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Dr. Bob is Robert Hsiung, MD,
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Posted by tensor on January 7, 2005, at 8:48:31
Hi,
i read that ibuprofen can interact with lithium, as well as other non-steroidal anti-inflammatory drugs. Is this true for a single pill? Or is it merely for treatments for weeks? Please share your experiences on this..
/Mattias
Posted by ed_uk on January 7, 2005, at 17:51:48
In reply to Lithium + ibuprofen, posted by tensor on January 7, 2005, at 8:48:31
Hi Mattias!
Here is some information about the interaction between Li and ibuprofen....
'The serum lithium levels of a patient rose by 25% (from 0.8 to 1.0 mmol/l) over a 7-day period while taking 2400 mg ibuprofen daily. He experienced nausea and drowsiness. Two other patients in the study taking 1200–2400 mg ibuprofen daily did not show this interaction. The serum lithium levels of 11 subjects rose by 15% when given 1600 mg ibuprofen daily. 1800 mg ibuprofen daily for 6 days raised lithium levels in 9 patients by 34% (range 12–66%). Lithium toxicity developed in one patient within 24 h, and in 3 others within 3–7 days of starting ibuprofen. The serum lithium levels of the latter patients doubled or tripled. Lithium toxicity has been seen in other patients attributable to the use of ibuprofen.'
Why do NSAIDs interact with Li?
'One suggestion is that the interacting NSAIDs do so by inhibiting the synthesis of the renal prostaglandins (PGE2) so that the renal blood flow is reduced, thereby reducing the renal excretion of the lithium. However, this fails to explain why aspirin, which blocks renal prostaglandin synthesis by 65–70%, does not affect serum lithium levels.'
In summary,
Most NSAIDs should be avoided during treatment with Li. A single tablet of ibuprofen would usually be ok but it would be safer to use a non-interacting alternative. Paracetamol (called acetaminophen in the USA) and aspirin do not appear to interact with Li. If it was absolutely necessary to use an NSAID during Li treatment it would be very important to monitor the Li level closely and adjust the Li dose as appropriate.
Best Regards,
Ed.
Posted by prodgirl on January 9, 2005, at 16:04:54
In reply to Re: Lithium + ibuprofen, posted by ed_uk on January 7, 2005, at 17:51:48
I will confirm - I hate that I can no longer take my Excedrene, but that's that. My pdoc said that if I get a migrane level headache, once will not kill me, but I need to use Tylenol. No asprin either.
Good luck!
>
> In summary,
>
> Most NSAIDs should be avoided during treatment with Li. A single tablet of ibuprofen would usually be ok but it would be safer to use a non-interacting alternative. Paracetamol (called acetaminophen in the USA) and aspirin do not appear to interact with Li. If it was absolutely necessary to use an NSAID during Li treatment it would be very important to monitor the Li level closely and adjust the Li dose as appropriate.
>
> Best Regards,
> Ed.
>
>
This is the end of the thread.
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