Lithium as medicine (drug interactions)
Lithium is a medication commonly used to treat bipolar disorder, but it requires careful management due to potential drug interactions that can affect its efficacy and safety. Numerous substances can influence lithium levels, including diuretics (both herbal and prescription), which may lead to increased lithium concentrations in the blood, heightening the risk of toxicity. For instance, certain herbal diuretics, often included in weight-loss formulas, have been reported to cause dangerously high lithium levels. Additionally, supplements such as potassium and sodium citrate can reduce lithium's effectiveness by altering urinary acidity.
Other medications, particularly ACE inhibitors, NSAIDs, and certain antidepressants, also pose risks when taken alongside lithium, as they can either increase toxicity or lead to serious side effects. Patients are advised to communicate openly with healthcare providers about all medications and supplements they are taking to avoid adverse interactions. It is crucial for individuals on lithium to maintain adequate hydration and be cautious about dietary choices, particularly regarding sodium and dehydrating herbs. Understanding these interactions is essential for those considering or currently undergoing lithium treatment.
Lithium as medicine (drug interactions)
DEFINITION: Medication used to treat bipolar disorder.
INTERACTIONS: Citrate, herbal diuretic, inositol, cardiac medications, NSAIDs, St. John's wort, caffeine, many herbs, supplements, and prescription medications
TRADE NAMES: Lithobid
Inositol
Effect: Possible Helpful Interaction
Lithium may cause or exacerbate symptoms of psoriasis. One small, double-blind study found that using supplemental inositol may help alleviate this problem.
Herbal Diuretic
Effect: Possible Harmful Interaction
The use of lithium as a therapy requires careful attention to lithium levels in the blood. If there is too little lithium, the treatment will not work; if lithium levels get too high, toxicity may result.
One cause of excessively high lithium levels is dehydration. Lithium levels rise proportionally when the amount of water in the blood decreases. For this reason, persons taking lithium are warned that they must drink sufficient liquids when exposed to heat. Diuretic drugs (water pills) can also cause problems, causing the body to excrete water.
One case report suggests that herbal diuretics can also lead to increased lithium levels. Certain herbs are thought to act as diuretics, including buchu, celery seed, cleavers, corn silk, couch grass, dandelion, goldenrod, gravel root, horsetail, juniper, parsley, rosemary, and wild carrot.
This report noted the case of a twenty-six-year-old woman who had been taking a constant dose of lithium for five months without any problems. When she suddenly developed drowsiness, tremors, unsteadiness in walking, and rapid involuntary movements of the eyes, doctors conducted a laboratory examination and found that her lithium level had skyrocketed. It turned out that a few weeks before this episode, she had started taking an herbal weight-loss formula that included numerous herbal diuretics.
Manufacturers frequently add herbal diuretics to weight-loss formulas to cause short-term loss of water weight. This has no value for long-term weight loss, but it does give some immediate sense of success. However, in this case, the herbal diuretics also caused lithium levels to rise.
Citrate
Effect: Possible Harmful Interaction
Potassium citrate, sodium citrate, and potassium-magnesium citrate are sometimes used to prevent kidney stones. These supplements reduce urinary acidity, which can, therefore, decrease blood levels and the effectiveness of lithium.
Other Medications
Many other prescribed medications may interact with lithium, and it is important for patients to discuss all drugs with their healthcare providers when taking lithium. ACE inhibitors and angiotensin II receptor antagonists increase the chance of lithium toxicity. Non-steroidal anti-inflammatory drugs (NSAIDs) and acetazolamide should also be avoided due to vascular issues. Antidepressants that affect serotonin levels should be avoided when taking lithium, as the combination could increase the risk of serotonin syndrome, a potentially dangerous condition. When taking lithium with certain antipsychotic drugs, the side effects of both may be drastically increased. Patients should avoid foods and supplements that are high in sodium, as well as dehydrating herbs, such as juniper berries, which may act as diuretics. Finally, herbs that deplete the body's potassium levels, such as licorice root, should be avoided, as these can lead to lithium toxicity.
Bibliography
Allan, S. J., et al. "The Effect of Inositol Supplements on the Psoriasis of Patients Taking Lithium." British Journal of Dermatology, vol. 150, 2004, pp. 966-969.
"Drug Interactions with Lithium and Therapeutic Drug Monitoring." Medsafe, 7 Sept. 2017, www.medsafe.govt.nz/profs/PUArticles/September2017/Lithium.htm. Accessed 11 Sept. 2024.
"Lithium Interactions." Drugs.com, www.drugs.com/drug-interactions/lithium.html. Accessed 11 Sept. 2024.
Malhi, Gin S., et al. "Lithium Therapy and Its Interactions." Australian Prescriber, vol. 43, no. 3, 2020, pp. 91-93, doi.org/10.18773/austprescr.2020.024. Accessed 21 Aug. 2023.
Pyevich, D., and M. P. Bogenschutz. "Herbal Diuretics and Lithium Toxicity." American Journal of Psychiatry, vol. 158, 2001, p. 1329.
"Taking Lithium with Other Medicines and Herbal Supplements." NHS, 9 Aug. 2023, www.nhs.uk/medicines/lithium/taking-lithium-with-other-medicines-and-herbal-supplements. Accessed 11 Sept. 2024.