Drug-Drug Interactions Between Lithium and Cardiovascular as Well as Anti-Inflammatory Drugs

Scherf‐Clavel, Maike; Treiber, Susanne; Deckert, Jürgen; Unterecker, Stefan; Hommers, Leif

doi:10.1055/a-1157-9433

Cited by 13 publications

(9 citation statements)

References 37 publications

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“…102 Similarly, NSAID administration (except for ASA) can result in lithium accumulation. 102,105 This has also been observed during short-term use of NSAIDs at low doses (1600 mg ibuprofen per day).…”

Section: Types Of Interactionsmentioning

confidence: 81%

Drug–Drug Interactions With Over-The-Counter Medicines: Mind the Unprescribed

Oliver

2022

Therapeutic Drug Monitoring

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Background:This review provides a summary of the currently available clinical data on drug–drug interactions (DDIs) involving over-the-counter (OTC) medicines. It aims to educate and increase awareness among health care providers and to support decisions in daily practice.Methods:An extensive literature search was performed using bibliographic databases available through PubMed.gov. An initial structured search was performed using the keywords “drug-drug-interaction AND (over-the-counter OR OTC),” without further restrictions except for the language. The initial results were screened for all described DDIs involving OTC drugs, and further information was gathered specifically on these drugs using dedicated database searches and references found in the bibliography from the initial hits.Results:From more than 1200 initial hits (1972–June 2021), 408 relevant publications were screened for DDIs involving OTC drugs, leading to 2 major findings: first, certain types of drug regimens are more prone to DDIs or have more serious DDI-related consequences, such as antiretroviral, anti-infective, and oral anticancer therapies. Second, although most DDIs involve OTC drugs as the perpetrators, some prescription drugs (statins or phosphodiesterase-5 inhibitors) that currently have OTC status can be identified as the victims in DDIs. The following groups were identified to be frequently involved in DDIs: nonsteroidal anti-inflammatory drugs, food supplements, antacids, proton-pump inhibitors, H2 antihistamines, laxatives, antidiarrheal drugs, and herbal drugs.Conclusions:The most significant finding was the lack of high-quality evidence for commonly acknowledged interactions. High-quality interaction studies involving different phenotypes in drug metabolism (cytochrome P450) and distribution (transporters) are urgently needed. This should include modern and critical drugs, such as oral anticancer medications and direct oral anticoagulants.

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Section: Types Of Interactionsmentioning

confidence: 81%

Drug–Drug Interactions With Over-The-Counter Medicines: Mind the Unprescribed

Oliver

2022

Therapeutic Drug Monitoring

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“…Moreover, doses of the drugs were not included in the analysis. If concentrations of lithium carbonate [9] or prothrombin time are appropriately monitored, the risks of those combination therapies could be minimized. Sixth, some of the recommendations of unfavorable combinations listed in IBM MICROMEDEX [14] are not always supported by solid evidence.…”

Section: Discussionmentioning

confidence: 99%

“…First, non-steroidal anti-inflammatory drugs (NSAIDs), loop/thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs) should be avoided when lithium is prescribed. These drugs affect the renal excretion of sodium, which results in an increase in the blood concentration of lithium 9 . Second, the use of NSAIDs, antiplatelet drugs, and anticoagulants should be avoided in combination with serotonin reuptake inhibitors such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) 10 .…”

Section: Introductionmentioning

confidence: 99%

Drug Combinations for Mood Disorders and Physical Comorbidities That Need Attention: A Cross-Sectional National Database Survey

et al. 2022

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Introduction This study investigated combined prescriptions of drugs for mood disorders and physical comorbidities that need special attention in the light of frequent physical comorbidities in patients with mood disorders. Methods We used the claims sampling data of 581,990 outpatients in January 2015 from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Fisher’s exact test was performed to compare the prescription rates of non-steroidal anti-inflammatory drugs (NSAIDs), loop/thiazide diuretics, angiotensin-converting enzyme inhibitors, and/or angiotensin II receptor blockers between lithium users and age- and sex-matched non-lithium users; NSAIDs, antiplatelet drugs, and/or anticoagulants between selective serotonin reuptake inhibitor (SSRI)/serotonin-noradrenaline reuptake inhibitor (SNRI) users and non-users; warfarin between mirtazapine users and non-users; and the proportions of patients in the two groups with a diagnosis of somatic conditions for which these medications were indicated and actually received them. A Bonferroni corrected p-value of<0.05/3 was considered statistically significant. Results Prescriptions of the above-mentioned medications were less frequent in lithium and mirtazapine users and comparable in SSRI/SNRI users, compared to non-users (18.3 vs. 31.9%, p=7.6×10−10; 0.78 vs. 1.65%, p=0.01; 23.1 vs. 24.1%, p=0.044). In a subgroup of patients with somatic diseases for which these medications were indicated, the prescription rates were comparable in lithium and mirtazapine users and higher in SSRI/SNRI users compared to non-users (28.0 vs. 29.4%, p=0.73; 4.7 vs. 7.4%, p=0.28; 35.6 vs. 33.4%, p=0.0026). Discussion Pharmacotherapy with drugs for mood disorders and physical comorbidities that require attention was commonly observed in clinical practice.

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“…Lithium is a salt and is renally excreted, so medications that impact free water or electrolyte balances, as well as those that impact renal excretion, may impact lithium. Notably, lithium levels can be increased and lead to toxicity if lithium is combined with nonsteroidal anti-inflammatory medications ( Scherf-Clavel et al, 2020 ). As these are commonly taken over-the-counter medications, patients should be advised about this interaction.…”

Section: Materiality Of Risks or Side Effectsmentioning

confidence: 99%

“…Lithium may also be impacted by a number of cardiovascular medications, including some used to treat high blood pressure and heart failure. There have been data to suggest that thiazides, loop diuretics, angiotensin-converting enzyme inhibitors, and angiotensin-receptor blockers may all lead to increased levels of lithium ( Scherf-Clavel et al, 2020 ). As the therapeutic window for lithium is narrow, it is important to be aware of what other medications a patient is being prescribed prior to starting lithium as well as changes to their medication regimen, in order to avoid accidental toxicity.…”

Section: Materiality Of Risks or Side Effectsmentioning

confidence: 99%

Pharmacotherapy of Primary Impulsive Aggression in Violent Criminal Offenders

et al. 2021

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Primary impulsive aggression (PIA) can be implicated as a common factor that results in an arrest, disciplinary, and restraint measures during confinement, and criminal recidivism after release. Evidence suggests that anti-impulsive aggression agents (AIAAs) can diminish or prevent impulsive aggression even when occurring with personality pathology such as borderline or antisocial personality disorder (ASPD), common conditions in offender populations. A previous review identified agents that have been subjected to controlled drug trials of sufficient quality, and subsequently, a decisional algorithm was developed for selecting an AIAA for individuals with IA. This selection process began with the five agents that showed efficacy in two or more quality studies from the earlier review. Today, 8 years after the quality review study, the present authors undertook this follow-up literature review. The aims of the present review were to survey the literature to identify and assess: (1) drug trials of comparable quality published since the 2013 review, including trials of the previously identified AIAAs as well as trials of agents not included in the earlier review; (2) severity of aggressive outbursts; (3) the materiality of risks or side-effects that are associated with individual AIAAs as well as antipsychotic agents commonly used to control clinical aggression; (4) efficacy of these agents in special populations (e.g., females); and (5) cost and convenience of each agent. Improved pharmacotherapy of PIA by addressing risks, side effects and practicality as well as the efficacy of AIAAs, should promote the rehabilitation and reintegration of some pathologically aggressive offenders back into the community.

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Drug-Drug Interactions Between Lithium and Cardiovascular as Well as Anti-Inflammatory Drugs

Cited by 13 publications

References 37 publications

Drug–Drug Interactions With Over-The-Counter Medicines: Mind the Unprescribed

Drug–Drug Interactions With Over-The-Counter Medicines: Mind the Unprescribed

Drug Combinations for Mood Disorders and Physical Comorbidities That Need Attention: A Cross-Sectional National Database Survey

Pharmacotherapy of Primary Impulsive Aggression in Violent Criminal Offenders

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