NSAIDs and Lithium

[MiaB]

Can anyone explain exactly what the issue is between NSAIDs and Lithium? Is it simply that the anti-inflammatories increase the risk of lith toxicity? This is a problem. I'm still dealing with daily hip pain (broke it 4 months ago) and up til now I've been taking a codeine-ibuprofen drug. My orthopaedic surgeon is okay with putting me on just codeine, but I feel I need an anti-inflammatory more. Are there any options at all for me, or is this just a done deal? I did a quick search and none of the sites I saw came up with a viable alternative. The pain isn't likely to go away anytime soon, as it's caused by the pins they put in my femur moving to encourage the growth of bone spurs across the break. The doc wants me to live with it for as long as possible.

thanks

M

[Dee]

Yes, NSAIDs increase lithium levels and could lead to toxicity. My pdoc said I could take Advil, but only occassionally.

Opiate-based painkillers are ok. I take Tylenol with codeine.

[mrsloony]

My doctor really prefers me to avoid nsaids- he said if i need to take some , then i should have a lithium level done in the next 24 hrs. he did look up nsaids that may have less of this risk- i believe one called clinoral had the fewest risks so you may want to discuss with you your doc/pdoc

[AirMarshall]

NSAIDs tend to reduce the kidney's clearance rate of lithium, meaning blood levels can rise.

I have never seen any way to predict this or any comparison of NSAIDs effect. A number of factors probably come in to play including, your lithium dosage, your normal blood level, your kidney's clearance capacity, which NSAID, NSAID dosage, and how long the NSAID is taken. Truly YMMV.

I think you have to follow your doctor's advice. You might talk to your pdoc and see how he feels about you taking an NSAID, or has a better game plan.

a.m.

[sepia]

I take NSAIDs for arthritis. My pdoc ran WEEKLY lithium levels for the first six weeks, then one every 2-3 weeks for several months afterward. If you're a chronic NSAID user, it's not like they're bombs laced throughout your bloodstream in order to suddenly trigger lithium toxicity at some random juncture. Stable levels of NSAIDs will have a stable effect on your lithium level. It's what AM said: NSAIDs cause your body to clear lithium more slowly. The basic effect of this is that it will take less lithium for you maintain a therapeutic level. YMMV. Start low, work up. Doc should watch closely... though a blood test a week might be a tad excessive.