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Drug Interactions between doxepin topical and Lithobid

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

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Interactions between your drugs

Moderate

lithium doxepin topical

Applies to: Lithobid (lithium) and doxepin topical

MONITOR: The concomitant use of lithium and tricyclic antidepressants (TCAs) may potentiate the risk of neurotoxicity and psychotic symptoms, even at therapeutic serum lithium levels. The mechanism is unknown but may be related to synergistic effects on neurotransmission. Mania, myoclonus, tremors, memory difficulties, confusion, serotonin syndrome, and a neuroleptic malignant-like syndrome have been reported in patients treated with TCAs several days after the addition of lithium, in most cases requiring discontinuation of either the TCA or lithium. Elderly patients may be particularly susceptible to this interaction.

MANAGEMENT: Close monitoring for symptoms of neurotoxicity is recommended if TCAs are used with lithium. Dosage adjustment or discontinuation of one or both drugs may be necessary if an interaction is suspected.

References

  1. Rosenberg PB, Pearlman CA "NMS-like syndrome with a lithium-doxepin combination." J Clin Psychopharmacol 11 (1991): 75-6
  2. Devanand DP, Sackeim HA, Brown RP "Myoclonus during combined tricyclic antidepressant and lithium treatment." J Clin Psychopharmacol 8 (1988): 446-7
  3. Austin LS, Arana GW, Melvin JA "Toxicity resulting from lithium augmentation of antidepressant treatment in elderly patients." J Clin Psychiatry 51 (1990): 344-5
  4. Delisle JD "Rapid switch in a bipolar patient during lithium-tricyclic therapy." Am J Psychiatry 143 (1986): 1326-7
  5. Kojima H, Terao T, Yoshimura R "Serotonin syndrome during clomipramine and lithium treatment." Am J Psychiatry 150 (1993): 1897
View all 5 references

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Drug and food interactions

Moderate

lithium food

Applies to: Lithobid (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

lithium food

Applies to: Lithobid (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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