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Lithium Disease Interactions

There are 12 disease interactions with lithium.

Major

Atypical antipsychotic agents (applies to lithium) dementia

Major Potential Hazard, High plausibility.

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 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.

References

  1. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals (2001):
  2. "Product Information. Risperdal (risperidone)." Janssen Pharmaceuticals (2001):
  3. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company (2001):
  4. "Product Information. Seroquel (quetiapine)." Astra-Zeneca Pharmaceuticals (2001):
  5. "Product Information. Geodon (ziprasidone)." Pfizer U.S. Pharmaceuticals (2001):
  6. "Product Information. Abilify (aripiprazole)." Bristol-Myers Squibb (2002):
  7. "Product Information. Invega (paliperidone)." Janssen Pharmaceuticals (2007):
  8. "Product Information. Fanapt (iloperidone)." Vanda Pharmaceuticals Inc (2009):
  9. "Product Information. Saphris (asenapine)." Schering-Plough Corporation (2009):
  10. "Product Information. Latuda (lurasidone)." Sunovion Pharmaceuticals Inc (2010):
  11. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
  12. "Product Information. Vraylar (cariprazine)." Actavis Pharma, Inc. (2015):
  13. "Product Information. Nuplazid (pimavanserin)." Accelis Pharma (2016):
View all 13 references
Major

Lithium (applies to lithium) cardiac disease

Major Potential Hazard, Moderate plausibility. Applicable conditions: Cardiovascular Disease, Syncope, Tachyarrhythmia

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. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  2. "Product Information. Lithobid (lithium)." Ciba-Geigy Pharmaceuticals (2002):
Major

Lithium (applies to lithium) dehydration

Major Potential Hazard, Moderate plausibility. Applicable conditions: 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. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  2. "Product Information. Lithobid (lithium)." Ciba-Geigy Pharmaceuticals (2002):
  3. 4th Rodriguez-Paz G, Martinez EJ, Oehler RL, Sinnott JT "Lithium-induced nephrogenic diabetes insipidus treated with indomethacin." South Med J 86 (1993): 971-3
Major

Lithium (applies to lithium) diarrhea/hyperhidrosis

Major Potential Hazard, Moderate plausibility.

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 (2002):
  2. "Product Information. Lithobid (lithium)." Ciba-Geigy Pharmaceuticals (2002):
Major

Lithium (applies to lithium) hypothyroidism

Major Potential Hazard, Moderate plausibility.

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. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  2. "Product Information. Lithobid (lithium)." Ciba-Geigy Pharmaceuticals (2002):
Major

Lithium (applies to lithium) renal dysfunction

Major Potential Hazard, Moderate plausibility.

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. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  2. "Product Information. Lithobid (lithium)." Ciba-Geigy Pharmaceuticals (2002):
  3. Braden GL. Lithium induced renal diseases. In: Greenberg A, ed. "Primer on Kidney Diseases." San Diego, CA: Academic Press Inc. (1994): 173-4
Major

Lithium (applies to lithium) sodium depletion

Major Potential Hazard, Moderate plausibility. Applicable conditions: 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. Hurtig DL, Dyson WL "Lithium toxicity enhanced by diuresis." N Engl J Med 290 (1974): 748-9
  2. Amdisen A, Hansen HE, Hestbech J, Olsen S "Renal function and renal pathology in patients with lithium-induced impairment of renal concentrating ability." Dial Transplant Nephrol 14 (1977): 518-27
  3. Gershon S, Reisberg B "Side effects associated with lithium therapy." Arch Gen Psychiatry 36 (1979): 879-87
  4. Depner TA "Nephrotic syndrome secondary to lithium therapy." Nephron 30 (1982): 286-9
  5. Foreman JW, Parmalee DX, Wood IK "Lithium-induced nephrotic syndrome." Am J Psychiatry 146 (1989): 84-7
  6. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  7. "Product Information. Lithobid (lithium)." Ciba-Geigy Pharmaceuticals (2002):
View all 7 references
Major

Miscellaneous antipsychotics (applies to lithium) previous neuroleptic malignant syndrome (NMS)

Major Potential Hazard, Moderate plausibility.

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.

References

  1. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical (2002):
  2. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  3. "Product Information. Moban (molindone)." Gate Pharmaceuticals (2001):
  4. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  5. "Product Information. Adasuve (loxapine)." Teva Pharmaceuticals USA (2015):
View all 5 references
Major

Miscellaneous antipsychotics (applies to lithium) seizure disorders

Major Potential Hazard, Moderate plausibility. Applicable conditions: 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. Brown R, Markowitz J "Seizures with neuroleptics and antidepressants." Gen Hosp Psychiatry 9 (1987): 135-41
  2. Dunner FJ, Lowry MR "Seizures during tricyclic therapy." Am J Psychiatry 137 (1980): 1461-2
  3. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical (2002):
  4. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  5. "Product Information. Moban (molindone)." Gate Pharmaceuticals (2001):
  6. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  7. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
View all 7 references
Moderate

Lithium (applies to lithium) fever

Moderate Potential Hazard, Moderate plausibility.

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. Eskalith (lithium)." SmithKline Beecham (2002):
  2. "Product Information. Lithobid (lithium)." Ciba-Geigy Pharmaceuticals (2002):
Moderate

Miscellaneous antipsychotics (applies to lithium) hyperprolactinemia/breast cancer

Moderate Potential Hazard, Moderate plausibility.

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.

References

  1. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical (2002):
  2. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  3. "Product Information. Moban (molindone)." Gate Pharmaceuticals (2001):
  4. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  5. "Product Information. Adasuve (loxapine)." Teva Pharmaceuticals USA (2015):
View all 5 references
Moderate

Miscellaneous antipsychotics (applies to lithium) neutropenia

Moderate Potential Hazard, Moderate plausibility.

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).

References

  1. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical (2002):
  2. "Product Information. Eskalith (lithium)." SmithKline Beecham (2002):
  3. "Product Information. Moban (molindone)." Gate Pharmaceuticals (2001):
  4. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  5. "Product Information. Adasuve (loxapine)." Teva Pharmaceuticals USA (2015):
View all 5 references

Lithium drug interactions

There are 684 drug interactions with lithium.

Lithium alcohol/food interactions

There is 1 alcohol/food interaction with lithium.

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.