[krzyk101]

Hi, I am hoping someone may know anything about Lithium and interactions with Non Stereoid Anti-Infamitory Agents, such as Ibuprofen, Naproxen Sodium, Napryson...etc. Also with blood pressure medications such as Lisinipril and diuretic's like Lasix and the effects that these meds can have on the Lithium level itself as being inconsistant at given times of the day.

I have been on Lithium for about 8 years now. The first four years I was on Lithobid Brand and tood 600mg three times a day.

Then I ended up with a new pdoc who put me on Eskalith CR tablets 450mg bid. After being on Brand Eskalith CR for about a year the FDA approved a generic Lithium CR in it's place and have taken that since.

I was supposed to be taking the Lithium CR 450mg (2) bid only I was taking Napryson at the time for pain and my electrolytes were and still are out of control. I was reading about anti-inflamatory agents and the effects of lithium. Being they can cause interactions.

So Feeling I was most likely toxic most of the time, over 8 months ago I cut the dose of Lithium CR 450mg down to three times a day and it has been ok since then. Once the former Pdoc left last month I told them what dose I had actually been taking and the decided to leave me on that dose of 450mg (1) tid.

Yet for about 10 months now I have not had a Lithium level as the Pdoc who prescribes it says it is the responsibility of the MD who prescribes the lisinipril and lasix and that MD says it is up to the Pdoc to do the level as the Pdoc is the one who is prescribing the Lithium, so as far as me getting any type of Lithium level I am caught in between some sort of doctor fight.

I had noticed that since I have been on Oxycodone APAP 10/325mg (2) tid and was still having pain, I would try and take 800mg in addition and it made me real depressed, nervous, and really spacy and more weird than usual. Now I am on the Oxycodone and a Fentynal Transdermal System of 25mcg/h delivered for 72hours, generic for Duragesic.

Since going on the patch I have been instructed by the pain doc due to my experiences with the ibuprofen not to take and anti inflamitory drugs. So I am wonder if even otc ibuprofin has this side affect with lithium? Thanks for any help, Chris

[Dolfin]

I am currently on Lithium 300mg three times a day. When I asked my doctor if I could continue Naprosyn (NSAID) for my osteoarthritis, he told me to stop taking it daily, only as needed. Basically all I can take is Tylenol (acetaminophen) for headaches.

Not on any diuretics, so I'm not sure on that one...

As far as blood testing goes, what harm would it do your MD to tack on a Lithium level with your other blood levels? I have my MD manage my blood levels, and he faxes the levels to my pdoc. Maybe your MD & pdoc need to work out a similar arrangement?

OK, I've spent my 2 cents already

Dolfin

[darkeyes]

Hi there, haven't seen you for awhile here, hope you are doing alright.
I was on Lithobid, it was great for the time I needed it, then later was switched to my present med.
I do recall diuretics (Lasix) should not be used when on Lithium, and even during times of heavy perspiration a person should take care and be sure to drink water, to help avoid concentration levels from rising or lowering, gee, can't remember how it went, if Cam drops in or T_md, they can help explain this better.
My brother has been on Eskalith for eons now, and he too has to be very careful, about fluid intake, he is on blood pressure meds now (thanks to being middle aged, and probably inherited from mom) but whatever med that is has had no interaction with the Lithium.
I'm unclear about what you were saying (my ADD is bad) but if I am interpreting your post, did you say you haven't had a Lithium blood level done lately?
A family doctor or your pain managment doc. aren't the docs that should do Lithium level checks, you need to have your pdoc or your replacment one follow up and read the lab results . . . very important.
This is a good question about your pain, blood pressure, anti-inflammatory meds. and Lithium.
I never tolerated Naprosyn, and others like it even alone, made me sick, spacey and feel downright miserable, cortisone/steroid meds can produce depression, I had a bad reaction (depression wise) with prednisone that was given to me years ago for a skin problem, I have low to normal blood pressure, well this stuff raised it, made me gain weight, tired and fall into a super deep depression, I thought I was losing my mind once off the prednisone I was fine, the "cloud of doom" lifted.
Well, I'm not sure if this info helped you at all, till Cam or T_md reply, but wanted to share this with you.
Plus to say "hi"
I'm wishing you lots of luck with this,

Sincerely,
DE

[Larry_Hoover]

Lithium has a very clear interaction with some NSAIDs, but not all of them.

Lithium blood levels rise with concurrent use of ibuprofen, sometimes to toxic levels (close to doubling, in some subjects).

However, there is no interaction with tylenol (acetominophen, paracetamol in the British system).

Here's a quick quotation from a private website:
"A marked and rapid rise in serum lithium levels (+60%) with intoxication may develop in patients given clometacin or indometacin (indomethacin). A more moderate rise (+15–34%) occurs with diclofenac and ibuprofen, but much larger rises have been seen in a few patients. Increased serum lithium levels and/or intoxication have also been seen in small and variable numbers of patients when given flurbiprofen, ketoprofen, ketorolac, lornoxicam, mefenamic acid, meloxicam, naproxen, niflumic acid, phenylbutazone, piroxicam or tiaprofenic acid. Sulindac is reported to increase, reduce or have no effect on serum lithium levels. Aspirin, lysine acetylsalicylate, sodium salicylate and paracetamol (acetaminophen) appear not to interact. "

Aspirin and tylenol are good choices, so you could use that Oxycodone APAP 10/325mg you mentioned, without pharmacological interaction. You may notice a symptomatic interaction (the two may not promote a feeling of wellness, when taken together), but it is not due to any reported drug interaction. There is no reported interaction between lithium carbonate and any member of the opioid analgesics.

About the Lasix....here's another quote from the paysite: "The concurrent use of lithium carbonate and furosemide (frusemide) can be safe and uneventful, but serious lithium intoxication has been described in a few individuals." In the detailed evidence shown, most people have no interaction of any sort between these two drugs, but for some people, the Lasix can bring on toxic lithium levels. It is the responsibility of the doctor prescribing the diuretics, IMHO, to ensure that you're on one that is safe for you.

I couldn't find anything on the lisinopril interaction.

Lar

[darkeyes]

Thanks, Larry
I appreciate when someone can come to our "question" rescue
Hope you are doing well.


DE

[krzyk101]

Thanks Dolfin, DarkEyes, and Larry for sharing the experiences with Lithium and for the advice and facts regarding the interaction precautions of Ibuprofen and other meds with Lithium. I Have been off Ibuprofin only still on lasix since my last level so I will take the advice of all and see about getting an order from one of my Doctors.

My family Doctor would probably be the easiest to get an order from, my Pdoc I have never seen, only see a 'Clinical Nurse Specialist' who writes out scripts and then the pdoc (not even able to recall the name) signs them and the Case Manager gives me the signed scripts. Seems like the old game 'telephone" half the time with it..

Thanks again all

Have a Good Today