Neurotoxicity with combined administration of lithium and a neuroleptic

Prakash, Rudra; Kelwala, Surendra; Ban, Thomas A.

doi:10.1016/0010-440x(82)90049-9

Cited by 46 publications

(11 citation statements)

References 22 publications

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“…Previously published case reports have noted a neurotoxic reaction in patients treated with both lithium and sundry antipsychotics, including clozapine and risperidone, [12][13][14][15][16][17][18] and the etiologic role of a specific drug interaction remains uncertain. There are several possible mechanisms that may explain this possible interaction.…”

Section: Discussionmentioning

confidence: 99%

“…3,5,11,13,16,[26][27][28][29][30] Because these medications have all been commonly coadministered with lithium, the relative risk of serious interactions appears to be quite low, but caution is advised.…”

Section: Discussionmentioning

confidence: 99%

“…However, various forms of toxicity have been described when lithium and different psychotropic medications are used in combination. [8][9][10][11][12][13][14][15][16][17][18] Although lithium continues to be regarded as the treatment of choice for bipolar and schizoaffective disorders, the clinical use of this mood stabilizer is limited by an extremely narrow therapeutic range. Even a minor increase in serum concentration may induce a serious adverse event, and concentrations within the therapeutic range may result in toxic reactions.…”

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confidence: 99%

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Lithium Intoxication Associated With Intramuscular Ziprasidone in Schizoaffective Patients

Miodownik

Hausmann²,

Frolova³

et al. 2005

Clinical Neuropharmacology

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Antipsychotic agents have been used for the treatment of mood disorders in schizophrenic and schizoaffective patients. It has also been suggested that combinations of lithium and antipsychotics may be more effective than either class alone in treatment of schizoaffective patients. Lithium is known to interact with a variety of medications, including conventional and atypical antipsychotics. Although these combinations are generally well tolerated, they may sometimes lead to various adverse side effects. The authors report two schizoaffective patients with manic psychotic state and psychomotor agitation treated with lithium. Both patients developed symptoms of lithium intoxication after intramuscular ziprasidone treatment. To the best of their knowledge, this is the first description of such an adverse effect of this new atypical neuroleptic drug. They assume that lithium intoxication in the two presented cases was associated with the fast increase of ziprasidone serum level after its parenteral application, possibly affecting lithium excretion and thereby leading to lithium intoxication.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Lithium Intoxication Associated With Intramuscular Ziprasidone in Schizoaffective Patients

Miodownik

Hausmann²,

Frolova³

et al. 2005

Clinical Neuropharmacology

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“…Ever since a 1974 report of irreversible neurotoxicity in four patients treated with lithium and haloperidol (82), there has been concern about combining lithium with neuroleptics, particularly haloperidol and thioridazine, and with carbamazepine (83). Some studies suggest that there is no increased neurotoxicity with the combination of lithium and neuroleptics (11,41,84).…”

Section: Drug Interactions Of Lithiummentioning

confidence: 98%

Review Article: Psychopharmacologic Treatment in Neurological Practice

Dubovsky

Ringel

1987

Neurorehabilitation and Neural Repair

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Colorado 80262.Numerous medications are currently available to treat behavioral disturbances that are commonly encountered in neurological practice. This paper reviews psychopharmacotherapy of depression, mania, anxiety, agitation, and psychosis. The effects of commonly used psychotropic agents in neurological patients, particularly those who are elderly, are emphasized. DepressionDiagnosis At any given time, 4-6% of men and twice as many woman are clinically depressed; the lifetime risk of depression is approximately 12% for men and 25% for women (1). Depression is typically manifested by a disturbance in mood (depressed, irritable, and/or anxious), thinking (helplessness, hopelessness, negativism, suicidal thoughts, self-blame, lowered self-esteem, psychomotor slowing), and vegetative function (appetite and weight change, sleep disturbance, diurnal and seasonal variation in mood). Not infrequently, neurological illnesses and/or the medications used to treat them cause depression. For example, 50-70% of patients with left hemisphere strokes develop clinical depression (2-5). Anticonvulsants, tranquilizers, and corticosteroids are common causes of depression in neurological patients (6,7). Right hemispheral dysfunction, diffuse brain disease, and some personality disorders might interfere with the ability to express emotion directly so that depressed mood is &dquo;masked&dquo; by other complaints.Most common among these are disturbances of social functioning (e.g., marital problems, frequent job changes, personality deterioration, chronic insomnia), behavior (e.g., disheveled appearance, hostility, substance abuse, catatonia, agitation, failure to recover as expected from neurological illness), thinking, (e.g., negativism, noncompliance, pseudodementia, physical complaints, expression of a wish to die), or affect (e.g., inappropriate or labile affect) (3,7,8).

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“…Prakash et al [37] surveyed the reports of neurotoxic ity with lithium-neuroleptic combination and concluded that (1) of 37 patients. 3 (8.1 %) had suffered enduring or irreversible neurotoxicity; (2) extrapyramidal and or ganic symptoms (confusion, disorientation, uncon sciousness) presented the major clinical picture of neuro toxicity, and (3) a reversible neurotoxic reaction may be observed in middle-aged patients despite serum lithium levels within the therapeutic range.…”

Section: Introductionmentioning

confidence: 99%

Electroencephalographic Changes and Other Indices of Neurotoxicity with Haloperidol-Lithium Therapy

et al. 1988

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This prospective study was undertaken in order to establish indices of possible neurotoxicity due to the combination of lithium with haloperidol and a combination of lithium with other neuroleptics. Twenty-one subjects who were receiving neuroleptic-lithium combination were studied. Of them, 14 had a primary affective disordermanic phase, and 7 had schizophrenia as judged by Feighner criteria. The subjects were evaluated on clinical, neuropsychological measures and EEG at baseline and 10–14 days after addition of lithium to the neuroleptic regimen. Of 11 subjects receiving the haloperidol-lithium combination, 5 (45.4%) showed abnormal responses on EEG. Of these 5 subjects, 3 showed abnormal photic responses, and 2 showed slowing in posterior alpha activity. These photoparoxysmal and photomyoclonic responses are indicative of cerebral pathophysiology resulting from the interactive effect of the haloperidol-lithium combination. The photic and other associated EEG abnormalities reported may be the earliest indication of neurotoxicity. No significant changes were observed in the EEG in 10 subjects treated with other neuroleptic-lithium combinations. In a statistical comparison the haloperidol-lithium combination had significantly more frequent EEG changes than the combination of lithium with other neuroleptics. This study presents sufficient evidence from reported photic and other associated EEG changes to pursue further investigation of neurotoxicity due to haloperidol-lithium therapy. Such a study should employ a larger number of subjects, random assignment of subjects to treatment and control groups, and blind evaluation of data.

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Neurotoxicity with combined administration of lithium and a neuroleptic

Cited by 46 publications

References 22 publications

Lithium Intoxication Associated With Intramuscular Ziprasidone in Schizoaffective Patients

Lithium Intoxication Associated With Intramuscular Ziprasidone in Schizoaffective Patients

Review Article: Psychopharmacologic Treatment in Neurological Practice

Electroencephalographic Changes and Other Indices of Neurotoxicity with Haloperidol-Lithium Therapy

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