Lithium Interactions

Excerpt from Cafer's Mood Stabilizers and Antiepileptics


Lithium Pharmacokinetic Interactions

 
Lithium is removed from the body almost exclusively by the kidneys. Several medications affect the rate of lithium clearance. Since lithium has a narrow therapeutic index, blood levels need to be closely followed. 

Thiazide diuretics and NSAIDS have the greatest potential to increase lithium concentrations, usually 25% to 40%.  Rarely the increase may be much greater, leading to lithium toxicity. If another prescriber insists on adding a thiaze or NSAID, a reasonable approach is to decrease lithium dose by about 30% and recheck blood level in one week. 

Educate patients that NSAIDS, blood pressure meds, and diuretics can cause lithium toxicity. For OTC pain medications, they should choose Tylenol or aspirin. Advise them to inform the prescriber if they are planning to change their caffeine intake. Excedrin is OK (combo of aspirin, acetaminophen, and caffeine). Check lithium levels frequently for patients on interacting medications. Teach the signs of lithium toxicity including tremor, nausea, diarrhea, fatigue, and drowsiness.
Lithium's Pharmacokinetic Interactions
Here is the simple version:
Lithium interactions - visual mnemonic by Jason Cafer MD


...and this one incorporates mnemonics from other chapters of the book:

Lithium interactions - Dawg I heard you like visual mnemonics by Jason Cafer MDLithium levels are not significantly affected by:    

Loop diuretics
  ❖ Furosemide (LASIX)
  ❖ Bumetanide (BUMEX)

Potassium-sparing diuretics
  ❖ Spironolactone (ALDACTONE)
  ❖ Amiloride (MIDAMOR)
  ❖ Triamterene (DYRENIUM)

Calcium channel blockers
  ❖ Amlodipine (NORVASC)
  ❖ Diltiazem (CARDIZEM)  
  ❖ Verapamil (CALAN) 
  ❖ Nifedipine (PROCARDIA)

Central alpha agonists 
  ❖ Clonidine (CATAPRES)  
  ❖ Guanfacine (TENEX)

Beta blockers
  ❖ Metoprolol (LOPRESSOR)
  ❖ Atenolol (TENORMIN)
  ❖ Propranolol (INDERAL)
  ❖ Labetalol (TRANDATE)
  ❖ Nebivolol (BYSTOLIC)
  ❖ Bisoprolol (ZEBETA)
  ❖ Nadolol (CORGARD)

Vasodilators
  ❖ Hydralazine (APRESOLINE)
  ❖ Isosorbide mononitrate (IMDUR)

Pain medications
  ❖ Aspirin (BAYER, EXCEDRIN)
  ❖ Sulindac (NSAID)
  ❖ Acetaminophen (TYLENOL)
  ❖ Tramadol (ULTRAM)
  ❖ Opioids

Copyright 2020 CaferMed LLC, Jason Cafer MD




























Location:
Mick Deaver Memorial Dr, Columbia, MO 65203, USA
















Comments











Post a Comment























Popular posts from this blog









Cenobamate (XCOPRI) visual mnemonics




















Image







Excerpt from  Cafer's Mood Stabilizers and Antiepileptics, available on Amazon Cenobamate (XCOPRI) “Cinnab on  Ex-co uple ” Pronunciation:  sen oh BAM ate / EX cop ree  ❖ Antiepileptic  ❖ GABA A  modulator  ❖ DEA Schedule V   FDA approved for:   ❖ Partial-onset seizures (adults)   Cenobamate (Xcopri) is the newest antiepileptic drug (AED) , released in 2020. There are some serious risks , side effects and kinetic drug/drug interactions.   Dosing is similar to lamotrigine (Lamictal), with a slow titration to a recommended dose  of 200 mg over 11 weeks . As with lamotrigine, maximum dose is 400 mg. The slow titration is necessary to avoid Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) , also known as multiorgan hypersensitivity. There were no cases of DRESS among over 1,000 patients with adherence to the slow titration schedule. Cenobamate shortens QT  interval and is contraindicated with Familial Short QT Syndrome. QTc interval under 300 is dangerous.   Dose-dependent








Read more










Pregabalin mascot & Black Friday Sale




















Image







Check out the Black Friday sale on Cafer's Psychopharmacology: Visualize to Memorize 270 Medication Mascots.  For a limited time, the paperback is $49.95  and the PDF version is $29.95  (regular price $89.95).  The PDF is formatted for ultra-rapid navigation with thousands of internal links. Included are medication mascots to assist you with memorization of trade name / generic name pairings. Here are excerpts from from 5-star Amazon reviews: ★★★★★ Love it I barely look at the pictures, honestly. I'm most impressed by the way the author explains everything through text, simply and efficiently. ★★★★★  GREAT PSYCH NO STUDENT EASY TO READ RESOURCE This breaks things down easily and is a great study resource for those needing something more concise and easier to read. ★★★★★  THIS BOOK helped me SO MUCH! First of all, I don’t write reviews but this book deserves it. I am in a CMHC graduate program where a class asked me to know most of the antipsychotics and antidepressants. It was 








Read more










Lumateperone (Caplyta)




















Image







Available on Amazon:  Cafer's Mood Stabilizers and Antiepileptic Drugs        Lumateperone (CAPLYTA) Pronunciation:  luma TEP er ohn / cap LIE ta  “’Lum inated  Cap lighter” Antipsychotics are represented  with spooky mascots. Year of US release: 2020  ❖ Antipsychotic (SGA) ❖ D2 antagonist - ⇩DA ❖ 5-HT2A antagonist - ⇧DA ❖ Glutamate modulator  FDA-approved for:  ❖ Schizophrenia  Lumateperone is a new antipsychotic that purportedly modulates glutamate  in addition to the usual SGA mechanism of blocking D2 and 5-HT2A receptors. However, the official prescribing information does not mention glutamate, suggesting the FDA saw insufficient evidence for lumateperone being a first-in-class novel antipsychotic. It appears to be equally effective as risperidone (Risperdal) with fewer side effects other than sedation (Citrome, 2016).  Lumateperone’s D2 receptor occupancy is lower than most other antipsychotics. This means extrapyramidal side effects are unlikely. The other antipsychotics with








Read more