Skip to main content

Drug Interactions between Eskalith-CR and tbo-filgrastim

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

Edit list (add/remove drugs)

Interactions between your drugs

Moderate

lithium tbo-filgrastim

Applies to: Eskalith-CR (lithium) and tbo-filgrastim

MONITOR: Lithium may potentiate the myeloproliferative effects of colony-stimulating factors (CSF). In vitro and in vivo studies suggest that lithium can enhance the production of granulocyte-CSF and directly stimulate the proliferation of pluripotential stem cells. The exact mechanism is not known but may involve inhibition of glycogen synthase kinase-3 (GSK-3), which indirectly increases the CXC chemokine CXCL12 gradient toward a hypoxic marrow trophic niche. Hematopoietic stem cells thrive in this environment, which is reflected by peripheral neutrophilia, increased platelets, and increased CD34+ counts. In one prospective study of adult patients with bipolar disorder (n=8), patient's CD34+ counts significantly increased (from 0.11 +/- 0.01% to 0.18 +/- 0.08%) and their neutrophil counts increased by an average of 88% (from 4625 +/- 1350 x 10^9/L to 8300 +/- 3910 x 10^9/L) after 3 to 4 weeks of lithium therapy.

MANAGEMENT: Patients receiving concomitant treatment with colony-stimulating factors and lithium may require more frequent monitoring of blood counts in order to avoid the potential complications of excessive leukocytosis.

References

  1. Lapierre G, Stewart RB "Lithium carbonate and leukocytosis." Am J Hosp Pharm 37 (1980): 1525-8
  2. Baldessarini RJ, Lipinski JF "Lithium salts: 1970-1975." Ann Intern Med 83 (1975): 527-33
  3. Reisberg B, Gershon S "Side effects associated with lithium therapy." Arch Gen Psychiatry 36 (1979): 879-87
  4. Boggs DR, Joyce RA "The hematopoietic effects of lithium." Semin Hematol 20 (1983): 129-38
  5. McCormack JJ, Tseng CK, Marquez VE, Paull KE "INHIBITION STUDIES WITH PURINE NUCLEOSIDE PHOSPHORYLASE (MEETING ABSTRACT)." Proc Annu Meet Am Assoc Cancer Res 29 (1988): a1387
  6. "Product Information. Neupogen (filgrastim)." Amgen PROD (2002):
  7. "Product Information. Leukine (sargramostim)." Immunex Corporation PROD (2001):
  8. Ozdemir MA, Sofuoglu S, Tanrikulu G, Aldanmaz F, Esel E, Dundar S "Lithium-induced hematologic changes in patients with bipolar affective disorder." Biol Psychiatry 35 (1994): 210-3
  9. "Product Information. Neulasta (pegfilgrastim)." Amgen (2002):
  10. "Product Information. Granix (tbo-filgrastim)." Teva Pharmaceuticals USA (2013):
  11. Focosi D, Azzara A, Kast RE, Carulli G, Petrini M "Lithium and hematology: established and proposed uses." J Leukoc Biol 85 (2009): 20-8
  12. Ballin A, Lehman D, Sirota P, Litvinjuk U, Meytes D "Increased number of peripheral blood CD34+ cells in lithium-treated patients." Br J Haematol 100 (1998): 219-21
  13. Harker WG, Rothstein G, Clarkson D, Athens JW, Macfarlane JL "Enhancement of colony-stimulating activity production by lithium." Blood 49 (1977): 263-7
View all 13 references

Switch to consumer interaction data

Drug and food interactions

Moderate

lithium food

Applies to: Eskalith-CR (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

lithium food

Applies to: Eskalith-CR (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