✽ Nonsteroidal anti-inflammatory agents, including ibuprofen and selective COX-2 inhibitors (cyclooxygenase 2), can increase plasma lithium concentrations; add with caution to patients stabilized on lithium
✽ Diuretics, especially thiazides, can increase plasma lithium concentrations; add with caution to patients stabilized on lithium
• Angiotensin-converting enzyme inhibitors can increase plasma lithium concentrations; add with caution to patients stabilized on lithium
• Metronidazole can lead to lithium toxicity through decreased renal clearance
• Acetazolamide, alkalizing agents, xanthine preparations, and urea may lower lithium plasma concentrations
• Methyldopa, carbamazepine, and phenytoin may interact with lithium to increase its toxicity
• Use lithium cautiously with calcium channel blockers, which may also increase lithium toxicity
• Use of lithium with an SSRI may raise risk of dizziness, confusion, diarrhea, agitation, tremor
• Some patients taking haloperidol and lithium have developed an encephalopathic syndrome similar to neuroleptic malignant syndrome
• Lithium may prolong effects of neuromuscular blocking agents
• No likely pharmacokinetic interactions of lithium with mood-stabilizing anticonvulsants or atypical antipsychotics
Stahl, S. (2020). Stahl’s Essential Psychopharmacology: Prescriber’s Guide. In Prescriber’s Guide: Stahl’s Essential Psychopharmacology (p. Iii). Cambridge: Cambridge University Press.
