Diuretics are dangerous with lithium.

Kerry, R. J.; Ludlow, J M; Owen, G.

doi:10.1136/bmj.281.6236.371

Cited by 27 publications

(5 citation statements)

References 3 publications

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“…Three major drug classes have been identified as potential precipitants of lithium toxicity 1,12 . Both diuretics, which promote renal sodium wasting, and angiotensin‐converting enzyme (ACE) inhibitors, which reduce glomerular perfusion pressure, can enhance the tubular reabsorption of lithium 13–20 . Nonsteroidal antiinflammatory drugs (NSAIDs) have also been associated with lithium toxicity through a mechanism that is presumed to involve interruption of renal prostaglandin synthesis 4,21–24 .…”

mentioning

confidence: 99%

“…1,12 Both diuretics, which promote renal sodium wasting, and angiotensin-converting enzyme (ACE) inhibitors, which reduce glomerular perfusion pressure, can enhance the tubular reabsorption of lithium. [13][14][15][16][17][18][19][20] Nonsteroidal antiinflammatory drugs (NSAIDs) have also been associated with lithium toxicity through a mechanism that is presumed to involve interruption of renal prostaglandin synthesis. 4,[21][22][23][24] Reports of pharmacokinetic interactions between lithium and other medications are uncommon.…”

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confidence: 99%

See 1 more Smart Citation

Drug‐Induced Lithium Toxicity in the Elderly: A Population‐Based Study

Juurlink

Mamdani

Kopp

et al. 2004

J American Geriatrics Society

154

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confidence: 99%

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confidence: 99%

Drug‐Induced Lithium Toxicity in the Elderly: A Population‐Based Study

Juurlink

Mamdani

Kopp

et al. 2004

J American Geriatrics Society

154

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“…Thirteen per cent (53/402) of lithium levels, involving 18 patients, were below that accepted as being effective (0.4 mmol/l). In eight of these cases, lithium dosage was increased as a consequence, although there was no documented evidence of a lack of efficacy.…”

Section: Serum Levelsmentioning

confidence: 86%

“…Six patients who received concomitant drugs which may increase lithium levels (NSAIDs and diuretics) (18,19), did exhibit side effects, although the levels were not elevated above the therapeutic range. In addition, two patients received a combination of fluvoxamine and lithium which, although beneficial in some patients, increases the severity of 5-HT-related side effects (20), and a third received sertraline, another 5-HT re-uptake inhibitor, in combination with lithium, which carries a similar risk to fluvoxamine (4).…”

Section: Discussionmentioning

confidence: 99%

Serum drug level monitoring in affective disorders

Krska¹,

Corner²

1992

Journal of Clinical Pharmacy and Therapeutics

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This study surveyed serum level monitoring of lithium and carbamazepine in three psychiatric hospitals, to determine how the service is used with respect to affective disorders. The monitoring of lithium serum levels appears to be carried out in relatively close adherence to recommended guidelines. Carbamazepine serum levels are monitored with a similar frequency to lithium, despite the lack of an established therapeutic window for indications other than epilepsy. Changes in drug therapy, which are consequent upon monitoring of serum drug levels, occurred after only 7.5% of lithium and 13.7% of carbamazepine samples. Changes were made independently of serum level results with greater frequency in carbamazepine-treated patients, although less frequently with lithium-treated patients. Adverse consequences of such changes occurred only once, involving lithium. More research is needed to determine the potential benefits of carbamazepine serum level monitoring in affective disorders because the service appears to be overutilized at present.

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“…Nevertheless, there have been a number of clinically important case reports, which have highlighted a potentially serious interaction between these drugs in which thiazide diuretics increase serum lithium concentrations. KERRY et al (1980) reported on a patient stabilized on lithium (serum concentration 0.9-1.2mmol/l) in which the addition of bendrofluazide increased the serum lithium concentration to 2.4 mmol/l and in four normal healthy subjects administered SOmg/day hydrochlorothiazide there was a significant (P < 0.01) increase in serum lithium concentrations from 0.4 to 0.S3mmol/l (JEFFERSON and KALIN 1979). HIMMELHOCH et al (1977 showed an association between the percentage reduction in calculated lithium renal clearance and the dose of chlorothiazide (SOOmg/day, a 40% decrease, 1000mg/day, a 68% decrease).…”

Section: C) Diuretics A) Thiazide Diureticsmentioning

confidence: 99%

Mechanisms of Drug Interactions

Amidon¹,

D’Arcy²,

McElnay³

et al. 1996

Handbook of Experimental Pharmacology

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softcover reprint of the hardcover 1st edition 1996 PrefaceOver the years a number of excellent books have classified and detailed drugdrug interactions into their respective categories, e.g. interactions at plasma protein binding sites; those altering intestinal absorption or bioavailability; those involving hepatic metabolising enzymes; those involving competition or antagonism for receptor sites, and drug interactions modifying excretory mechanisms. Such books have presented extensive tables of interactions and their management. Although of considerable value to clinicians, such publications have not, however, been so expressive about the individual mechanisms that underlie these interactions.It is within this sphere of "mechanisms" that this present volume specialises. It deals with mechanisms of in vitro and in vivo, drug-drug, drugfood and drug-herbals interactions and those that cause drugs to interfere with diagnostic laboratory tests. We believe that an explanation of the mechanisms of such interactions will enable practitioners to understand more fully the nature of the interactions and thus enable them to manage better their clinical outcome.If mechanisms of interactions are better understood, then it may be possible for the researcher to develop meaningful animal/biochemical/tissue culture or physicochemical models to which new molecules could be exposed during their development stages. The present position, which largely relies on patients experiencing adverse interactions before they can be established or documented, can hardly be regarded as satisfactory.This present volume is classified into two major parts; firstly, pharmacokinetic drug interactions and, secondly, pharmacodynamic drug interactions. Within these parts, we have been fortunate to enlist the help of acknowledged experts in preparing specific chapters focusing on aspects of the interaction spectrum.We believe that this volume will add much to that which is currently known about drug interactions and will directly enhance the safer use of medicines.

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Diuretics are dangerous with lithium.

Cited by 27 publications

References 3 publications

Drug‐Induced Lithium Toxicity in the Elderly: A Population‐Based Study

Drug‐Induced Lithium Toxicity in the Elderly: A Population‐Based Study

Serum drug level monitoring in affective disorders

Mechanisms of Drug Interactions

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