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Interactions between Lithonate and Mefloquine

1 drug interaction and 30 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

lithium mefloquine

Applies to: Lithonate (lithium) and mefloquine
Monitor

Mefloquine is a myocardial depressant and can cause ECG abnormalities. Theoretically, coadministration with other agents that can affect cardiac conduction (e.g., antiarrhythmic agents, beta blockers, calcium channel blockers, certain antihistamines, tricyclic antidepressants, phenothiazines, some neuroleptics) may result in additive effects and increased risk of ventricular arrhythmias including ventricular tachycardia and torsade de pointes. Parenteral studies in animals have shown that mefloquine possesses 20% of the antifibrillatory action of quinidine and can cause 50% of the increase in PR interval reported with quinine. ECG alterations reported with mefloquine include sinus bradycardia, sinus arrhythmia, first degree AV block, prolongation of the QTc interval, and abnormal T waves. According to mefloquine labeling, there has been one report of cardiopulmonary arrest, with full recovery, in a patient who was taking a beta blocker (propranolol).

Management

Caution and clinical monitoring are recommended if mefloquine is used in combination with other drugs that can prolong the QT interval or otherwise affect cardiac conduction. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes or other arrhythmia such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope.

References (4)
  1. (2021) "Product Information. Mefloquine Hydrochloride (mefloquine)." Hikma USA (formerly West-Ward Pharmaceutical Corporation)
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. Canadian Pharmacists Association (2006) e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink
  4. Cerner Multum, Inc. "Australian Product Information."

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

lithium Food/Lifestyle

Applies to: Lithonate (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 America Pharmaceutical, Inc.
Moderate:

mefloquine Food/Lifestyle

Applies to: mefloquine
Adjust dosing interval

Food enhances the oral absorption and bioavailability of mefloquine. The proposed mechanism is increased drug solubility in the presence of food. In 20 healthy volunteers, administration of a single 750 mg oral dose of mefloquine 30 minutes following a high-fat meal increased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of mefloquine by 73% and 40%, respectively, compared to administration in the fasting state. The Cmax and AUC of the carboxylic acid metabolite were also increased by 35% and 33%, respectively, compared to fasting. In addition, the time to reach peak plasma concentration (Tmax) of mefloquine was significantly shorter after food intake (17 hours) than in the fasting state (36 hours). There was no difference in the elimination half-life of mefloquine and metabolite, or the Tmax for the metabolite.

Management

To ensure maximal oral absorption, mefloquine should be administered immediately after a meal with at least 8 ounces of water.

References (2)
  1. (2021) "Product Information. Mefloquine Hydrochloride (mefloquine)." Hikma USA (formerly West-Ward Pharmaceutical Corporation)
  2. Schmidt LE, Dalhoff K (2002) "Food-drug interactions." Drugs, 62, p. 1481-502
Moderate:

lithium Caffeine

Applies to: Lithonate (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

Disease interactions

27 potential interactions Applies to: 24 conditions, including Depression, Underactive Thyroid, Seizures, Diarrhea, and Breast Cancer.

Alcoholism

Major:

Lithonate

The lithium in Lithonate has a major potential interaction with Alcoholism.

Antipsychotics can lower the seizure threshold and trigger seizures in a dose-dependent manner. Seizures have been reported in patients receiving antipsychotic therapy and may occur in epileptic patients even with maintenance of routine anticonvulsant treatment. Therapy with antipsychotics should be administered cautiously in patients with a history of seizures or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism. High dosages should be avoided if possible.

Breast Cancer

Moderate:

Lithonate

The lithium in Lithonate has a moderate potential interaction with Breast Cancer.

Antipsychotic drugs can elevate serum prolactin concentrations, and this elevation persists during chronic administration. This should be considered if therapy will be prescribed in patients with previously detected breast cancer as one-third of human breast cancers are prolactin-dependent in vitro. Associated disturbances such as galactorrhea, amenorrhea, gynecomastia, and impotence have been reported. Appropriate laboratory testing and follow-up is advised.

Cardiovascular Conditions and Disorders

Major:

Lithonate

The lithium in Lithonate has a major potential interaction with Cardiovascular Conditions and Disorders.

Lithium should generally not be given to patients with significant cardiovascular disease since the risk of lithium toxicity is high in these patients. Additionally, there have been postmarketing reports of a possible association between lithium therapy and the unmasking of Brugada Syndrome, a disorder characterized by abnormal EKG findings and a risk of sudden death. Lithium should be avoided in patients with this diagnosis or suspicion of it, or that have risk factors, which include unexplained syncope, family history of this syndrome, or family history of unexplained sudden death before the age of 45 years.
Therapy with lithium should be administered with extreme caution in patients with preexisting cardiac disease. Consultation with a cardiologist is highly recommended and cardiac monitoring should be completed before and during treatment.

Central Nervous System Disorders

Major:

Lithonate

The lithium in Lithonate has a major potential interaction with Central Nervous System Disorders.

Antipsychotics can lower the seizure threshold and trigger seizures in a dose-dependent manner. Seizures have been reported in patients receiving antipsychotic therapy and may occur in epileptic patients even with maintenance of routine anticonvulsant treatment. Therapy with antipsychotics should be administered cautiously in patients with a history of seizures or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism. High dosages should be avoided if possible.

Dehydration

Major:

Lithonate

The lithium in Lithonate has a major potential interaction with Dehydration.

Lithium reduces the ability of the kidney to concentrate urine and produces a mild diabetes insipidus and polyuria. Therefore, patients with preexisting dehydration are more prone to lithium retention and toxicity. Therapy with lithium should be administered cautiously in dehydrated patients and may need to be discontinued until improvement in hydration status. Careful monitoring of lithium levels are recommended. Patients with sweating, diarrhea or concomitant infection with fever may need a temporary reduction or cessation of medication.

Dementia

Major:

Lithonate

The lithium in Lithonate has a major potential interaction with Dementia.

Antipsychotic drugs are not approved for the treatment of patients with dementia-related psychosis. Older patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death; although the causes were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. A causal relationship with antipsychotic use has not been established. In controlled trials in older patients with dementia-related psychosis, patients randomized to risperidone, aripiprazole, and olanzapine had higher incidence of cerebrovascular adverse events (e.g., stroke, transient ischemic attack), including fatalities, compared to patients treated with placebo.

Depression

Major:

mefloquine

Mefloquine has a major potential interaction with Depression.

The use of mefloquine for malaria prophylaxis is contraindicated in patients with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, or other major psychiatric disorders. Mefloquine may cause psychiatric symptoms in some patients, including agitation, anxiety, depression, mood changes, panic attacks, paranoia, confusion, hallucinations, aggression, and psychotic behavior. Occasionally, these symptoms have been reported to continue long after mefloquine has been withdrawn due to its long half-life. Rare cases of suicidal ideation and suicide have occurred during mefloquine use, although a causal relationship has not been established. Therapy with mefloquine should be administered cautiously in patients with a previous history of depression. Psychiatric symptoms that occur during prophylactic use such as acute anxiety, depression, restlessness, or confusion should be considered prodromal to a more serious event, and the drug must be discontinued and an alternative medication substituted.

Diarrhea

Major:

Lithonate

The lithium in Lithonate has a major potential interaction with Diarrhea.

The risk for lithium toxicity may be increased in patients with diarrhea and excessive sweating. Dehydration and sodium depletion may occur in these patients leading to lithium retention and toxicity. The use of lithium may need to be reduced or suspended until the condition resolves. Supplemental fluid and salt may need to be administered. Monitoring serum lithium levels is recommended.

Major:

Lithonate

The lithium in Lithonate has a major potential interaction with Diarrhea.

Lithium reduces the ability of the kidney to concentrate urine and produces a mild diabetes insipidus and polyuria. Therefore, patients with preexisting dehydration are more prone to lithium retention and toxicity. Therapy with lithium should be administered cautiously in dehydrated patients and may need to be discontinued until improvement in hydration status. Careful monitoring of lithium levels are recommended. Patients with sweating, diarrhea or concomitant infection with fever may need a temporary reduction or cessation of medication.

Fever

Major:

Lithonate

The lithium in Lithonate has a major potential interaction with Fever.

Lithium reduces the ability of the kidney to concentrate urine and produces a mild diabetes insipidus and polyuria. Therefore, patients with preexisting dehydration are more prone to lithium retention and toxicity. Therapy with lithium should be administered cautiously in dehydrated patients and may need to be discontinued until improvement in hydration status. Careful monitoring of lithium levels are recommended. Patients with sweating, diarrhea or concomitant infection with fever may need a temporary reduction or cessation of medication.

Moderate:

Lithonate

The lithium in Lithonate has a moderate potential interaction with Fever.

Patients with fever may have a lower tolerance to lithium due to increased fluid and sodium loss. Lithium dosage may need to be reduced or suspended in such patients. Monitoring lithium serum levels is recommended.

Heart Disease

Moderate:

mefloquine

Mefloquine has a moderate potential interaction with Heart Disease.

Mefloquine is a myocardial depressant. Animal studies with parenteral mefloquine indicate that the drug possesses 20% of the antifibrillatory action of quinidine and produces 50% of the increase in the PR interval reported with quinine. The effect of mefloquine on the compromised cardiovascular system has not been evaluated. However, transient and asymptomatic ECG alterations have been reported during the use of mefloquine, including sinus bradycardia, sinus arrhythmia, first-degree AV block, prolongation of the QTc interval, and abnormal T waves. In postmarketing use, hypotension, hypertension, flushing, syncope, chest pain, tachycardia, palpitation, bradycardia, irregular pulse, extrasystoles, AV block, and other transient cardiac conduction alterations have been reported rarely. Therapy with mefloquine should be administered cautiously in patients with cardiac disease and only if potential benefits justify the risks.

Hyperhidrosis

Major:

Lithonate

The lithium in Lithonate has a major potential interaction with Hyperhidrosis.

Lithium reduces the ability of the kidney to concentrate urine and produces a mild diabetes insipidus and polyuria. Therefore, patients with preexisting dehydration are more prone to lithium retention and toxicity. Therapy with lithium should be administered cautiously in dehydrated patients and may need to be discontinued until improvement in hydration status. Careful monitoring of lithium levels are recommended. Patients with sweating, diarrhea or concomitant infection with fever may need a temporary reduction or cessation of medication.

Major:

Lithonate

The lithium in Lithonate has a major potential interaction with Hyperhidrosis.

The risk for lithium toxicity may be increased in patients with diarrhea and excessive sweating. Dehydration and sodium depletion may occur in these patients leading to lithium retention and toxicity. The use of lithium may need to be reduced or suspended until the condition resolves. Supplemental fluid and salt may need to be administered. Monitoring serum lithium levels is recommended.

Hyperprolactinemia

Moderate:

Lithonate

The lithium in Lithonate has a moderate potential interaction with Hyperprolactinemia.

Antipsychotic drugs can elevate serum prolactin concentrations, and this elevation persists during chronic administration. This should be considered if therapy will be prescribed in patients with previously detected breast cancer as one-third of human breast cancers are prolactin-dependent in vitro. Associated disturbances such as galactorrhea, amenorrhea, gynecomastia, and impotence have been reported. Appropriate laboratory testing and follow-up is advised.

Hyponatremia

Major:

Lithonate

The lithium in Lithonate has a major potential interaction with Hyponatremia.

Lithium decreases sodium reabsorption by the renal tubules which could lead to sodium depletion. Therapy with lithium should be administered cautiously in patients with preexisting sodium depletion as the risk of lithium toxicity is increased. Lower dosages may be required. Patients should maintain a normal diet, including salt, and an adequate fluid intake. Monitoring lithium serum concentrations is recommended.

Liver Disease

Moderate:

mefloquine

Mefloquine has a moderate potential interaction with Liver Disease.

Mefloquine is primarily metabolized by the liver. Patients with liver disease may be at greater risk for adverse effects from mefloquine due to decreased drug clearance. Therapy with mefloquine should be administered cautiously in patients with liver disease. Periodic evaluation of hepatic function should be performed during prolonged therapy.

Neuroleptic Malignant Syndrome

Major:

Lithonate

The lithium in Lithonate has a major potential interaction with Neuroleptic Malignant Syndrome.

Neuroleptic Malignant Syndrome (NMS), a potentially fatal symptom complex, has been reported in association with the use of antipsychotic drugs. The diagnostic evaluation is complicated and the management requires immediate discontinuation of the antipsychotic therapy and intensive symptomatic treatment and medical monitoring. If a patient that has recovered from NMS requires antipsychotic drug treatment again, the reintroduction of therapy should be carefully considered as NMS recurrences have been reported.

Neurosis

Major:

mefloquine

Mefloquine has a major potential interaction with Neurosis.

The use of mefloquine for malaria prophylaxis is contraindicated in patients with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, or other major psychiatric disorders. Mefloquine may cause psychiatric symptoms in some patients, including agitation, anxiety, depression, mood changes, panic attacks, paranoia, confusion, hallucinations, aggression, and psychotic behavior. Occasionally, these symptoms have been reported to continue long after mefloquine has been withdrawn due to its long half-life. Rare cases of suicidal ideation and suicide have occurred during mefloquine use, although a causal relationship has not been established. Therapy with mefloquine should be administered cautiously in patients with a previous history of depression. Psychiatric symptoms that occur during prophylactic use such as acute anxiety, depression, restlessness, or confusion should be considered prodromal to a more serious event, and the drug must be discontinued and an alternative medication substituted.

Neutropenia

Moderate:

Lithonate

The lithium in Lithonate has a moderate potential interaction with Neutropenia.

The use of antipsychotics has been associated with events of leukopenia, neutropenia and agranulocytosis. Possible risk factors include preexisting low white blood cell count, and history of drug induced leukopenia/neutropenia. Patients with these risk factors should have complete blood count monitored frequently during the first few months of therapy. Patients should also be monitored for any signs or symptoms of infection. Treatment should be discontinued in any patient who develops a sore throat, fever, stomatitis, or other signs of infection along with a low WBC count or severe neutropenia (ANC < 1000/mm3).

Psychiatric Disorders

Major:

mefloquine

Mefloquine has a major potential interaction with Psychiatric Disorders.

The use of mefloquine for malaria prophylaxis is contraindicated in patients with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, or other major psychiatric disorders. Mefloquine may cause psychiatric symptoms in some patients, including agitation, anxiety, depression, mood changes, panic attacks, paranoia, confusion, hallucinations, aggression, and psychotic behavior. Occasionally, these symptoms have been reported to continue long after mefloquine has been withdrawn due to its long half-life. Rare cases of suicidal ideation and suicide have occurred during mefloquine use, although a causal relationship has not been established. Therapy with mefloquine should be administered cautiously in patients with a previous history of depression. Psychiatric symptoms that occur during prophylactic use such as acute anxiety, depression, restlessness, or confusion should be considered prodromal to a more serious event, and the drug must be discontinued and an alternative medication substituted.

Psychosis

Major:

mefloquine

Mefloquine has a major potential interaction with Psychosis.

The use of mefloquine for malaria prophylaxis is contraindicated in patients with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, or other major psychiatric disorders. Mefloquine may cause psychiatric symptoms in some patients, including agitation, anxiety, depression, mood changes, panic attacks, paranoia, confusion, hallucinations, aggression, and psychotic behavior. Occasionally, these symptoms have been reported to continue long after mefloquine has been withdrawn due to its long half-life. Rare cases of suicidal ideation and suicide have occurred during mefloquine use, although a causal relationship has not been established. Therapy with mefloquine should be administered cautiously in patients with a previous history of depression. Psychiatric symptoms that occur during prophylactic use such as acute anxiety, depression, restlessness, or confusion should be considered prodromal to a more serious event, and the drug must be discontinued and an alternative medication substituted.

Renal Dysfunction

Major:

Lithonate

The lithium in Lithonate has a major potential interaction with Renal Dysfunction.

Lithium is primarily eliminated by the kidneys and should generally not be administered to patients with significant renal dysfunction. Additionally, morphological changes with glomerular and interstitial fibrosis and nephron atrophy have been reported in patients on chronic lithium therapy, although the association has not been clearly established. Kidney function should be assessed in patients prior to starting therapy, during and thereafter and routine urinalysis and renal function tests are recommended. Progressive or sudden changes in renal function indicate the need for reevaluation of treatment. Monitoring lithium serum levels is also recommended.

Seizures

Major:

mefloquine

Mefloquine has a major potential interaction with Seizures.

The use of mefloquine for malaria prophylaxis is contraindicated in patients with a history of seizures. Mefloquine can increase the risk of convulsions in patients with epilepsy and may lower the plasma levels of some anticonvulsant medications. Therefore, it should only be prescribed for curative treatment of malaria in such patients and only if there are compelling medical reasons for its use.

Syncope

Major:

Lithonate

The lithium in Lithonate has a major potential interaction with Syncope.

Lithium should generally not be given to patients with significant cardiovascular disease since the risk of lithium toxicity is high in these patients. Additionally, there have been postmarketing reports of a possible association between lithium therapy and the unmasking of Brugada Syndrome, a disorder characterized by abnormal EKG findings and a risk of sudden death. Lithium should be avoided in patients with this diagnosis or suspicion of it, or that have risk factors, which include unexplained syncope, family history of this syndrome, or family history of unexplained sudden death before the age of 45 years.
Therapy with lithium should be administered with extreme caution in patients with preexisting cardiac disease. Consultation with a cardiologist is highly recommended and cardiac monitoring should be completed before and during treatment.

Tachyarrhythmia

Major:

Lithonate

The lithium in Lithonate has a major potential interaction with Tachyarrhythmia.

Lithium should generally not be given to patients with significant cardiovascular disease since the risk of lithium toxicity is high in these patients. Additionally, there have been postmarketing reports of a possible association between lithium therapy and the unmasking of Brugada Syndrome, a disorder characterized by abnormal EKG findings and a risk of sudden death. Lithium should be avoided in patients with this diagnosis or suspicion of it, or that have risk factors, which include unexplained syncope, family history of this syndrome, or family history of unexplained sudden death before the age of 45 years.
Therapy with lithium should be administered with extreme caution in patients with preexisting cardiac disease. Consultation with a cardiologist is highly recommended and cardiac monitoring should be completed before and during treatment.

Underactive Thyroid

Major:

Lithonate

The lithium in Lithonate has a major potential interaction with Underactive Thyroid.

The use of lithium has been associated with hypothyroidism in 5% to 15% of patient as it blocks the release of thyroxine (T4) and triiodothyronine (T3) mediated by thyrotropin. Therapy with lithium should be administered cautiously in patients with preexisting hypothyroidism. Careful monitoring of the thyroid function is recommended and supplemental thyroid treatment may be required.

More resources

Lithonate

A total of 750 drugs are known to interact with Lithonate.

mefloquine

A total of 442 drugs are known to interact with mefloquine.

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.