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Drug Interactions between Lithium Carbonate ER and Raplon

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

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Interactions between your drugs

Moderate

lithium rapacuronium

Applies to: Lithium Carbonate ER (lithium) and Raplon (rapacuronium)

MONITOR: Limited data suggest that lithium may potentiate the pharmacologic effects of neuromuscular blocking agents. The exact mechanism of interaction is unknown. There have been isolated reports of prolonged apnea and delayed recovery from anesthesia in patients treated with lithium who were administered a neuromuscular blocking agent (succinylcholine or pancuronium) during surgery. Additional data have come from animal studies, thus clinical significance of the interaction has not been determined.

MANAGEMENT: Caution is advised if neuromuscular blocking agents are used in patients who have been treated with lithium. Patients should be monitored closely for development of respiratory depression, and life support should be readily available if needed.

References

  1. Borden H, Clarke MT, Katz H (1974) "The use of pancuronium bromide in patients receiving lithium carbonate." Can Anaesth Soc J, 21, p. 79-82
  2. Hill GE, Wong KC, Hodges MR (1977) "Lithium carbonate and neuromuscular blocking agents." Anesthesiology, 46, p. 122-6
  3. Martin BA, Kramer PM (1982) "Clinical significance of the interaction between lithium and a neuromuscular blocker." Am J Psychiatry, 139, p. 1326-8
  4. (2002) "Product Information. Eskalith (lithium)." SmithKline Beecham
  5. Hill GE, Wong KC, Hodges MR (1976) "Potentiation of succinylcholine neuromuscular blockade by lithium carbonate." Anesthesiology, 44, p. 439-42
View all 5 references

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Drug and food interactions

Moderate

lithium food

Applies to: Lithium Carbonate ER (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

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Moderate

lithium food

Applies to: Lithium Carbonate ER (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

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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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