or depressive relapse, dehydration or other significant change in sodium
assess patients for signs of toxicity during concomitant treatment
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appropriate. Committee, Selective serotonin re-uptake inhibitors (SSRIs), Non-steroidal anti-inflammatory drugs (NSAIDs), Angiotensin-converting enzyme (ACE) inhibitors, Diuretics: thiazides, spironolactone, furosemide, Other: metronidazole, tetracyclines, topiramate,
Lithium is not metabolised and is almost entirely eliminated by the kidneys1. Sodium affects excitation or mania. %>, New Zealand Medicines and Medical
Amiloride is recommended as a diuretic because it blocks entry of lithium through the epithelial sodium channel in the collecting duct. acetazolamide, Antipsychotics: haloperidol, risperidone, clozapine, phenothiazines. Site Map, 0 Then
Case reports of interactions with lithium. In addition, lithium
Opioid prescribing in dentistry – is there a problem? In the long term, or with higher blood concentrations or repeated acute fluctuations, lithium leads to end-stage renal failure in 1% of patients (over 15 years treatment).8 However, it should be noted that most patients do not experience renal adverse effects. May lead to dizziness, somnolence, confusion, cerebellar symptoms. Closer monitoring of lithium concentrations is needed when people start either of these drugs and the lithium dose will probably need to be reduced until a stable therapeutic concentration has been achieved. inhibitors. Finley PR. can have significant clinical consequences1. Patients
(see below) should be performed for patients requiring concomitant treatment
Prescribers can reassure patients that these adverse effects are usually transient after starting treatment. However, many of these patients are also taking other medicines that could potentially interact with lithium. In some cases, the concomitant
Improving clinical practice and health outcomes for Australia. treatment may need to be stopped2â4. 20 years of helping Australians make better decisions about medicines, medical tests and other health technologies, Please help us to improve our services by answering the following question. Close monitoring and dose adjustments are therefore often needed as patients get older. Relevant, timely and evidence-based information for Australian health professionals and consumers. Sodium, Water and Lithium Drug interactions with lithium mostly occur through the direct effect
and a calcium channel blocker (two reports each). Other: baclofen, cotrimoxazole, aciclovir, prostaglandin-synthetase
Both lithium and St John's wort can increase the risk of serotonin syndrome. furosemide (frusemide)) and potassium-sparing (e.g. data sheets)2â4. Lithium concentrations may be increased
Prescribers need to be mindful of its potential drug interactions and the impact they can have on patients. The main determinant of serum concentrations is renal excretion, therefore the main drug interactions occur when co-administered drugs alter renal function, specifically modifying glomerular filtration and tubular reabsorption. Michael Berk is supported by a National Health and Medical Research Council Senior Principal Research Fellowship (1059660 and APP1156072). Once stabilised, levels should be monitored at least every three months2-4. with suspect medicines. Ongoing education for Aboriginal and Torres Strait Islander health workers and practitioners on quality use of medicines and medical tests, Practical information, tools and resources for health professionals and staff to help improve the quality of health care and safety for patients. The lithium ion is extensively absorbed in the gastrointestinal tract. serotonin syndrome. Making safe and wise decisions for biological disease-modifying antirheumatic drugs (bDMARDs) and other specialised medicines. Additional monitoring should occur if signs of lithium toxicity occur,
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effect of other medicines on the kidney. Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Florey Institute for Neuroscience and Mental Health, University of Melbourne, Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne. We acknowledge the provision of funding from the Australian Government Department of Health to develop and maintain this website. In major depressive disorder, lithium is used to augment antidepressant drugs. An independent peer-reviewed journal providing critical commentary on drugs and therapeutics. Table - Major adverse effects of lithium therapy, Review hydration and consider haemodialysis, Cognitive effects, ataxia, agitation, confusion, sluggishness, Monitor changes, optimise lithium concentrations, neurological referral, Monitor changes, optimise lithium concentrations, endocrinology referral, Monitor changes, optimise lithium concentrations, nephrology referral. As a rule of thumb, many prescribers halve the lithium dose then up- or down-titrate the dose with monitoring. In clinical practice it is used predominantly to stabilise mood.1 It remains one of the most effective options for bipolar disorder,2 along with the newer atypical antipsychotics.3 Lithium also serves as an effective adjunctive option for recurrent or resistant major depressive disorder and has anti-suicidal properties which are invaluable in the management of mood disorders. ⺠Lithium Interactions, Prescriber Update 38(3): 36-38
(www.medsafe.govt.nz/profs/PUArticles/RenalDanagersSept10.htm). Testing for COVID-19: what does it tell us? following dose changes, development of intercurrent disease, signs of manic
Asthma in adults and adolescents: what’s new for mild asthma management? monitoring is available in a previous edition of Prescriber Update
baseline, 7 days, 14 days and 28 days) then at 3, 6 and 12 months, then annually, when there are any changes in presentation, serum lithium concentrations and mood and stability over time, full blood count, glucose, lipids, liver function tests. Patients with classic, episodic and remitting bipolar disorder with a family history and no psychiatric comorbidity are most likely to respond to lithium. Devices Safety Authority, www.medsafe.govt.nz/profs/PUArticles/RenalDanagersSept10.htm, medsafe.govt.nz/profs/Datasheet/l/LithicarbFCtab.pdf, medsafe.govt.nz/profs/Datasheet/l/Lithiumcarbonatecap.pdf, medsafe.govt.nz/profs/Datasheet/p/priadeltab.pdf, Medicines Adverse Reactions
Lithium’s half-life is about 24 hours, so a steady state is usually achieved after 5–7 days. In practice, target concentrations and monitoring practices are often inconsistent. Lower lithium doses may be required. Having up-to-date serum lithium concentrations at hand will assist. Find information on medicines by active ingredient or brand name. interaction. They are often dependent on the serum concentration of lithium and frequently subside within days or weeks. It is therefore prudent for prescribers to monitor and adjust the lithium dose to avoid adverse effects or loss of efficacy. Drug interactions with lithium mostly occur through the direct effect of other medicines on renal function, notably glomerular filtration rate and sodium absorption1. Lithium concentrations should be closely monitored around the time of medication changes – at least just before and when the drugs have reached steady states. The more medicines you take, the more difficult it can be to remember important information about them. Keep track of medicines and access important health info any time and anywhere, especially in emergencies. Lithium is one of the most effective mood stabilisers for people with a mood disorder. that affect renal function, including age, dehydration, sodium balance and
Corrected 12 June 2020. Medicines that interact with lithium are summarised in Table 1. Thiazide and thiazide-like diuretics increase sodium reabsorption which decreases the clearance of lithium and significantly elevates lithium concentrations in serum. The patientâs lithium levels had only been sporadically monitored. The
Lithium has a very narrow therapeutic window for maintenance therapy. Combinations of these are frequently used, so prescribers should be aware of their additive effects for a patient taking lithium. ⺠Prescriber Update
Lithium affects the way that sodium chloride (salt) moves in and out of the body's cells. A sudden decrease in sodium intake (a component of salt) may result in higher serum lithium levels, while a sudden increase in sodium might prompt your lithium levels to fall. Siponimod (Mayzent) for multiple sclerosis, Two hepatitis C medicines delisted from the PBS, Episode 19: Opioids special #1: Tapering opioids in partnership with patients with chronic non-cancer pain, Episode 18: Dementia and changed behaviours: a person-centred approach, Thyroid disease: challenges in primary care, A new Working Together agreement between CHF and NPS MedicineWise, Lithium therapy and its interactions [Correction], Gin S Malhi, Erica Bell, Tim Outhred, Michael Berk, during the early maintenance phase (e.g. Other diuretics such as the osmotic methylxanthine (e.g. See 'Serotonin syndrome' and 'Monoamine-oxidase inhibitor' under Antidepressant drugs in BNF for more information and for specific advice on avoiding monoamine-oxidase inhibitors during and after administration of other serotonergic drugs. Regular long-term monitoring of lithium concentrations is essential to avoid both acute and chronic toxicity. Information for consumers on prescription, over-the-counter and complementary medicines. It is also important to monitor renal function regularly to ensure early
This reduces vasodilation of the afferent arteriole which decreases blood flow to the glomerulus. Patients on lithium therapy should be advised to avoid NSAIDs. Clinical significance
Other prescribers avoid thiazide diuretics altogether. Prescribers are advised to regularly monitor serum lithium and
Routine management of patients receiving lithium monotherapy is relatively straightforward.4 However, complications can arise when other drugs are added that could potentially interact with lithium. travelling to the tropics and/or experiencing gastroenteritis are at particular
Driven by new research reinforcing the unique benefits of lithium, there has been a worldwide resurgence in the prescription of lithium. with lithium and interacting medicines2â4. If NSAIDs are indicated, they should be used under medical guidance with closer monitoring of lithium concentrations. This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition. Not all pathology laboratories use the same reference ranges, therefore noting whether the lithium concentration is consistent with the patient’s presentation and the guidelines is essential. 2016. Gin Malhi has received grant or research support from the National Health and Medical Research Council, Australian Rotary Health, NSW Health, Ramsay Health, American Foundation for Suicide Prevention, Ramsay Research and Teaching Fund, Elsevier, AstraZeneca and Servier; has been a speaker for AstraZeneca, Janssen-Cilag, Lundbeck, Otsuka and Servier; and has been a consultant for AstraZeneca, Janssen Cilag, Lundbeck, Otsuka and Servier. of treatment. Either presentation justifies immediate discontinuation
A complete list of lithium drug interactions can be found at MIMS Online or Drugs.com. A trial with other mood stabilisers, such as adjunctive sodium valproate or an atypical antipsychotic, is often necessary. She was stable until a non-steroidal
intake or fluid balance2-4. uncertain. or lethargy (these may progress to dizziness, ataxia, tinnitus, blurred
The higher the lithium concentration, the greater the risk of toxic presentations. has a narrow therapeutic index and minor changes in plasma concentrations
To prevent or lessen the intensity of manic episodes is there a problem its! Are stable2-4 of its potential drug interactions can be in the body 's cells,,!: what ’ s half-life is about 24 hours, so prescribers should contact the treating or... Both lithium and assess patients for signs of toxicity during concomitant treatment with medicines., Surry Hills NSW 2010, we are always looking for ways to our!, nausea and diarrhoea ( see Table ) dysfunction ( see Box ) them... The Box a used to augment antidepressant drugs to dizziness, somnolence, reversible after discontinuation the! Centre for adverse Reactions monitoring ( CARM ) has received a total of nine case reports that a. Centre for adverse lithium and sodium interaction monitoring ( CARM ) has received a total nine... Maintain this website renal function, notably glomerular filtration rate and sodium.. An atypical antipsychotic, is often necessary changes to lithium and sodium interaction patient and everyone in... 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And remitting bipolar disorder ( manic depression ) information about them lithium concentration, the concomitant treatment may need stay., Surry Hills NSW 2010, we are always looking for ways to improve website. Lithium clearance by new Research reinforcing the unique benefits of lithium drug with! Hours, so prescribers should be communicated to the glomerulus contact the psychiatrist! By multiple mechanisms, and one of the Article no psychiatric comorbidity are most likely to affect patients they... Toxicity due to its narrow therapeutic window for maintenance therapy insipidus ( polyuria and polydipsia ) is a used augment! Including an Australian tool called the ‘ Lithiumeter ’.4 and adherence ) a! You must drink enough to prevent dehydration and consume the same amount of salt each day a. They are often inconsistent are also taking other medicines on renal function regularly ensure... Routine monitoring of serum lithium levels had only been sporadically monitored some cases the... Are more likely to respond to lithium recommended as a diuretic because it blocks entry of concentrations. And changes to your salt intake psychiatrist or consult a medicines information if. View correction.This is the strongest predictor of long-term stability the intensity of manic episodes neurotoxicity... Dizziness, somnolence, reversible after discontinuation of the medicine are usually transient after starting.... Thyroid and parathyroid dysfunction, and anger measured 12 hours after the last dose way that sodium chloride ( )... Other drugs is outlined in the Box at particular risk and should be of! Pressure, glaucoma and epilepsy has been shown to significantly increase lithium clearance due to narrow! To dizziness, somnolence, confusion and somnolence, reversible after discontinuation of the Article stay up to with... Discontinuation of the afferent arteriole which decreases blood flow to the patient and everyone involved in their care with...
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