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Drug Interactions between lithium and Promethazine VC Plain

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

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Interactions between your drugs

Moderate

lithium promethazine

Applies to: lithium and Promethazine VC Plain (phenylephrine / promethazine)

MONITOR: Although lithium and phenothiazines are frequently used together in the setting of acute mania, concurrent administration may induce a number of neurologic and psychiatric effects (despite decreased phenothiazine levels during lithium therapy). Mental status changes, delirium, seizures, extrapyramidal effects, fever, and other symptoms have been reported. The mechanism is unknown.

MANAGEMENT: Patients receiving lithium and a phenothiazine should be closely monitored for altered efficacy and safety. In some circumstances, discontinuation of one or both agents may be necessary.

References (7)
  1. Yassa R (1986) "A case of lithium-chlorpromazine interaction." J Clin Psychiatry, 47, p. 90-1
  2. Stevenson R, Blanshard C, Patterson D (1989) "Ventricular fibrillation due to lithium withdrawal: an interaction with chlorpromazine?" Postgrad Med J, 65, p. 936-8
  3. Rivera-Calimlim L, Kerzner B, Karch FE (1978) "Effect of lithium on plasma chlorpromazine levels." Clin Pharmacol Ther, 23, p. 451-5
  4. Prakash R, Kelwala S, Ban TA (1982) "Neurotoxicity with combined administration of lithium and a neuroleptic." Compr Psychiatry, 23, p. 567-71
  5. Singh SV (1982) "Lithium carbonate/fluphenazine decanoate producing irreversible brain damage." Lancet, 2, p. 278
  6. Sachdev PS (1986) "Lithium potentiation of neuroleptic-related extrapyramidal side effects." Am J Psychiatry, 143, p. 942
  7. (2002) "Product Information. Eskalith (lithium)." SmithKline Beecham
Minor

lithium phenylephrine

Applies to: lithium and Promethazine VC Plain (phenylephrine / promethazine)

Lithium may decrease the pressor effect of some sympathomimetic agents. The mechanism is unknown. Also, dopamine may increase the plasma clearance of lithium. Plasma lithium levels may be decreased.

References (3)
  1. Macdonald TM, Cotton M, Prescott LF (1988) "Low dose dopamine in lithium poisoning." Br J Clin Pharmacol, 26, p. 195-7
  2. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr (1979) "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res, 1, p. 45-52
  3. Grof E, Brown GM, Grof P, Van Loon GR (1986) "Effects of lithium administration on plasma catecholamines." Psychiatry Res, 19, p. 87-92

Drug and food interactions

Moderate

lithium food

Applies to: 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 (4)
  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
Moderate

promethazine food

Applies to: Promethazine VC Plain (phenylephrine / promethazine)

GENERALLY AVOID: Concurrent use of ethanol and phenothiazines may result in additive CNS depression and psychomotor impairment. Also, ethanol may precipitate dystonic reactions in patients who are taking phenothiazines. The two drugs probably act on different sites in the brain, although the exact mechanism of the interaction is not known.

MANAGEMENT: Patients should be advised to avoid alcohol during phenothiazine therapy.

References (2)
  1. Lutz EG (1976) "Neuroleptic-induced akathisia and dystonia triggered by alcohol." JAMA, 236, p. 2422-3
  2. Freed E (1981) "Alcohol-triggered-neuroleptic-induced tremor, rigidity and dystonia." Med J Aust, 2, p. 44-5
Moderate

lithium food

Applies to: 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)
  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
Moderate

phenylephrine food

Applies to: Promethazine VC Plain (phenylephrine / promethazine)

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References (7)
  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr (1979) "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res, 1, p. 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA (1970) "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther, 11, p. 656
  3. (2001) "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc
  4. (2001) "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals
  5. (2001) "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals
  6. (2001) "Product Information. Focalin (dexmethylphenidate)." Mikart Inc
  7. (2002) "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company

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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