Skip to main content

Drug Interactions between Demadex IV and Eskalith

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

Edit list (add/remove drugs)

Interactions between your drugs

Major

lithium torsemide

Applies to: Eskalith (lithium) and Demadex IV (torsemide)

GENERALLY AVOID: Loop diuretics may increase 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 loop diuresis, which produces a compensatory increase in proximal tubular reabsorption of sodium along with lithium. Although a few studies using furosemide found no significant effect on serum lithium levels for up to 12 weeks of concomitant use, serious lithium toxicity has been reported, particularly in elderly patients. In a population-based case-control study of 10,615 patients older than 65 years who were receiving continuous lithium therapy for a total of 26,866 patient-years, 413 (4%) case patients were identified over a 10-year period who had at least one hospital admission for lithium toxicity. After adjustment for potential confounders, any exposure to a loop diuretic within the preceding 28 days of the episode was associated with a 1.7 relative risk of hospitalization for lithium toxicity compared to matched controls, and new exposure to a loop diuretic (defined as no other use of a loop diuretic in the preceding 365 days) was associated with a relative risk of 5.5. Overall, approximately 2.4% of all hospitalizations for lithium toxicity in this elderly cohort could be attributed to new use of a loop diuretic. There have also been individual case reports of patients developing lithium toxicity shortly after initiation of a loop diuretic. The risk for lithium toxicity may be further increased during concomitant sodium restriction.

MANAGEMENT: Loop 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.

References

  1. Crabtree BL, Mack JE, Johnson CD, Amyx BC (1991) "Comparison of the effects of hydrochlorothiazide and furosemide on lithium disposition." Am J Psychiatry, 148, p. 1060-3
  2. MacNeil S, Hanson-Nortey E, Paschalis C, et al. (1975) "Diuretics during lithium therapy." Lancet, 06/07/75, p. 1295-6
  3. Atherton JC, Green R, Hughes S, et al. (1987) "Lithium clearance in man: effects of dietary salt intake, acute changes in extracellular fluid volume, amiloride and frusemide." Clin Sci, 73, p. 645-51
  4. Beutler JJ, Boer WH, Koomans HA, Dorhout Mees EJ (1992) "Comparative study of the effects of furosemide, ethacrynic acid and bumetanide on the lithium clearance and diluting segment reabsorption in humans." J Pharmacol Exp Ther, 260, p. 768-72
  5. Huang LG (1990) "Lithium intoxication with coadministration of a loop-diuretic." J Clin Psychopharmacol, 10, p. 228
  6. Hurtig HI, Dyson WL (1974) "Lithium toxicity enhanced by diuresis." N Engl J Med, 290, p. 748-9
  7. Kerry RJ, Ludlow JM, Owen G (1980) "Diuretics are dangerous with lithium." Br Med J, 281, p. 371
  8. (2002) "Product Information. Eskalith (lithium)." SmithKline Beecham
  9. Aronson JK, Reynolds DJM (1992) "ABC of monitoring drug therapy. Lithium." Br Med J, 305, p. 1273-6
  10. Jefferson JW, Kalin NH (1979) "Serum lithium levels and long-term diuretic use." JAMA, 241, p. 1134-6
  11. Finley PR, Warner MD, Peabody CA (1995) "Clinical relevance of drug interactions with lithium." Clin Pharmacokinet, 29, p. 172-91
  12. Bennett WM (1997) "Drug interactions and consequences of sodium restriction." Am J Clin Nutr, 65, S678-81
  13. Juurlink DN, Mamdani MM, Kopp A, Rochon PA, Shulman KI, Redelmeier DA (2004) "Drug-induced lithium toxicity in the elderly: a population-based study." J Am Geriatr Soc, 52, p. 794-8
View all 13 references

Switch to consumer interaction data

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

Switch to consumer interaction data

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 (1995) "Caffeine withdrawal increases lithium blood levels." Biol Psychiatry, 37, p. 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