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how does alcohol effect lithium levels?


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#1 betcsu

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Posted 13 June 2006 - 07:31 PM

all i could find out about alcohol and lithium is that it effects or affects the lithium level but i can find out how it effects. does it lower or increase it? thanks in advance to anyone who can tell me.

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#2 AirMarshall

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Posted 13 June 2006 - 09:15 PM

No effect whatsoever.

Alcohol is detoxified by the liver.

Lithium is a salt that takes the place of an equal portion of sodium chloride (table salt) in your body and is excreted by the kidneys without any chemical changes.

Lithium can change the effects of how alcohol feels. It varies by person , and sometimes with time. It often can decrease the pleasurable feeling of alcohol, leading you to drink more alcohol chasing the buzz. And drinking more alcohol is generally not good. Since one may not feel intoxicated, it could cause you to drive while actually impaired, but wihout feeling impaired.

If you get dehydrated while drinking, which is easy to do, this could lead to lithium toxicity, e.g. shakes, nausea, vomiting, various other. Keeping well hydrated while taking lithium is important.

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#3 betcsu

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Posted 14 June 2006 - 07:49 AM

thanks for answering. all i could find yesterday said this:

Can I drink alcohol while I am taking this ?

There is not a complete ban on drinking alcohol if you are taking lithium, try not take more than about one or two drinks a day as this may affect the level of lithium in your blood. It may also cause you to feel more drowsy. This is especially important if you need to drive or operate machinery as it can affect your reaction times. You should seek advice on this.
http://www.nmhct.nhs...rmacy/mood1.htm

and also this:

Taking lithium and alcohol can make people feel very drowsy and can also change the level of lithium in. the blood.
http://www.nhslothia...hiumLeaflet.pdf

can you point me in the right direction that shows that alcohol does not affect the lithium level? im not trying to be argumentative. i just want to be sure. thanks again.

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dx: bp 1, sa, gad
current rx: am: lamictal 100mg, pm: celexa 20mg, hydroxyzine 25mg prn


#4 AirMarshall

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Posted 14 June 2006 - 09:50 AM

Ok, How do I prove a negative? *sigh* ;)

Granted, I'm not a doctor, nor a pharmacologist. Offhand I can't think of a bodily mechanism that would cause a direct interaction. However, I accept your challenge.

Here is the drug interaction section from the manufacturers PI sheet. It does NOT mention alcohol:
http://us.gsk.com/pr...us_eskalith.pdf

Drug Interactions: Caution should be used when lithium and diuretics are used concomitantly because diuretic-induced sodium loss may reduce the renal clearance of lithium and increase serum lithium levels with risk of lithium toxicity. Patients receiving such combined therapy should have serum lithium levels monitored closely and the lithium dosage adjusted if necessary.

Lithium levels should be closely monitored when patients initiate or discontinue NSAID use. In some cases, lithium toxicity has resulted from interactions between an NSAID and lithium. Indomethacin and piroxicam have been reported to increase significantly steady-state plasma lithium concentrations. There is also evidence that other nonsteroidal anti-inflammatory agents, including the selective cyclooxygenase-2 (COX-2) inhibitors, have the same effect. In a study conducted in healthy subjects, mean steady-state lithium plasma levels increased approximately 17% in subjects receiving lithium 450 mg b.i.d. with celecoxib 200 mg b.i.d. as compared to subjects receiving lithium alone.

Concurrent use of metronidazole with lithium may provoke lithium toxicity due to reduced renal clearance. Patients receiving such combined therapy should be monitored closely.

There is evidence that angiotensin-converting enzyme inhibitors, such as enalapril and captopril, and angiotension II receptor antagonists, such as losartan, may substantially increase steady-state plasma lithium levels, sometimes resulting in lithium toxicity. When such combinations are used, lithium dosage may need to be decreased, and plasma lithium levels should be measured more often.

Concurrent use of calcium channel blocking agents with lithium may increase the risk of neurotoxicity in the form of ataxia, tremors, nausea, vomiting, diarrhea, and/or tinnitus. Caution is recommended.

The concomitant administration of lithium with selective serotonin reuptake inhibitors should be undertaken with caution as this combination has been reported to result in symptoms such as diarrhea, confusion, tremor, dizziness, and agitation.

The following drugs can lower serum lithium concentrations by increasing urinary lithium excretion: acetazolamide, urea, xanthine preparations, and alkalinizing agents such as sodium bicarbonate.
The following have also been shown to interact with lithium: methyldopa, phenytoin, and carbamazepine.



Ok,
I did Medline searches with key words Lithium, Alcohol and Interaction/Adverse. This returned over 500 international citations going back to the early 1970's. I only found Two (2) relevent reports.

- One was a study in mice injected with alcohol and Lithium Chloride (which is not used in humans). The summary did not relate the quantities or human equivalent. Minor agranular supression was found in the Spleen (makes blood) and some minor inflammation in the heart sac and circulatory system.

- The second study was published in a journal on alcoholism. Rats were forced to either consume alcohol for 10 months, or have it injected into their abdomen and then injected with Lithium. The researchers were interested in Lithium distribution and urinary excretion. No conclusion was stated.


So, from the lack of ANY research on humans in the last 35 years, I would conclude that there is not a significant Lithium/alcohol interaction problem.

Your NIH brochure is very handy. I am quite puzzled over the suggestion of 1 or 2 drinks a day being acceptable. Most authorities strongly suggest NO drinking, or 1 - 2 drinks per WEEK maximum. Personally, two drinks a day is essentially an alcoholic. Us bipolars particularly don't need anything to make our emotions swing more.

In any case, I won't contradict official publications. You need to ask your doctor.

best,

a.m.

p.s. If anyone offers you alcohol from a big glass bottle with a metal spout or from a syringe, just say no.

p.p.s. What's an alcoholic? Someone who drinks more than you do.

:)

Edited by AirMarshall, 14 June 2006 - 09:53 AM.

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#5 betcsu

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Posted 14 June 2006 - 11:55 AM

AM- thanks for digging up that info. i didnt mean to challenge you. i hope i didnt come off as argumentative. i just thought maybe you had a handy dandy url file that you could pull the info from. i really appreciate all the effort you went to to look this up for me. really.

as for contradicting official publications... ive been thinking about this today and as far as my quotes above and others ive found saying that it is affected they wont say how. and unless they can be more specific, then they should be invalidated.

anyway, thanks again for all your effort!

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it didn't happen!


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dx: bp 1, sa, gad
current rx: am: lamictal 100mg, pm: celexa 20mg, hydroxyzine 25mg prn


#6 AirMarshall

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Posted 14 June 2006 - 12:03 PM

I meant "accept your challenge" as the positive urging to find the source for my statements. Fair enough.

Also i realized later that you are in the US, not the UK. I thought that you had gotten them through the UK National Health Service. Therefore, UK health pamphlets have no medico/legal authority here, whether they are correct or not.

a.m.

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#7 zsandoz

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Posted 14 June 2006 - 07:09 PM

all i could find out about alcohol and lithium is that it effects or affects the lithium level but i can find out how it effects. does it lower or increase it? thanks in advance to anyone who can tell me.



there is no overall effect, but during the period of drinking and the hangover there is often dehydration which can cause temporary elevation of lithium levels, and other electrolyte imbalance. so its probably not a good idea.
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#8 crazynotstupid

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Posted 15 June 2006 - 12:05 AM

I am quite puzzled over the suggestion of 1 or 2 drinks a day being acceptable. Most authorities strongly suggest NO drinking, or 1 - 2 drinks per WEEK maximum. Personally, two drinks a day is essentially an alcoholic. Us bipolars particularly don't need anything to make our emotions swing more.


(sigh) No. nononononon...and, no. One thing, a drink a day has been shown to be heart0healthy. (correct me if I'm wrong, but last I knew it wasn't just red wine, but alcohol in general)

Two drinks a day does, in no way, make one an alcoholic. Nor does six, for that matter. The most basic definition of an alcoholic is one that can't NOT go without drinking. And then, it doesn't matter--two drinks or drinking til passing out. It's the need, not the amount, though the frequncy does play a large part.
The woods are lovely, dark and deep.
But I have promises to keep,
And miles to go before I sleep
And miles to go before I sleep.
-Robert Frost

#9 AirMarshall

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Posted 15 June 2006 - 11:41 AM

CNS,

I'll re-iterate the last comment from my post above:

What's an alcoholic? Someone who drinks more than you do. ;)


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#10 crazynotstupid

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Posted 15 June 2006 - 08:39 PM

CNS,

I'll re-iterate the last comment from my post above:


What's an alcoholic? Someone who drinks more than you do. :)


Hey, if they can even keep up with me, they've got probs. ;)
The woods are lovely, dark and deep.
But I have promises to keep,
And miles to go before I sleep
And miles to go before I sleep.
-Robert Frost

#11 Guest_Jesse_*

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Posted 18 August 2009 - 09:39 PM

Lithium

"Lithium has been the standard treatment for bipolar disorder for several decades. Unfortunately, several studies have reported that substance abuse is a predictor of poor response of bipolar disorder to lithium. More specifically, as stated previously, compared to non–substance abusers, alcoholics appear to be at greater risk for developing mixed mania and rapid cycling. Researchers have found that patients with mixed mania respond less well to lithium than patients with the nonmixed form of the disorder (Prien et al. 1988). This suggests that lithium may not be the best choice for a substance–abusing bipolar patient."

Firstly I have to say that taking a view on medication interactions based purely on a excretion point of view is foolish and dangerous, particularly when discussing psychotic drugs which are renowned for lack of understanding even among medical professionals and pharmacologists. The effects of these drugs are in chemistry poorly understood, so to stand there and say they don't interact because they are aborbed and excreted differently is amongst the stupidest things I have ever read. Advice like yours only creates confusion and bad advice for people already struggling with a mental illness.

And honestly read your research properly people - a low to moderate intake of alcohols has shown some health benifits in heart disease, but detrimental effects across a broad spectrum of other conditions. Well lead by the media sheep!

#12 recoverymouse

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Posted 18 August 2009 - 09:46 PM

Lithium

"Lithium has been the standard treatment for bipolar disorder for several decades. Unfortunately, several studies have reported that substance abuse is a predictor of poor response of bipolar disorder to lithium. More specifically, as stated previously, compared to non–substance abusers, alcoholics appear to be at greater risk for developing mixed mania and rapid cycling. Researchers have found that patients with mixed mania respond less well to lithium than patients with the nonmixed form of the disorder (Prien et al. 1988). This suggests that lithium may not be the best choice for a substance–abusing bipolar patient."


From the quote it's unclear if this is about alcoholics who are actively drinking or alcoholics who are in recovery.


#13 AirMarshall

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Posted 23 August 2009 - 12:31 AM

Lithium

Firstly I have to say that taking a view on medication interactions based purely on a excretion point of view is foolish and dangerous, particularly when discussing psychotic drugs which are renowned for lack of understanding even among medical professionals and pharmacologists. The effects of these drugs are in chemistry poorly understood, so to stand there and say they don't interact because they are aborbed and excreted differently is amongst the stupidest things I have ever read. Advice like yours only creates confusion and bad advice for people already struggling with a mental illness.

Read the original post. The pertinent question was "does alcohol affect lithium levels", not "is there any psychological interaction", nor "how do these drugs work".

1. There is no clinical indication that alcohol consumption affects lithium levels.
2. Consideration of both metabolism and elimination of any drug is appropriate when discussing interactions.
3. While pharmacologists may not know the precise method of action for Lithium or other psych meds, they often have pretty good clues. Lithium is thought to work on calcium channels.
4. Lithium is not approved nor recommended for treating psychosis.

a.m.

p.s. One can disagree with my opinions, but I think my factual advice is pretty damn good. I always stand ready to accept documented corrections to any of my mistatements or errors.

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#14 Guest_rm_*

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Posted 07 September 2009 - 10:33 AM

consuming alcohol can definitively effect your lithium level. Intake causes dehydration which in turn will lead to toxicity. to answer your question it will increase li+ levels

#15 Guest_MARVELLETTE_*

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Posted 08 October 2009 - 03:09 PM

I was hospitalized this week for a high lithium level with total confusion and body spasms. I had been up all night vomiting, etc. and my lithium level was three times the acceptable level. I've been taking this prescription for 8 years. The difference: I had started drinking again. Lithium dehydrates your body and can cause high lithium levels and of course alcohol dehydrates the body, too. In addition, my thyroid was below normal even though I take meds for it. So alcohol does not go well with this med.

#16 Guest_Rhea_*

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Posted 29 July 2010 - 12:49 AM

Just as heads up...alcohol does not neccesarily dehydrate you. It is a diuretic, therefore you urinate more frequently. THAT can dehydrate you. If you are going to consume any alcohol with lithium, you should drink a very moderate amount and consume water as you do so. And as for psychological effects of mixing the two, each person is going to be different. As someone said before, drugs used to treat mental illness are frequently not fully understood. I think it's best to err on the side of caution and consume alcohol in great moderation. I recently went out last weekend and drank a bit too much, but I did not experience feelings of intoxication. It was quite odd, but I didn't get sick or have a black-out or anything like that. However, I have heard of those who do, so it's important to know first and foremost, alcohol and lithium together will create different reactions in different people.

#17 Guest_Guest_*

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Posted 09 February 2011 - 04:40 PM

Maybe you all should quit reading things online and go ask your pharmacist these questions!

#18 null0trooper

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Posted 09 February 2011 - 04:58 PM

Maybe you all should quit reading things online and go ask your pharmacist these questions!


Why are you reading things online here instead of consulting your own psychiatrist, if the discussion bothers you so much?

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