Basic Information
ID DDInter1910 and DDInter1081
Interaction Coadministration with nonsteroidal anti-inflammatory drugs (NSAIDs) may increase serum lithium levels and induce toxicity in some patients. The exact mechanism of interaction is unknown, but is thought to involve inhibition of renal prostaglandin synthesis by NSAIDs, resulting in decreased renal blood flow and lithium excretion. There have been numerous published reports of lithium toxicity, including severe cases, following the introduction of various NSAIDs including diclofenac, ibuprofen, indomethacin, ketorolac, mefenamic acid, piroxicam, and COX-2 inhibitors.
Management Given the narrow therapeutic index of lithium, caution is advised during coadministration with NSAIDs, particularly in the elderly or patients with other risk factors (e.g., sodium restriction; renal impairment; congestive heart failure; dehydration; concomitant use of diuretics, ACE inhibitors, or angiotensin II receptor antagonists). Patients should have serum lithium levels checked every 4 to 5 days after starting an NSAID until the extent of any potential interaction can be evaluated. A reduction in lithium dosage may be needed in some cases. Renal function should also be monitored regularly. Patients should be advised to seek medical attention if they experience potential signs and symptoms of lithium toxicity such as drowsiness, dizziness, confusion, muscle weakness, vomiting, diarrhea, polydipsia, polyuria, tinnitus, tremor, ataxia, and blurred vision.
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Alternative for Valdecoxib M01A
Glucosamine Chondroitin sulfate Misoprostol Rabeprazole Esomeprazole
Alternative for Lithium carbonate -
Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.