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Taking phenothiazines along with lithium might decrease the effectiveness of lithiumLithium might also decrease the effectiveness of phenothiazinesSome phenothiazines include chlorpromazineThorazinefluphenazineProlixintrifluoperazineStelazinethioridazineMellariland others.

Lithium interferes with the production and uptake of chemical messengers by which nerves communicate with each otherneurotransmittersLithium also affects the concentrations of tryptophan and serotonin in the brainIn additionlithium increases the production of white blood cells in the bone marrowLithium’s effects usually begin within 1 week of starting treatmentand the full effect is seen by 2 to 3 weeks.

Lithium increases a chemical in the brainThis chemical is called serotoninSome medications used for depression also increase serotoninTaking lithium with these medications used for depression might cause there to be too much serotoninThis could cause serious side effects including heart problemsshiveringand anxietySome of these medications used for depression include phenelzineNardiltranylcypromineParnateand others.

Nonsteroidal anti-inflammatory drugsNSAIDsfor exampleibuprofenMotrinAdvilnaproxenNaprosynAleveindomethacinIndocinnabumetoneRelafendiclofenacVoltarenCataflamArthrotecketorolacToradolreduce the kidney’s ability to eliminate lithium and lead to elevated levels of lithium in the blood andside effects from lithiumBlood concentrations of lithium may need to be measured for 4 to 7 days after an NSAID is either added or stopped during lithium therapyAspirin and sulindacClinorildo not appear to affect lithium concentrations in the bloodDiureticswater pillsshould be used cautiously in patients receiving lithiumDiuretics that act at the distal renal tubulefor examplehydrochlorothiazideHydrodiurilspironolactoneAldactonetriamtereneDyreniumDyazideMaxzidecan increase blood concentrations of lithiumDiuretics that act at the proximal tubulefor exampleacetazolamideDiamoxare more likely to reduce blood concentrations of lithiumDiuretics such as furosemideLasixand bumetanideBumexmay have no affect on lithium concentrations in bloodACE inhibitorsfor exampleenalaprilVasoteclisinoprilZestrilPrinivilbenazeprilLotensinquinaprilAccuprilmoexiprilUnivasccaptoprilCapotenramiprilAltacemay increase the risk of developing lithium toxicity by increasing the amount of lithium that is reabsorbed into the body in the tubules of the kidney and thereby reducing the excretion of lithiumWhen carbamazepineTegretoland lithium are used togethersome patients may experience side effectsincluding dizzinesslethargyand tremorCentral nervous system side effects also may occur when lithium is used with antidepressantsfor examplefluoxetineProzacsertralineZoloftand paroxetinePaxilfluvoxamineLuvoxamitriptylineElavilimipramineTofranildesipramineNorpraminCombining lithium with monoamine oxidase inhibitorMAOIclass of antidepressantsfor exampleisocarboxazidMarplanphenelzineNardiltranylcypromineParnateselegilineEldepryland procarbazineMatulaneor other drugs that inhibit monoamine oxidasefor examplelinezolidZyvoxmay lead to serious reactionsMedications which cause the urine to become alkalinethe opposite of acidiccan increase the amount of lithium that is lost into the urineThis results in lower blood concentrations of lithium and reduces the effects of lithiumSuch drugs include potassium acetatepotassium citrateUrocit-Ksodium bicarbonateand sodium citrateBicitraCytra-2Liqui-CitraOracitShohl’sCaffeine appears to reduce serum lithium concentrationsand side effects of lithium have increased in frequency when caffeine is consumedBoth diltiazemCardizem-CDTiazacDilacor-XRand verapamilCalan-SRIsoptin-SRVerelanCovera-HShave been reported to have variable effects on lithium levels in bloodIn some patients there may be decreased lithium blood levels and in others lithium toxicityMethyldopaAldometmay increase the likelihood of lithium toxicityVarious reactions have resulted when lithium is administered with phenothiazinesfor examplechlorpromazineThorazinethioridazineMellariltrifluoperazineStelazineor with haloperidolHaldolSuch reactions have included deliriumseizuresencephalopathyhigh fever or certain neurologic reactions that affect movement of musclescalled extrapyramidal symptomsLithium can cause goiter or hypothyroidismThe use of lithium with potassium iodide can increase the likelihood of this adverse reactionThe use of the beta blockerpropranololInderalwith lithium can lead to a slow heart rate and dizzinessOther beta blockersfor examplemetoprololLopressoratenololTenorminalso may interact with lithium and be associated with a slow heart rate.

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