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Lithium and Risperidone Interaction

lithium risperidone lithium toxicity drug interaction

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#1 crtclms

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Posted 06 August 2012 - 01:32 AM

I've been feeling like absolute shit, and DH for some reason suggested that the lithium was interacting with the risperidone, but I hadn't heard of that. But I was falling into walls as I walked around the house. My hands are shaking so badly I can't really knit. I knock over everything in my vicinity, even things that I don't believe I've actually touched. DH has started running in front of me to clear a path to lessen the destruction (ironically, I do this for him when he is in a post-ictal fugue state).

I'm not exactly dizzy, but I'm unsteady on my feet. I feel sick to my stomach most of the day. I am confused, and having trouble thinking clearly. All of the sudden, I am pissing copiously. Copiously. I say that as someone who has to use the bathroom at least 12 times a day because I have a spastic bladder (that was the diagnosis, not my calling my bladder names).

I actually thought to myself, "This reminds me of when I was toxic on lithium." It didn't occur to me that that could actually be what was going on. Two days ago, my blood level was normal, and my normal is considered sub-therapeutic.

So I looked up "risperidone, lithium, interaction" in Pubmed, and came up with a study on topa, and 4 case studies, one of which wasn't applicable (different circumstances). The three remaining case studies say that neuroleptics can sometimes interact with lithium, and cause lithium toxicity even at low doses. So in theory, my actual blood level isn't the indicator of toxicity, the symptoms are.

This fits perfectly with what I am experiencing. But 3 case studies? Can I really go in and say to a covering pdoc, "Well, there were these 3 case studies of this phenomenon on PubMed, and they remind me of what is going on with me?"

So has anyone here experienced this? It says it is a rare interaction, but I am one of those people who often has rare side effects (bruxism with atenalol, anyone?). But I feel like I have heard of this from someone or some people here. Is this possible (with the caveat that that doesn't mean that is what is wrong with me)?

I think I'm toxic. As of Friday, my blood level was .5, which is the level it is always at. On Thursday night, I had my first risperdal, and when I woke up on Friday, I fell, and had trouble walking, but it cleared up, so I attributed to normal AAP start up SEs. By Friday night, I was falling down regularly, but I actually do fall down a lot more than the average person, so I was thinking it was just a really bad day. It has just gotten worse and worse.

I took myself off the risperdal. It is only 1mg, and if the pdoc thinks I made a mistake, I'll only have missed one day. I am scared. If she is mad at me for stopping it (not that I think she will be), thems the breaks. No more risperdal for me. I am hoping I'll be allowed to stay on the lithium, but am realizing the copious pissing may be the last straw. But I'll keep taking it until told not to.

This always happens when my pdoc is out of town. Ugh. In some ways, it pisses me off, because while he believes what I and his colleagues say about my state when they saw me, *he* has never seen me at the height of an episode. My worst time of year coincides with his vacation. Nobody's fault, that's just how it is. He takes me seriously, but I feel like because he hasn't seen it with his own eyes, he doesn't really believe it. This is completely a made up thing I have in my head that makes me cry as I tell you it is imaginary.

Vomiting words again.

Ahh! I totally forgot to tell you about the crazy bad derealization I am experiencing, the worst ever. And other things. And I have more hallucinations, I can't remember them all anymore.

Edited by crtclms, 06 August 2012 - 01:35 AM.
More whining.

Dx: Bipolar 1; GAD; Migraine w/ Aura; Migraine w/o Aura; Status Migrainosus
Rx: Alprazolam; Botox; Buproprion; CoQ10; Dihydroergotomine via IV Infusion; Flexeril; Green Coffee Bean Extract; Lamotrigine; Lithium; Magnesium Chloride; Metoclopramide; Midrin; Migranal; Prilosec; Promethazine; Riboflavin; Verapamil; Vitamin D3
Currently Shelved: Abilify; Amerge; Anaprox; Atenolol; Buspar; Cafergot; Cymbalta; Depakote; Di-Hydro-ergotamine, injected; Gabapentin; Geodon; Imitrex Tablets; Klonopin; Maxalt; Namenda; Nortriptyline; Norvasc; Propranolol; Prozac; Risperidone; Relpax; Sansert; Sumatriptan injectables; Tegretol; Trazadone; Zoloft; Zolpidem; Zomig; Zonegran


Affectations can be dangerous. -Gertrude Stein

 

I moderate Bipolar, Panic/Anxiety, Dissociative Disorders, Migraine, Seizures, Not Otherwise Specified, Anticonvulsants, Side Effects, Family Feud, and I Still Have Issues. PM me if you have any questions



#2 Titania

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Posted 06 August 2012 - 03:17 AM

It is interesting, I am on Lithium and used to take risperidone too. I would regularly feel something like that even though my levels stayed normal.

“I am naïve and I have fucked up but I tell you something else. I believe in change. I don't mind getting my hands dirty because my hands are dirty already. I don't mind giving my life to this because I'm only alive because of the compassion and love of others.” Russell Brand.

 

"She said to go ahead and feel the feelings. I did. They felt like shit." Anne Lammot.

 

"you are not too old/and it is not too late/to dive into your increasing depths/where life calmly gives out/it's own secret" Rilke

 

"You," he said, "are a terribly real thing in a terribly false world, and that, I believe, is why you are in so much pain." Emilie Autumn - The Asylum For WayWard Victorian Girls.


#3 konings

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Posted 06 August 2012 - 03:46 AM

You havent checked this maybe:
http://www.drugs.com...t=1477-0,2019-0
And something your pdoc didnt employ:

Lithium toxicity can be avoided by conservative prescribing, care in combining drug therapies, and, above all, educating the patient and caregivers to recognize early signs of the condition.



#4 crtclms

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Posted 06 August 2012 - 05:21 AM

Actually, my pdoc didn't put me on it. The covering pdoc of the covering pdoc put me on it. My pdoc is pretty restrained with my use of lithium, because I've been toxic before, and because I have mild kidney disease. If this is a known interaction, he'll probably know. The covering pdoc doesn't know my entire health situation, there just hasn't been time to fill her in on the last 48 years.

I don't tend to look at drugs.com, they are extremely risk averse, and unfortunately, you sometimes have to take a risk.

Anyway, Titania, that is interesting to know. I think as much as I can say this with any confidence as a layperson, it is an interaction. Otherwise, it is a pretty uncanny imitation of lithium toxicity, at least as I remember it. I am really more interested in other people's experiences, so I have an idea of how to present this to a pdoc that isn't mine. I have to call her tomorrow, because I stopped a med, and also because I should probably get another creatinine level, just to make sure my kidneys aren't in free fall. My next face to face appt. is actually on Friday, though.

Dx: Bipolar 1; GAD; Migraine w/ Aura; Migraine w/o Aura; Status Migrainosus
Rx: Alprazolam; Botox; Buproprion; CoQ10; Dihydroergotomine via IV Infusion; Flexeril; Green Coffee Bean Extract; Lamotrigine; Lithium; Magnesium Chloride; Metoclopramide; Midrin; Migranal; Prilosec; Promethazine; Riboflavin; Verapamil; Vitamin D3
Currently Shelved: Abilify; Amerge; Anaprox; Atenolol; Buspar; Cafergot; Cymbalta; Depakote; Di-Hydro-ergotamine, injected; Gabapentin; Geodon; Imitrex Tablets; Klonopin; Maxalt; Namenda; Nortriptyline; Norvasc; Propranolol; Prozac; Risperidone; Relpax; Sansert; Sumatriptan injectables; Tegretol; Trazadone; Zoloft; Zolpidem; Zomig; Zonegran


Affectations can be dangerous. -Gertrude Stein

 

I moderate Bipolar, Panic/Anxiety, Dissociative Disorders, Migraine, Seizures, Not Otherwise Specified, Anticonvulsants, Side Effects, Family Feud, and I Still Have Issues. PM me if you have any questions


#5 Titania

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Posted 06 August 2012 - 06:12 AM

I present maybe four or five times a year with these kinds of symptoms, sometimes linked to hot weather/change in fluids/food intake, when they get around to doing my tests, my levels are steady and my kidney function is fine. My pdoc has wanted me off risperidone for a while (I now finally am) and so maybe he has been aware of an interaction. It seems, over here at least, until you're in a emergency state of toxicity, it is regarded as a not a big deal, therefore I have learned to endure it.

“I am naïve and I have fucked up but I tell you something else. I believe in change. I don't mind getting my hands dirty because my hands are dirty already. I don't mind giving my life to this because I'm only alive because of the compassion and love of others.” Russell Brand.

 

"She said to go ahead and feel the feelings. I did. They felt like shit." Anne Lammot.

 

"you are not too old/and it is not too late/to dive into your increasing depths/where life calmly gives out/it's own secret" Rilke

 

"You," he said, "are a terribly real thing in a terribly false world, and that, I believe, is why you are in so much pain." Emilie Autumn - The Asylum For WayWard Victorian Girls.


#6 Not me

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Posted 06 August 2012 - 08:01 AM

My level went up .3 (From .7 to 1.0) on starting Saphris, So it can happen. I've had my level double checked a few times, and its held steady at 1.0.
Different drug, but same sort of effect. I'm getting more GI side effects, tremor is under control using inderal still.

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#7 gizmo

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Posted 06 August 2012 - 11:33 AM

I personally was on risperdal and lithium for several years, and had no problems. But I do recall (right?) that you recently increased your lithium dose? Even though you may have a sub-therapeutic level, maybe the increase is too much for your body and kidneys. Can you get the on call dr to run a lithium test 12 hours after your last dose to see where it's at right now?

As a side note, I had therapeutic levels of lithium, and drank like a fish and pissed like a racehorse. I also had whole body tremors. So those wouldn't worry me, ESP if you have had them awhile. But the clumsiness would be concerning if you had mental lack of clarity and proper functioning. I think toxicity causes you to be lethargic and get dizzy and vomit, doesn't it?

Call the pdoc and keep us posted.
Diagnosis: BP I with Psychotic Features, GAD, ADHD, Chronic Migraines, various physical stuff.
Meds Currently On: Depakote 2000 mg, Risperdal 8 mg, Latuda 80 mg, Prozac 60 mg, Vyvanse 70 mg, Propranolol 40 mg BID, Klonopin 2 mg BID PRN
Meds Sort-Of Mental Related: Lipitor 40 mg, Zofran 4 mg PRN, Fioricet PRN, Stadol PRN, Botox received on 8/16/13

I post on an iPhone, so please forgive grammatical errors or strange word inclusions. It's the auto correct!

#8 Furious George

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Posted 06 August 2012 - 09:07 PM

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Edited by Furious George, 16 July 2013 - 06:19 PM.


#9 crtclms

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Posted 07 August 2012 - 03:39 PM

I talked to the pdoc's pdoc's pdoc today, and she agreed with my decision to take myself off the Risperidone. At first, she was really skeptical, and said "well you took it last summer and didn't have a problem." :wall: She doesn't listen to me, and she doesn't look at the notes, and I knew as soon as we started interacting that she sucked. (I wasn't *on* lithium that time, and I told her that, and it was in my pdoc's notes).

I like my pdoc's "real" covering pdoc, but this one is just who they could find an appt with on an emergency basis.

But the fortunate thing about not seeing my pdoc's usual covering pdoc is that my DH just did an intake for depression (hooray for wifely nagging!), and he was assigned to her. We actually had appointments on the same morning.

Ah! My brain is going in 100 directions at once, sorry. When I left my message yesterday, I told her I thought I needed a level and another creatinine level. After realizing I hadn't been on Lithium last summer, she agreed to my kind of insisting on the tests, even though it is rare. Um, rare doesn't equal impossible. And I ran down the list of symptoms listed for toxicity in a number of places, and had almost all of them (obviously, not coma). AND it happened in the exact time frame it would have. But because it is rare, she didn't think I needed to test my lithium level, or even my creatinine after I told her I had been peeing a HUGE amount.

Gizmo, you remember correctly that I was actually prescribed a higher dose. But before I could start it, my pdoc called me and said not to raise it, because my creatinine level had risen. I am allowed to stay on enough to bring me to .5, and I would like to go higher, but cannot. .5 truly does help, it just doesn't knock it out. I am now concerned that something is up with my kidneys, and if so, I will have to be taken off of that. Which means fuck me; I don't know what we are going to do with my meds if that happens.

The course tremor from the lithium sucks. Just saying.

Dx: Bipolar 1; GAD; Migraine w/ Aura; Migraine w/o Aura; Status Migrainosus
Rx: Alprazolam; Botox; Buproprion; CoQ10; Dihydroergotomine via IV Infusion; Flexeril; Green Coffee Bean Extract; Lamotrigine; Lithium; Magnesium Chloride; Metoclopramide; Midrin; Migranal; Prilosec; Promethazine; Riboflavin; Verapamil; Vitamin D3
Currently Shelved: Abilify; Amerge; Anaprox; Atenolol; Buspar; Cafergot; Cymbalta; Depakote; Di-Hydro-ergotamine, injected; Gabapentin; Geodon; Imitrex Tablets; Klonopin; Maxalt; Namenda; Nortriptyline; Norvasc; Propranolol; Prozac; Risperidone; Relpax; Sansert; Sumatriptan injectables; Tegretol; Trazadone; Zoloft; Zolpidem; Zomig; Zonegran


Affectations can be dangerous. -Gertrude Stein

 

I moderate Bipolar, Panic/Anxiety, Dissociative Disorders, Migraine, Seizures, Not Otherwise Specified, Anticonvulsants, Side Effects, Family Feud, and I Still Have Issues. PM me if you have any questions


#10 gizmo

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Posted 07 August 2012 - 06:11 PM

Just shoot my horrible memory!

I'm glad you are able to back off the risperdal. I hope you return to yourself soon.

I hope your husband's appt. went well and that he gets the help he needs.
Diagnosis: BP I with Psychotic Features, GAD, ADHD, Chronic Migraines, various physical stuff.
Meds Currently On: Depakote 2000 mg, Risperdal 8 mg, Latuda 80 mg, Prozac 60 mg, Vyvanse 70 mg, Propranolol 40 mg BID, Klonopin 2 mg BID PRN
Meds Sort-Of Mental Related: Lipitor 40 mg, Zofran 4 mg PRN, Fioricet PRN, Stadol PRN, Botox received on 8/16/13

I post on an iPhone, so please forgive grammatical errors or strange word inclusions. It's the auto correct!






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