New to Lithium

[Avis]

I am confused. Am I able to take ibuprofen or acetaminophen when taking Lithium?

Back injury re-started recently. I have been taking ibuprofen during the day and a generic hydrocodone at night for it. the Hydrocodone is prescribed to me and in my medicine cabinet from a previous occurence of this back injury crap.

I don't know if the hydrocodone has ibuprofen or acetaminophen in it.

I can call my doctor but she is out of the office until Monday. I was going to call my pharmacy but the prescription is from earlier in the year and I don't know if they will freak out that I am taking the med again since it was prescribed for me in the early summer.

So .... quick answer please.

Can I take one or the other with lithium?

Regards, Avis

[Loon-A-TiK]

i'll put in a call to my uncle, a pharmacist, but i don't think they're bad together in the short term. they're all hard on you, but if it's not a long term thing i don't think you'll suffer damage.

try the pharmacy. if they give you a hard time, tell them the injury is bothering you again and that's why you have refills.

oh yeah, and you're not supposed to take old scripts. just a disclaimer i have to throw in.

[resonance]

moving to mood stabilizers board, may get more info there.

There is concern about NSAIDs interacting with lithium - but less so for tylenol and aspirin. It's not clear how many people this is a problem for.

It's good to call your doc anyway if you're taking meds that were prescribed to you for an older injury for a re-occurrence, especially since the re-occurrence could require different treatment, or more serious attention.

[AirMarshall]

Tylenol, acetominophen, will not interefere with Lithium.

Ibuprofen, and other NSAIDS, MAY cause increased blood levels of Lithium, which could cause increased tremors/shakiness, etc. It is possible that if you were on a high Lithium dose, it could push it you to a toxic level.

The safe blood level of lithium is 0.6 - 1.2 equivalents. This is a number that you should learn and know each time your doctor does a blood draw. The typical dosage range of Lithium Carbonate is ranges up to 1800mg per day. While it isn't possible to draw a direct correlation between all persons dosage and blood levels, after a while you should have some idea how your body reacts to particular dosages.

I'll hazard a guess, but most people on lithium probably don't have problems taking an NSAID in reasonable amounts for short periods. Be sure to discuss this with your Pdoc.

a.m.

[Silver]

Even a short term addition of NSAIDs can be problematic with serum level of lithium. If the SL is at the lower range, and the person taking it has no renal disease, a low-dose NSAID for a few days (e.g., 400 ibu for headache 1x) is not a big deal. But even short term use can result in a doubling of the SL. If doubling is still within the desired/safe range, great; acceptable risk. If the base SL is kept high, then not such a good idea. This is a "base decisions on the worst-case scenario" approach, which is what I'm all about when it comes to my Li SL at this point.

All in all, NSAIDs as a rule are best avoided with even low-dose lithium, especially without a recent SL. There are other good options out there for analgesia. If it's an issue of inflammation, then NSAIDs might be worth a look, if the SL is lowish and the kidneys are healthy. Otherwise, adding a longer-term NSAID to lithium merits a significant reduction in lithium dose - like a 50% reduction - and then careful monitoring of the SL over the next 7 days with titration back to therapeutic range.

When lithium is added to an NSAID, then the Li dosing starts lower (or should). If lithium is added to long-term, high-dose NSAIDs, it's particularly important to start lower, as the renal effects of NSAIDs are cumulative.

NSAIDs as a class alter sodium balance at the kidneys, and thus decrease lithium excretion (there are other mechanisms as well, but I'm trying to not get into prostaglandin inhibition.)

This isn't limited to ibuprofen, naproxen, ketorolac, etc.; there are some case reports now of the same interaction occuring with the COX-2 drugs (Celebrex/Bextra.)

Avis, the odds are very, very, very good that your hydrocodone has acetaminophen as the other ingredient. Does it say "Hydrocodone/APAP" on the bottle? If so, that's acetaminophen.

Sorry to go on and on about NSAIDS and lithium. Near and dear to my heart. I'm a lot of fun at parties, too.

[Avis]

Okay Wow!

Now a whole new language to learn. "SL" and "draw" numbers?! Maybe now I remember why lithium scared me. After 10 yrs of crazy land I have most of the lingo in my head. This is new stuff.

How often do lithium patients usually get a blood draw?

I will be closely examining my hydrocodone bottle at home. I also need to re-think my use of it at all right now. Too much going on in the head. Maybe let the body hurt a bit more and get the head squared away first.

Blech!

Regards, Avis

[Silver]

Frequency of lithium labs varies by provider and pt.

Here's a pretty thorough schedule:

• baseline labs (CBC, CMP, TSH, and as needed by history)
  
• level after ~4-7d at the first target dose; this is often skipped and just rechecked at one month, if there are no big risk factors/complicating factors involved
  
• recheck level at 1 month; often at this point recheck TSH, recheck CBC, recheck CMP, and check urine for concentration if significant increase in output
  
• recheck level every 3-6 months or 4-7 days after any dose change
  often
  
• recheck TSH at 3 months, then just 1x/year unless symptomatic
  
• recheck CMP every 6 months or if symptomatic
  

I just plan on labs, or thinking about labs, in months divisible by 3.

For those who are more socially oriented, St. Patrick's Day, Father's Day, Labor Day, and some time between Thanksgiving and Christmas are nice reminders. Or whatever fixed, non-lunar-cycle-based holidays/rituals work.

[sun_zoom_spark]

Maybe I'm a freak but my S/L hasn't changed in over a year. (which is a good thing)

SZS

[Silver]

Show-off.

I'm delighted mine hasn't spiked up in weeks. But that's my weird ?TPM/Li process we're still sorting out.

Toradol - my favorite drug ever for kidney stones - isn't good with a maintenance level of 1.2, I learned the hard way, a few years back.

[Cetkat]

I will be closely examining my hydrocodone bottle at home. I also need to re-think my use of it at all right now. Too much going on in the head. Maybe let the body hurt a bit more and get the head squared away first.

It's Codone and Acetaminophen "Among the many brands the dose of acetaminophen ranges between 500 and 750 mg, and the dose of hydrocodone ranges between 2.5 and 10 mg". The max dose per day depends on the Acetaminophen. Tylenol says not to take more than 4,000mg.

Other than that, you can take as much as you want. I've found that "Codone" is not physically addicting like "Codine", but YMMV of course.

[null0trooper]

Even a short term addition of NSAIDs can be problematic with serum level of lithium.

Not all NSAIDs work alike - "non-steroidal anti-inflammatory drug" covers a hell of a lot of ground, although most of the common NSAIDs interfere with prostaglandin production and release, usually through COX enzyme inhibition.

Naproxen sodium is the one best known for increasing lithium levels by interfering with renal clearance, and not just the "interferes with renal prostaglandin synthesis" handwave. (That's the one known to double lithium levels) Iboprofen isn't exactly innocent (15% mean increase (rxlist)), but it's maybe not as risky as indomethecin (Arch Gen Psych.) Aspirin increases lithium levels, but not significantly.

Acetaminophen is metabolized primarily by the liver and most concern around it involves hepatic, not renal, sufficiency. Even the Journal of Clinical Psychopharmacology has reported that Tylenol doesn't interfere in lithium's reindeer games (study, ) but it's more of a pain reliever and antipyretic than antiinflammatory. And it screws with your liver.

So if you gotta, with lithium: Tylenol before Aspirin before Motrin before even listening to an Aleve commercial.

Disclaimer: I'm mildly allergic to aspirin (eyes swollen shut is "mild" right?), and have never gotten much use from ibuprofen or naproxen anyway. It's a miracle I have a liver.

[sun_zoom_spark]

I use Vicoprofen myself but never more than 2 days straight (for migraines). Never had a Li toxicity problem. Kills the migraines ta boot. Could use something for this damned arthritis but needless to say, I'm not taking that chance.

SZS

[SnowWhiteQueen]

I suffer from really bad lower back pain and have regularly taken prescription doses of Ibuprofen/Advil for a long time. I started lithium a couple months ago and was told I had to give up my Advil and switch to Tylenol. Lithium is working good and I am really liking it and don't want to give it up; but using Tylenol for my back pain really does suck. Advil worked so much better. I do take Valium before bed because it is a muscle relaxant so that helps a bit. But other than having to live with some extra back pain, I really do like lithium so far. But that's what I was told anyway, that Advil shouldn't be used but Tylenol is okay.

[FairlyOddParent]

I was given hydrocodone for kidney stones. It is an anti-inflamatory. I would avoid taking it with Lithium. Have you asked your doctor about lidocaine patches?

[Silver]

Hydrocodone is an opioid. It is not an anti-inflammatory. It is also [link=http://psy.psychiatryonline.org/cgi/content/full/44/6/515" target="_blank]metabolized [/link](goes through the liver) and is not cleared renally.

Acetaminophen, which is often combined with hydrocodone, is discussed above.

If it is combined with ibuprofen, an NSAID, then that would be a potential issue. But, with all respect, hydrocodone is NOT an anti-inflammatory, undergoes hepatic metabolism, and is not problematic unto itself with lithium.