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Lithium Carbonate ER (lithium) Disease Interactions

There are 12 disease interactions with Lithium Carbonate ER (lithium):

Major

Atypical Antipsychotic Agents (Includes Lithium Carbonate ER) ↔ Dementia

Severe Potential Hazard, High plausibility

Applies to: Dementia

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death, mostly from cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) causes. A causal relationship with antipsychotic use has not been established. In controlled trials, treatment with some atypical antipsychotic drugs had was also associated with an increased risk of cerebrovascular adverse events (e.g., stroke, transient ischemic attack), including fatalities, in elderly patients with dementia-related psychosis. These agents are not approved for the treatment of patients with dementia-related psychosis.

Major

Lithium (Includes Lithium Carbonate ER) ↔ Cardiac Disease

Severe Potential Hazard, Moderate plausibility

Applies to: Cardiovascular Disease, Syncope

Lithium should generally not be given to patients with significant cardiovascular disease since the risk of lithium toxicity is high in these patients. Additionally, there have been postmarketing reports of a possible association between lithium therapy and the unmasking of Brugada Syndrome, a disorder characterized by abnormal EKG findings and a risk of sudden death. Lithium should be avoided in patients with this diagnosis or suspicion of it, or that have risk factors, which include unexplained syncope, family history of this syndrome, or family history of unexplained sudden death before the age of 45 years.
Therapy with lithium should be administered with extreme caution in patients with preexisting cardiac disease. Consultation with a cardiologist is highly recommended and cardiac monitoring should be completed before and during treatment.

References

  1. Steckler TL "Lithium- and carbamazepine-associated sinus node dysfunction: nine-year experience in a psychiatric hospital." J Clin Psychopharmacol 14 (1994): 336-9
  2. Tangedahl TN, Gau GT "Myocardial irritability associated with lithium carbonate therapy." N Engl J Med 287 (1972): 867-9
  3. Reisberg B, Gershon S "Side effects associated with lithium therapy." Arch Gen Psychiatry 36 (1979): 879-87
View all 9 references
Major

Lithium (Includes Lithium Carbonate ER) ↔ Dehydration

Severe Potential Hazard, Moderate plausibility

Applies to: Dehydration, Diarrhea, Fever, Hyperhidrosis

Lithium reduces the ability of the kidney to concentrate urine and produces a mild diabetes insipidus and polyuria. Therefore, patients with preexisting dehydration are more prone to lithium retention and toxicity. Therapy with lithium should be administered cautiously in dehydrated patients and may need to be discontinued until improvement in hydration status. Careful monitoring of lithium levels are recommended. Patients with sweating, diarrhea or concomitant infection with fever may need a temporary reduction or cessation of medication.

References

  1. Vestergaard P, Amdisen A, Schou M "Clinically significant side effects of lithium treatment." Acta Psychiatr Scand 62 (1980): 193-200
  2. Walker RG "Lithium nephrotoxicity." Kidney Int Suppl 42 (1993): s93-8
  3. Martin A "Clinical management of lithium-induced polyuria." Hosp Community Psychiatry 44 (1993): 427-8
View all 8 references
Major

Lithium (Includes Lithium Carbonate ER) ↔ Diarrhea/Hyperhidrosis

Severe Potential Hazard, Moderate plausibility

Applies to: Diarrhea, Hyperhidrosis

The risk for lithium toxicity may be increased in patients with diarrhea and excessive sweating. Dehydration and sodium depletion may occur in these patients leading to lithium retention and toxicity. The use of lithium may need to be reduced or suspended until the condition resolves. Supplemental fluid and salt may need to be administered. Monitoring serum lithium levels is recommended.

References

  1. "Product Information. Eskalith (lithium)." SmithKline Beecham, Philadelphia, PA.
  2. "Product Information. Lithobid (lithium)." Ciba Pharmaceuticals, Summit, NJ.
Major

Lithium (Includes Lithium Carbonate ER) ↔ Hypothyroidism

Severe Potential Hazard, Moderate plausibility

Applies to: Hypothyroidism

The use of lithium has been associated with hypothyroidism in 5% to 15% of patient as it blocks the release of thyroxine (T4) and triiodothyronine (T3) mediated by thyrotropin. Therapy with lithium should be administered cautiously in patients with preexisting hypothyroidism. Careful monitoring of the thyroid function is recommended and supplemental thyroid treatment may be required.

References

  1. Waldman SA, Park D "Myxedema coma associated with lithium therapy." Am J Med 87 (1989): 355-7
  2. Terao T "Subclinical hypothyroidism in recurrent mania." Biol Psychiatry 33 (1993): 853-4
  3. "Product Information. Eskalith (lithium)." SmithKline Beecham, Philadelphia, PA.
View all 6 references
Major

Lithium (Includes Lithium Carbonate ER) ↔ Renal Dysfunction

Severe Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Lithium is primarily eliminated by the kidneys and should generally not be administered to patients with significant renal dysfunction. Additionally, morphological changes with glomerular and interstitial fibrosis and nephron atrophy have been reported in patients on chronic lithium therapy, although the association has not been clearly established. Kidney function should be assessed in patients prior to starting therapy, during and thereafter and routine urinalysis and renal function tests are recommended. Progressive or sudden changes in renal function indicate the need for reevaluation of treatment. Monitoring lithium serum levels is also recommended.

References

  1. DeSanto NG, Coppola S, Anastasio P, et al "Lithium clearance in patients with chronic renal failure." Miner Electrolyte Metab 17 (1991): 166-72
  2. Hansen HE, Hestbech J, Olsen S, Amdisen A "Renal function and renal pathology in patients with lithium-induced impairment of renal concentrating ability." Dial Transplant Nephrol 14 (1977): 518-27
  3. Hestbech J, Aurell M "Lithium-induced uraemia." Lancet 01/27/79 (1979): 212-3
View all 19 references
Major

Lithium (Includes Lithium Carbonate ER) ↔ Sodium Depletion

Severe Potential Hazard, Moderate plausibility

Applies to: Hyponatremia

Lithium decreases sodium reabsorption by the renal tubules which could lead to sodium depletion. Therapy with lithium should be administered cautiously in patients with preexisting sodium depletion as the risk of lithium toxicity is increased. Lower dosages may be required. Patients should maintain a normal diet, including salt, and an adequate fluid intake. Monitoring lithium serum concentrations is recommended.

References

  1. "Product Information. Eskalith (lithium)." SmithKline Beecham, Philadelphia, PA.
  2. "Product Information. Lithobid (lithium)." Ciba Pharmaceuticals, Summit, NJ.
  3. Wood IK, Parmalee DX, Foreman JW "Lithium-induced nephrotic syndrome." Am J Psychiatry 146 (1989): 84-7
View all 7 references
Major

Miscellaneous Antipsychotics (Includes Lithium Carbonate ER) ↔ Previous Neuroleptic Malignant Syndrome (Nms)

Severe Potential Hazard, Moderate plausibility

Applies to: Neuroleptic Malignant Syndrome

Neuroleptic Malignant Syndrome (NMS), a potentially fatal symptom complex, has been reported in association with the use of antipsychotic drugs. The diagnostic evaluation is complicated and the management requires immediate discontinuation of the antipsychotic therapy and intensive symptomatic treatment and medical monitoring. If a patient that has recovered from NMS requires antipsychotic drug treatment again, the reintroduction of therapy should be carefully considered as NMS recurrences have been reported.

Major

Miscellaneous Antipsychotics (Includes Lithium Carbonate ER) ↔ Seizure Disorders

Severe Potential Hazard, Moderate plausibility

Applies to: Seizures, CNS Disorder, Alcoholism

Antipsychotics can lower the seizure threshold and trigger seizures in a dose-dependent manner. Seizures have been reported in patients receiving antipsychotic therapy and may occur in epileptic patients even with maintenance of routine anticonvulsant treatment. Therapy with antipsychotics should be administered cautiously in patients with a history of seizures or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism. High dosages should be avoided if possible.

References

  1. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
  2. Markowitz J, Brown R "Seizures with neuroleptics and antidepressants." Gen Hosp Psychiatry 9 (1987): 135-41
  3. Lowry MR, Dunner FJ "Seizures during tricyclic therapy." Am J Psychiatry 137 (1980): 1461-2
Moderate

Lithium (Includes Lithium Carbonate ER) ↔ Fever

Moderate Potential Hazard, Moderate plausibility

Applies to: Fever

Patients with fever may have a lower tolerance to lithium due to increased fluid and sodium loss. Lithium dosage may need to be reduced or suspended in such patients. Monitoring lithium serum levels is recommended.

References

  1. "Product Information. Lithobid (lithium)." Ciba Pharmaceuticals, Summit, NJ.
  2. "Product Information. Eskalith (lithium)." SmithKline Beecham, Philadelphia, PA.
Moderate

Miscellaneous Antipsychotics (Includes Lithium Carbonate ER) ↔ Hyperprolactinemia/Breast Cancer

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperprolactinemia, Breast Cancer

Antipsychotic drugs can elevate serum prolactin concentrations, and this elevation persists during chronic administration. This should be considered if therapy will be prescribed in patients with previously detected breast cancer as one-third of human breast cancers are prolactin-dependent in vitro. Associated disturbances such as galactorrhea, amenorrhea, gynecomastia, and impotence have been reported. Appropriate laboratory testing and follow-up is advised.

Moderate

Miscellaneous Antipsychotics (Includes Lithium Carbonate ER) ↔ Neutropenia

Moderate Potential Hazard, Moderate plausibility

Applies to: Neutropenia

The use of antipsychotics has been associated with events of leukopenia, neutropenia and agranulocytosis. Possible risk factors include preexisting low white blood cell count, and history of drug induced leukopenia/neutropenia. Patients with these risk factors should have complete blood count monitored frequently during the first few months of therapy. Patients should also be monitored for any signs or symptoms of infection. Treatment should be discontinued in any patient who develops a sore throat, fever, stomatitis, or other signs of infection along with a low WBC count or severe neutropenia (ANC < 1000/mm3).

Lithium Carbonate ER (lithium) drug Interactions

There are 1106 drug interactions with Lithium Carbonate ER (lithium)

Lithium Carbonate ER (lithium) alcohol/food Interactions

There are 2 alcohol/food interactions with Lithium Carbonate ER (lithium)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

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.

Do not stop taking any medications without consulting your healthcare provider.

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