What common medications when used in combination with lithium increase lithium levels (and the possibility of toxicity) or cause idiosyncratic neurotoxicity?
Medications that increase lithium levels include
- nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen and ibuprofen (aspirin has no effect on lithium levels),
- thiazide diuretics,
- angiotensin II receptor antagonists,
- angiotensin-converting enzyme inhibitors
- some antibiotics (tetracycline, spectinomycin, and metronidazole)
Calcium channel blockers and antipsychotics with lithium can cause idiosyncratic neurotoxicity, and the latter combination can increase the risk for NMS.
