Drug Interactions between Lithium Carbonate ER and pamidronate

MONITOR: Coadministration of bisphosphonates with other nephrotoxic agents may increase the risk and severity of renal impairment due to additive effects on the kidney. The use of bisphosphonates has been associated with nephrotoxicity manifested as deterioration of renal function and renal failure. Cases have primarily involved intravenous formulations of the drugs such as pamidronate and zoledronic acid, especially when they are administered too rapidly. The risk of hypocalcemia may also be increased, as drug-induced renal tubular damage can lead to renal loss of calcium and other electrolytes such as magnesium. Bisphosphonates alone often cause mild, asymptomatic hypocalcemia via inhibitive effects on bone resorption and possibly chelation of blood calcium.

MANAGEMENT: Caution is advised if pamidronate, zoledronic acid, or other intravenous formulations of bisphosphonates must be used in patients who have recently received or are receiving treatment with other potentially nephrotoxic agents (e.g., aminoglycosides, polypeptide and polymyxin antibiotics, vancomycin, amphotericin B, adefovir, cidofovir, tenofovir, foscarnet, cisplatin, gallium nitrate, lithium, mesalamine, certain immunosuppressants, intravenous pentamidine, high intravenous dosages of methotrexate, high dosages of nonsteroidal anti-inflammatory agents). Renal function and serum electrolytes should be monitored. Patients should have serum creatinine assessed prior to each treatment, and treatment should be withheld for renal deterioration. In those treated for bone metastases, treatment should not be resumed until renal function returns to baseline.