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Bipolar I for about 15 years.  On Lamictal for the last ten, currently at 400mg. 200/200

 

Bad mood swings the last six months (same old story as the rest of you).  Can only get in to see him every six months if I am lucky.

 

Bad insomnia.  Bad side effects from all the sleep med circus.  Mood-related.

 

So yesterday he says he wants to put me on Lithium.  I totally agreed it was a good move and don't know why it wasn't the FIRST thing we tried, instead of Depakote then Lamictal.

 

I get my labs drawn and the prescription wasn't ready yet so I started reading up, being a hypochondriac and all, and I find out there is a life-threatening interaction between Lithium and the diuretic (hctz) I take for blood pressure.

 

WTF.

 

I really/really/really wanted to give lithium a go.  

 

Anyone else on a diuretic?

 

Is it really that bad?  

 

If I watch my water intake and pay attention is this do-able?

Standard disclaimers... not a place for medical advice... call my doctor.. yada yada...  

 

I won't sue anyone, I promise!  Just looking for similar experiences.

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I am not a doctor, but to the best of my understanding, the interaction is that HCTZ makes it harder for your kidneys to flush out the lithium, leading to higher levels in your body.  Since lithium is dosed by blood level anyway, it is possible that your doctor simply intends to monitor your blood levels.  Since your dose of HCTZ is, I am assuming, constant, it may be possible to compensate (i.e. it might take another person 800 mg to get up to the correct blood level and it might only take you 600 mg - I am pulling those numbers completely out of the air).  What would be life threatening is - you are on lithium, some doctor does a dumb thing and starts you on HCTZ, your lithium level shoots up and you end up toxic.

 

If you are really worried, call your pdoc or call your pharmacist.  It's always possible that somebody goofed.  It's pharmacists' jobs to catch doctors' goofs and between the two of them, they should be able to not kill you ;)

Edited by tryp
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First a question: Does your doc know that you take HCTZ? It's not true that these two meds cannot ever be taken together. But caution must be exercised because any diuretic will cause an increase in serum lithium levels. As a consequence, your lithium dosage will be low compared to others your size and age. So your treatment with HCTZ is not necessarily a deal-breaker.

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Thank you so much for the replies!

 

My hctz is in combination with losartan (Hyzaar). 

 

I'm sure he is aware of the prescription because he goes through the list each appointment.  

 

The HCTZ part is very low - 12.5 mg a day.  It's really only there with the Losartan because I had recurring kidney stones on my previous ACE inhibitor.  I could ask my primary to switch to Losartan only.

 

The lithium dose is low (I think).  Starting at 600mg (ER) at night with instructions to check levels in 10 to 14 days depending on response.  If nothing is felt after a week I'm supposed to up to 900mg and then get blood drawn at 14 days instead of  10.

 

My wife is furious.  She has wanted me to change pdoc for months because the tx is not meeting HER expectations.  Case in point - she threatened divorce if I didn't stop taking Ambien because it made me "weird".  

 

Anyway she wanted to be at the appointment yesterday and I had planned for her to be there but got cold feet at the last minute.  She's never gone with me in the 13 or 14 years I've seen my pdoc.  

 

I also didn't want her to hear the "ideations" I started having when we did a trial of Trileptal a few months back.  Her behavior (meeting up with a mutual male friend while out of town and texting him 50 to 60 times a day to bitch about me) didn't help.  

 

We are doing individual counseling and couples counseling but anyway...............   not a therapy session here lol.

 

It's a fucking mess.  Thankfully the "ideations" (cough) were not serious and they've become less frequent.  I mean that they were at most passing ideas that became a preoccupation with Trileptal but now are rare.  No plans, nothing beyond a feeling of hopelessness that seems to have faded.

 

I have a call in to the doc's office.  They are notoriously slow and his nurse is out today but they promised a call back sometime.  

 

I suppose just like all the crazy meds we take, prudence and titration are in order.  

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I love Lithium.

I have taken Lithium with a mild diuretic with no problems.  No problems whatsoever.

 

But I was aware of the possible interaction.

 

Thus, I switched to a different type of blood pressure med - Lisinopril

There are a LOT of high blood pressure meds, dozens.

 

There is only one Lithium.  It is unique.

Just get your blood pressure med changed.  My amateur opinion.

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I took Lisinopril for years and it dropped my white blood cell count to dangerously low levels and resulted in several kidney stones.

 

Switching to Losartan fixed all that.  

 

But you are absolutely right - there are a LOT of blood pressure meds.  In fact it seems from my reading that a lot of people take a beta-blocker (lowers blood pressure) along with Lithium to deal with side effects.

 

It seems glaringly obvious to me, given my history and mood, that taking Lithium is the right thing to do.  I can't believe that it wasn't the FIRST thing to do.  

I've read so many glowing reviews from BP patients that I think this will be the answer I'm looking for.  

I appreciate all the feedback!

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When I was on Lithium I was also on HCTZ at the same time, as well as atenolol.  I switched to Maxide as a diuretic though because if didn't deplete my potassium as much.  I had no bad reactions.  I didn't even know of the interaction at the time.

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I didn't read any of the above comments.   Here is my experience.  I only had side effects when we were working with my dose and trying to find a therapeutic level.  Those side effects were cognitive impairment (word retrieval) excessive thirst - I couldn't get enough lemonade, and some diarrhea.  To back track, I was on lithium for exactly 3 weeks when I developed the mother migraine to end all migraines. I started puking and couldn't stop for hours. My body started shaking pretty bad and I was sweating bad. Call pdoc, she had me go to urgent care.  They pumped 3 bags of saline water into me and I was still dehydrated. It sucked.

 

But then it got better. Went back on them a few days later, dropped dose, no side effects. Have been happy ever since and that was a few years ago.  Don't worry about drinking too much or too little, my body lets me know when it is thirsty.

 

I also take a beta blocker - Propranolol. Not for tremors, but for migraines and anxiety.  Lithium has worked well.  We have had to augment it, but it is a good drug.

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Can only get in to see him every six months if I am lucky.

 

This is the part I have trouble with. Especially if he's still switching your meds...???

 

 

 

Yeah.. it seems like he's been switching my meds for 13 years!  

 

I'm going to give Lithium a go... three days in and I'm mildly dizzy and all my joints hurt but things seem to be a little quieter in my head.  (LOL!  People without a MI just don't get it...  )

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Not to be an alarmist, but get your blood work right now!

 

And if your doc won't check it again next week and then monthly for the first six months and every time you change or adjust your blood pressure med, don't take Lithium!!

 

From someone who went toxic due to blood pressure med - Lithium interaction and learned a lot over the two years I then spent seeing a kidney specialist...

 

Yes, you can take two meds that interact, but with Lithium, you have to be monitored closely. Diuretics are the worst to take with Lithium. Much better to switch blood pressure meds, but be careful there, too. Get your levels checked a lot when changing, like the first week and then a couple weeks later. You can go toxic on some bp meds that don't directly interact with Lithium. Lisinopril, for example, doesn't directly interact, but it does indirectly. I know because I was on Lithium, put on Lisinopril, went toxic with a level over 1.8. I was on daily blood draws for almost a month to see if my kidneys would recover. Because I was nearly manic, when the basic kidney test came back okay, I went back on Lithium with a different bp med and had blood draws weekly, then monthly. I had some other complications, but the end result was that my kidneys scores dropped. I have some kidney damage and can no longer take Lithium. It was a good med for me, too. So, I can't stress enough how important it is to A.) get checked now, in a couple weeks, and monthly for while, B.) switch to a bp med that works better with Li with frequent blood draws at first, and really, C.) don't even start Li until you have a doc who will do frequent level checks at start up, for the first six months and every time you change your bp med dosage or type.

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Not to be an alarmist, but get your blood work right now!

 

And if your doc won't check it again next week and then monthly for the first six months and every time you change or adjust your blood pressure med, don't take Lithium!!

 

From someone who went toxic due to blood pressure med - Lithium interaction and learned a lot over the two years I then spent seeing a kidney specialist...

 

Yes, you can take two meds that interact, but with Lithium, you have to be monitored closely. Diuretics are the worst to take with Lithium. Much better to switch blood pressure meds, but be careful there, too. Get your levels checked a lot when changing, like the first week and then a couple weeks later. You can go toxic on some bp meds that don't directly interact with Lithium. Lisinopril, for example, doesn't directly interact, but it does indirectly. I know because I was on Lithium, put on Lisinopril, went toxic with a level over 1.8. I was on daily blood draws for almost a month to see if my kidneys would recover. Because I was nearly manic, when the basic kidney test came back okay, I went back on Lithium with a different bp med and had blood draws weekly, then monthly. I had some other complications, but the end result was that my kidneys scores dropped. I have some kidney damage and can no longer take Lithium. It was a good med for me, too. So, I can't stress enough how important it is to A.) get checked now, in a couple weeks, and monthly for while, B.) switch to a bp med that works better with Li with frequent blood draws at first, and really, C.) don't even start Li until you have a doc who will do frequent level checks at start up, for the first six months and every time you change your bp med dosage or type.

 

OMG that sounds horrific!

 

 

 

 

I started Friday and I have a blood draw scheduled for this Friday.  The initial labs were CBC/CMP/Thyroid and they all came back "normal" (normal for me, i have low platelets, high white count, high bilirubin.. due to other issues).  Thyroid was normal also.

 

I am going to stay on top of him.  (that's what she said.. .hey o...)

 

I believe he will do frequent checks.  The nurse called me back (you know, since I called last week about being worried about dying) and she said they would watch it closely.  

 

Both the Losartan and HCTZ act at the kidneys, and I have a history of stones also, so I'll keep an eye on it.

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I didn't read any of the above comments.   Here is my experience.  I only had side effects when we were working with my dose and trying to find a therapeutic level.  Those side effects were cognitive impairment (word retrieval) excessive thirst - I couldn't get enough lemonade, and some diarrhea.  To back track, I was on lithium for exactly 3 weeks when I developed the mother migraine to end all migraines. I started puking and couldn't stop for hours. My body started shaking pretty bad and I was sweating bad. Call pdoc, she had me go to urgent care.  They pumped 3 bags of saline water into me and I was still dehydrated. It sucked.

 

But then it got better. Went back on them a few days later, dropped dose, no side effects. Have been happy ever since and that was a few years ago.  Don't worry about drinking too much or too little, my body lets me know when it is thirsty.

 

I also take a beta blocker - Propranolol. Not for tremors, but for migraines and anxiety.  Lithium has worked well.  We have had to augment it, but it is a good drug.

 

 

The only things I've noticed so far are more thirsty than normal, a little dizzy and f-ing pain all over like the flu.  I'm hoping those go away as we get stabilized.

 

My insomnia came back with a vengeance... fell asleep 330am to 530am friday night (sat morning) and then Saturday night didn't fall asleep until 730am on Sunday.

 

It would not be a problem if I was a college student, but as a 41 (42 in three weeks) year old father of two and husband of a wife who is essentially fed up to the point that we have been in counseling for 8 months....  well it sucks donkey balls.

 

I've never gone off meds since BP dx (except for stopping celexa cold when I got serotonin syndrome) but I absolutely understand why people get fed up with the BS and want to start over.

 

Don't ever do that btw.  Just sayin' I understand.

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