." J Clin Pharmacol 32 (1992): 520-3
  2. Kuokkanen K, Mattila MJ "Demonstration of an additive antihypertensive effect of prazosin and polythiazide in out-patient." Curr Ther Res Clin Exp 17 (1975): 431-6
  3. Pool JL "Combination antihypertensive therapy with terazosin and other antihypertensive agents: results of clinical trials." Am Heart J 122 (1991): 926-31
  4. Cohen J "Long-term efficacy and safety of terazosin alone and in combination with other antihypertensive agents." Am Heart J 122 (1991): 919-25
  5. "Product Information. Xatral (alfuzosin)." Sanofi-Synthelabo Canada Inc (2002):
View all 5 references

Switch to consumer interaction data

Drug and food interactions

Moderate

lithium food

Applies to: Lithotabs (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

Switch to consumer interaction data

Moderate

reserpine food

Applies to: polythiazide / reserpine

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595
View all 8 references

Switch to consumer interaction data

Moderate

polythiazide food

Applies to: polythiazide / reserpine

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595
View all 8 references

Switch to consumer interaction data

Moderate

lithium food

Applies to: Lithotabs (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

Switch to consumer interaction data

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

Report options

Loading...
QR code containing a link to this page

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.

Medical Disclaimer