dedoubt Posted November 4, 2011 Share Posted November 4, 2011 I searched for "lithium ibuprofen" but didn't get any search results back. I'm in too much pain to keep looking, sorry if there is a thread about this already. I have a sinus infection which is making one side of my face throb in agony. Not just my sinuses, but my teeth are killing me. It's making me kind of frantic. Acetaminophen isn't touching the pain, and the Flonase I just started isn't reducing the inflammation very quickly (plus I'm freaking out that my moods will go more off kilter because of the Flonase). An ice pack helps a teeny bit, but I can't just carry one around all the time. I called my pdoc, but haven't heard back yet. What exactly is the problem with taking NSAIDs with lithium? I know I'm not supposed to, but if it is simply a temporary increase or decrease of my Li levels, I'm willing to do it at this point. Halp! Halp! I'm about to yank my teeth out with pliers to make it stop!! Link to comment Share on other sites More sharing options...
Becks Posted November 4, 2011 Share Posted November 4, 2011 Ugh!! I feel for you dedoubt! I know that pain all too well!! What I read online is NSAIDS can increase the level of Lithium excreted into the blood stream through the kidney's and can result in lithium toxitiy..... Has your doc given you an antibiotic for the sinus infection?? I know sometimes they don't work, but ugh! Sinus infections suck, big time! Link to comment Share on other sites More sharing options...
MageCorwin Posted November 4, 2011 Share Posted November 4, 2011 Here you go... MONITOR: Several case reports and small studies suggest that some nonsteroidal anti-inflammatory drugs (NSAIDs) may increase serum lithium levels and increase the risk of toxicity. The exact mechanism is unknown but may involve inhibition of renal prostaglandin synthesis by NSAIDs. Lithium toxicity has been reported during concomitant use of indomethacin, ketorolac, mefenamic acid, and piroxicam. Lithium plasma concentrations have been shown to increase in healthy subjects or patients taking various NSAIDs including celecoxib, diflunisal, flurbiprofen, meloxicam, naproxen, and valdecoxib. Limited data suggest that sulindac may participate in the interaction to a lesser extent than do other NSAIDs. Aspirin and other salicylates do not appear to interact with lithium. MANAGEMENT: Patients who must take lithium in combination with NSAIDs should be monitored for evidence of lithium toxicity, although clinically significant interactions are thought to be rare. More frequent monitoring of lithium levels is recommended. Patients should be advised to notify their physician if they experience potential signs and symptoms of lithium toxicity such as drowsiness, dizziness, confusion, weakness, ataxia, tremor, tinnitus, blurred vision, vomiting, diarrhea, thirst, and increased urination. From http://www.drugs.com/interactions-check.php?drug_list=1310-0,1477-0 Link to comment Share on other sites More sharing options...
dedoubt Posted November 4, 2011 Author Share Posted November 4, 2011 thank you! typing one handed- ice pack on face. no antibiotic yet- she won't give me one until i've had it a full week. i hope it doesn't come to that. i'm going to take the ibuprofen- my li levels tend to be on the low side anyway (though i get toxic at a lower level too). i can't take this any longer. owowowowowowow. Link to comment Share on other sites More sharing options...
dedoubt Posted November 4, 2011 Author Share Posted November 4, 2011 shit. got paranoid, called the pharmacist, he said NO, that the interaction is too potentially dangerous. he recommended afrin to reduce the inflammation.... which involves driving to the store......... gah this sucks. if anyone else can tell me it's not that big of a deal to combine the two, that would be great.......... Link to comment Share on other sites More sharing options...
Becks Posted November 4, 2011 Share Posted November 4, 2011 So sorry de and I can't tell ya that! Me personally, I wouldn't risk it, especially with the pharmacist saying no. Sorry Pffoey on the antibiotic, that's horrid! Why should you have to be in pain for a week before she'll offer you relief! Gah! Is there anyone that can drive and go pick up the afrin for you?? Link to comment Share on other sites More sharing options...
dedoubt Posted November 4, 2011 Author Share Posted November 4, 2011 thanks. no, nobody to help out. the plight of the single mom, i get to do everything no matter what. Link to comment Share on other sites More sharing options...
Becks Posted November 4, 2011 Share Posted November 4, 2011 yea I know.....I'm not a single Mom, but my Mom was.....I get it. Link to comment Share on other sites More sharing options...
hallowedink Posted November 4, 2011 Share Posted November 4, 2011 You could try pseudoephedrine. In the UK it's the active agent in OTC Sudafed. Not sure what the US equivalent would be, but it's great for sinus pain. Hope you feel better soon. N Link to comment Share on other sites More sharing options...
dedoubt Posted November 4, 2011 Author Share Posted November 4, 2011 My pdoc called. He said that the problem with combining the two is a possible increase in intracellular levels of Li, which can lead to toxicity just as easily as high serum levels. (I already have slightly elevated intracellular levels because of the trifluoperazine.) Anyway, we talked it through and he gave me the go ahead to try the ibuprofen. He told me what to watch for as early warning signs of toxicity-- tremor, diarrhea, nausea, dizziness, trouble speaking or walking. If I get those signs, even if I stop the ibuprofen outright and drop the lithium for a few days, it may still take several days for the toxicity to go away, because the Li is stored in the tissues. Oh joy. Well, I feel better already, knowing that relief is coming. I'm not too worried about toxicity, because I don't plan to take the ibuprofen more than once or twice. Maybe I will take it tonight so I can sleep. I would really like to sleep. Between coughing, pain and thinking I can't breathe, I haven't rested all that well (not that I ever do). I just want to say again how much I love my pdoc. He always gives me the information to make decisions for myself. You know, like I am a human being, and an adult. Thanks again, you all. I love CB & all its members! ETA x 2: I am going to pick up some Afrin when I go get my kid. I think the active ingredient in it is indeed pseudoephedrine, and I know that has helped me in the past. Oops, no it's not, it's oxymetazoline... I was taking cold medicine with pseudoephedrine, and it helped some, but not at all with the recent increase in pain. Link to comment Share on other sites More sharing options...
Becks Posted November 4, 2011 Share Posted November 4, 2011 Glad you talked to your pdoc and were able to get some answers and some help! Feel better!! Link to comment Share on other sites More sharing options...
MageCorwin Posted November 4, 2011 Share Posted November 4, 2011 Hope you're feeling better! Link to comment Share on other sites More sharing options...
dedoubt Posted November 5, 2011 Author Share Posted November 5, 2011 It only helped for about three hours, then the pain came back. So I took more at the 6 hr. mark. Three hours later, pain again, so I took acetaminophen. That isn't helping. Ice packs help a tiny bit, the Afrin didn't do anything at all, and I am getting frantic. It's really hard to do anything like this... AAAAAAAAAAAAAAAAAUUUUUUUUUUUUUUUUGGGGGGGGGGGGGHHHHHHHHHHHHHHHHH!!!!!!!!!!!!!!!!!!! Link to comment Share on other sites More sharing options...
muriel Posted November 5, 2011 Share Posted November 5, 2011 I wouldn't do it. Please read bpladybug's blog, I think she got severe lithium toxicity from taking an NSAID and lithium. http://www.crazyboards.org/forums/index.php/blog/947-loquacious-ladybug/ I would love to give Li a try again, but I have to take NSAIDs for menstrual cramps, and the risk is just too high. Link to comment Share on other sites More sharing options...
dedoubt Posted November 5, 2011 Author Share Posted November 5, 2011 I will read it when I have some pain free ability to read. But in the meantime, I need to do something for this pain-- it's making me feel crazy, like hurting myself crazy. Also, I have serious faith in my pdoc, and if he said it is OK to try it cautiously, I am going to try it. Unless someone has some narcotics to knock me out. I haven't had such bad pain in a long, long time. Link to comment Share on other sites More sharing options...
gizmo Posted November 5, 2011 Share Posted November 5, 2011 My pdoc told me that NSAIDS like advil raise your lithium level by 50%. He taught me how many pills to take when I needed advil (tylenol is a joke for me). Of course, I was taking 1500mg, so I had a lot of wiggle room. Ironically, I only became toxic one time, and the pdoc I had at the time didn't think it was a big deal. They didn't even tell me until I called about the results. But I wasn't taking pain meds then, it just happened. Link to comment Share on other sites More sharing options...
dedoubt Posted November 5, 2011 Author Share Posted November 5, 2011 Thanks, gizmo. That's basically what my pdoc said- that if I showed symptoms of toxicity, to stop the ibu. and drop back on lith. My face was really puffy this morning (happens to me with sinus infections), so I skipped my morning lith. just in case. I don't have any other signs, but I'm not taking ibu. today. The pain is manageable now, though I still feel like shit. It would have helped if I didn't have to work today... Bleagh... Yah, about getting toxic-- I'm pretty sensitive to lith. levels rising, and I had signs of toxicity at 1.2. It's what pushed me over the edge into the hospital last winter. I don't know why it happened, because my eating & drinking hadn't changed, but about a week after increasing from 300 to 600, I felt extra crazy and also sick. The level was 1.2 over 24 hours after my last dose. The dickhead docs at the hospital kept telling me I had just forgotten that I took it right before the level, that there was no way my level would be that high otherwise, etc. ARGH!!! At least my pdoc believed me. Which is why it took another 6 months to get my up to 900. Link to comment Share on other sites More sharing options...
crtclms Posted November 6, 2011 Share Posted November 6, 2011 Are you congested? I'm sorry if that is a stupid question you already said, my head is killing me. Have you tried nasal irrigation or a neti pot? I just do it with saline, not a neti pot, but it really helps; I stopped a minor infection once by doing it. (repeat, minor). Do it over a sink, with tissue at hand. It is disgusting, but it really helps. Ugh, I wrote this last night, and forgot to post it. My head really hurts, sorry. Link to comment Share on other sites More sharing options...
dedoubt Posted November 6, 2011 Author Share Posted November 6, 2011 Thanks for the recommendation. I have a neti pot, and have used them successfully in the past, but when I have an active infection, it hurts too much to use (even with the right temp/salt level). I think I am better enough to be able to use it today without too much pain. It's one of those things, if I would just do it every day, my sinuses wouldn't get so bad. But those 3 or 4 minutes devoted to self care are tooooo much. I have so many dumb things to keep track of, taking care of myself always ends up being last. I hope your head feels better. My dad used to have a horse riding helmet that he took the padding out of, then glued in gel freezer packs. He kept it in the freezer, then wore it when his head was hurting. He said it helped a lot. He lives outside now, so doesn't have refrigeration... Link to comment Share on other sites More sharing options...
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