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Not very interesting question about Lithium and Nsaids


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This may be a very short thread, but this is the forum for lithium.

 

When I started lithium, my pdoc said I could take nsaids once or twice a month. I probably didn't even take nsaids for the first year I was on it. But the headaches have been so awful, and every once in a while, I can stop them before they get started with an early dose of Excedrin. I also have taken Ibuprofen. I never do it more than two times a month (I even mark my calendar when I take them), even though my pdoc eventually said I could use them a bit more.

 

I've noticed on CBs that when some people on lithium take nsaids (with Dr's permission) that they skip the dose closest to ingestion. My pdoc never told me to do that. Is that a common practice?

 

I am wondering, because I just took some Excedrin, and I haven't taken my first daily dose. I do noon and midnight, because realistically, I will always be awake during those times, and my being awake at any other time is suspect.

 

I guess it is also relevant that I split my dose, because my pdoc believed it would be easier on my kidneys (I know there are other opinions about that).

 

Anyway, do you skip a dose when you use nsaids? Did your pdoc tell you to do this, or is it just something that is considered common sense? I understand it spikes your levels, but I was under the impression that was short-lived, less than a day.

 

Also, I am pretty sure the answer to this is no, but could I use my two doses per month on the same day?

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I never skipped a dose when I took NSAIDs. 

 

As far as I know, the main risk for lithium and NSAIDs is having the NSAID build up in your system and preventing your kidneys from excreting the lithium. Two doses on the same day may very well be fine, but you shouldn't take NSAIDs for more than two consecutive days.

 

YMMV in terms of toxicity after one or two days of NSAID use, but if you don't experience increased side effects (like a tremor), do what you need to do to stay pain-free.

 

Also, Excedrin should be totally safe to take--it has some caffeine, which isn't great, but the other ingredients are acetaminophen (Tylenol) and aspirin, both of which are safe to use on lithium. Aspirin does not cause the same interaction as other NSAIDs do in the kidneys.

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I've never skipped a dose of Li when I've needed ibuprofen. I used to take 800mg of ibuprofen several times a day. It never seemed to make a difference. My opinion is that Li levels can be increased, not will be increased. Like everything else, it depends on how your body reacts.

What does your level typically run? If it's on the low side I'd be tempted to go ahead and try it. Then again, when I'd feel a migraine coming on, I'd do everything I could think of to head it off. If your level is on the high side or if you're uncertain about it then go ahead and skip a dose if it'll make you less afraid of your level going too high. One missed Li shouldn't make a huge difference wrt mood.

Has your Li level ever gotten too high? If so you should be able to recognize the symptoms and adjust as needed.

This is all based on my experience.

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My blood level is actually .6, I respond to it though. I am on 600mg, but right after I was diagnosed, my then psychiatrist put me on 900mg. Which I know is often a starting dose, but it made me toxic. Oh, plus she didn't tell me to get blood tests. To be honest I can't remember a lot of that time period. Aside from the lithium, my life was just not going well. But I do remember weeping and weeping, which I only do if I am sick.

 

This time, I also have DH around to notice if anything is off.

 

Really? Excedrin is safe? I learned my lesson about abusing nsaids, finally, so I really didn't take them that much even before the lithium. But it would be nice to have Excedrin available.

 

I seem to have run off this headache, which is awesome, because I just spent 4 days moaning and groaning, and fortunately my friend took DH to the grocery store. I also have some migranal as backup, which works brilliantly, when it works.

 

We couldn't go out on our wedding anniversary, so if I make it through the day (how sad is that), we are going out.

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Excedrin is safe. I am one of the ones that lowers my Li if I take ibuprofen - I don't skip, just lower. But I have a history of easily flipping into toxicity. I really try not to do that but sometimes desperation kicks in. I also have a prescription for Sulindac, the one NSAID that's thought to be a-okay with lithium. It tends to make me queasy so I don't take it often but when the pain in my hand from my trigger thumb flares up it is great.

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Excedrin is safe. I am one of the ones that lowers my Li if I take ibuprofen - I don't skip, just lower. But I have a history of easily flipping into toxicity. I really try not to do that but sometimes desperation kicks in. I also have a prescription for Sulindac, the one NSAID that's thought to be a-okay with lithium. It tends to make me queasy so I don't take it often but when the pain in my hand from my trigger thumb flares up it is great.

I also had a prescription for Sulindac when I was on Li. It's hell on your stomach, but it works.

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could you ask your doctor about taking Sulindac?  it's a very very old anti-inflammatory that is safe with Lithium.  i don't get migraines, but i have osteoarthritis in my neck which causes a lot of pain in my neck/shoulders sometimes.  i don't need to take it every day, but when i do it works pretty well.  you only take it once a day, and plan to be kinda sedated (maybe that's just me, but i have to have a nap after i take it).  don't be surprised if your doctor has never heard of it, my pdoc is the only one who hasn't said "wtf is that?", my GP and backup pdoc and even my pharmacist had never seen it before.

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I'm looking for a new pdoc (after the move), and have been bad at following through (which I always am). I'll ask about it. I really could have used something on Monday, and there was nothing that would touch it.

 

I'm glad I asked this question, a lot of good information!

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could you ask your doctor about taking Sulindac? it's a very very old anti-inflammatory that is safe with Lithium. i don't get migraines, but i have osteoarthritis in my neck which causes a lot of pain in my neck/shoulders sometimes. i don't need to take it every day, but when i do it works pretty well. you only take it once a day, and plan to be kinda sedated (maybe that's just me, but i have to have a nap after i take it). don't be surprised if your doctor has never heard of it, my pdoc is the only one who hasn't said "wtf is that?", my GP and backup pdoc and even my pharmacist had never seen it before.

I pretty much have to nap with it too. I have severe chronic migraine but the sulindac really does zip for them for me - it's been a lifesaver with my trigger thumb and ear infection problems though.

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I never skip a dose when I take NSAIDS.  In fact, I took 2 Aleve today. I had a massive headache behind my left eye today.  My Dr. doesn't seem concerned unless it is something that I am doing/taking every day or every other day. 

 

It is so hard to figure what is ok to take when you are in pain and you have a pile of meds you are taking anyway.  I usually just stick to Naproxen or I tough it out.... depends.

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