Meta Information
ID:lithium
Name:
Schema Version:AIM-2.0
Interactions
Target id:
/class/thiazide-diuretics
Target name:
Thiazide Diuretics
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Thiazide diuretics increase sodium excretion, causing the kidneys to compensate by reabsorbing more sodium and lithium, which can lead to dangerously high lithium levels and toxicity.
Actionable advice:
Avoid using thiazide diuretics (e.g., hydrochlorothiazide) while taking lithium.
Target id:
/class/nsaids
Target name:
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
NSAIDs (e.g., ibuprofen, naproxen) can reduce blood flow to the kidneys and decrease lithium clearance by up to 40%, significantly increasing the risk of toxicity.
Actionable advice:
Avoid all NSAIDs while taking lithium; use alternatives like acetaminophen if necessary after consulting a physician.
Target id:
/class/ace-inhibitors
Target name:
ACE Inhibitors
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
ACE inhibitors (e.g., lisinopril) can impair the kidneys' ability to excrete lithium, leading to accumulation and a high risk of toxicity.
Actionable advice:
Avoid concurrent use of ACE inhibitors and lithium unless under strict medical supervision with frequent monitoring.
Target id:
/class/arbs
Target name:
Angiotensin II Receptor Blockers (ARBs)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
ARBs (e.g., losartan, telmisartan) reduce renal clearance of lithium, which can cause lithium levels to rise to toxic concentrations.
Actionable advice:
Avoid concurrent use of ARBs and lithium unless under strict medical supervision with frequent monitoring.
Target id:
/condition/renal-impairment
Target name:
Renal Impairment
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Since lithium is almost entirely cleared by the kidneys, any degree of renal impairment can dramatically decrease its excretion and lead to severe toxicity.
Actionable advice:
Avoid lithium if you have significant kidney disease; dose adjustments are critical even in mild impairment.
Target id:
/condition/dehydration
Target name:
Dehydration
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Dehydration triggers the body to conserve water and sodium, which also causes increased reabsorption of lithium in the kidneys, raising levels and risk of toxicity.
Actionable advice:
Maintain consistent, adequate hydration and avoid activities causing excessive fluid loss (e.g., saunas, intense exercise in heat).
Target id:
/dietary/water
Target name:
Adequate Hydration
Severity:
major
Interaction type:
requirement
Nature:
absolute
Description:
Sufficient fluid intake is essential for the kidneys to properly filter and excrete lithium, preventing its accumulation to toxic levels.
Actionable advice:
Ensure you drink plenty of fluids (typically 2-3 liters) consistently throughout the day.
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Lithium crosses the placenta and is associated with an increased risk of congenital malformations, particularly a heart defect known as Ebstein's anomaly.
Actionable advice:
Avoid lithium completely during pregnancy, especially in the first trimester.
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Lithium is excreted into breast milk and can reach significant concentrations, potentially causing toxicity in the nursing infant.
Actionable advice:
Avoid lithium while breastfeeding.
Target id:
/class/serotonergic-agents
Target name:
Serotonergic Medications (SSRIs, SNRIs, TCAs, Triptans)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
Combining lithium with other drugs that increase serotonin can raise the risk of serotonin syndrome, a potentially life-threatening condition.
Actionable advice:
Use extreme caution and monitor for symptoms like confusion, agitation, and tremor when combining with serotonergic drugs.
Target id:
/class/antipsychotics
Target name:
Antipsychotic Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
Concurrent use, especially with first-generation antipsychotics like haloperidol, may increase the risk of neurotoxicity and extrapyramidal side effects (movement disorders).
Actionable advice:
Monitor closely for neurological side effects if this combination is medically necessary.
Target id:
/class/calcium-channel-blockers
Target name:
Calcium Channel Blockers
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
Medications like verapamil and diltiazem can increase the risk of lithium-induced neurotoxicity, even when lithium blood levels are within the normal range.
Actionable advice:
Use this combination with caution and be vigilant for signs of neurotoxicity like confusion or ataxia.
Target id:
/intervention/caffeine
Target name:
Caffeine
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Description:
Caffeine acts as a diuretic and increases the renal excretion of lithium, which can lower its concentration and effectiveness. Abruptly stopping caffeine can cause lithium levels to rise.
Actionable advice:
Maintain a very consistent daily caffeine intake to ensure stable lithium levels.
Target id:
/dietary/low-sodium-diet
Target name:
Low Sodium Diet
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
A low-sodium diet signals the kidneys to conserve sodium, which also increases the reabsorption of lithium, raising the risk of toxicity.
Actionable advice:
Maintain a consistent and adequate daily sodium intake; avoid sudden dietary changes.
Target id:
/dietary/sodium-rich-foods
Target name:
High Sodium Diet
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Description:
A high-sodium diet signals the kidneys to excrete more sodium, which also increases the excretion of lithium, potentially reducing its effectiveness.
Actionable advice:
Maintain a consistent and adequate daily sodium intake; avoid large, sudden increases in salt consumption.
Target id:
/biomarker/thyroid-panel
Target name:
Thyroid Panel
Severity:
moderate
Interaction type:
requirement
Nature:
absolute
Description:
Lithium can interfere with the synthesis and release of thyroid hormones, commonly leading to hypothyroidism or goiter over time.
Actionable advice:
Obtain a baseline thyroid panel (TSH, Free T4) before starting and monitor every 6-12 months thereafter.
Target id:
/intervention/theophylline
Target name:
Theophylline
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Description:
Theophylline is a methylxanthine (similar to caffeine) that increases the renal clearance of lithium, thereby lowering its blood levels and efficacy.
Actionable advice:
Avoid concurrent use or monitor lithium levels closely if this combination is necessary.
Target id:
/class/carbonic-anhydrase-inhibitors
Target name:
Carbonic Anhydrase Inhibitors
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Description:
Drugs like acetazolamide can increase the excretion of lithium by the kidneys, potentially lowering its concentration and effectiveness.
Actionable advice:
Monitor for reduced lithium efficacy if taking these medications concurrently.
Target id:
/dietary/meal
Target name:
Any Caloric Meal
Severity:
minor
Interaction type:
synergistic
Nature:
temporal
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Taking lithium with food can slow its absorption and reduce the incidence of gastrointestinal side effects such as nausea, vomiting, or diarrhea.
Actionable advice:
Take your lithium dose with a meal or a snack to minimize stomach upset.
Target id:
/intervention/iodine
Target name:
Iodine
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Description:
Lithium can inhibit iodine uptake by the thyroid gland, which may increase the risk of developing hypothyroidism or goiter, especially if iodine intake is high.
Actionable advice:
Avoid high-dose iodine supplements unless directed by a physician.
Target id:
/biomarker/serum-calcium
Target name:
Serum Calcium
Severity:
minor
Interaction type:
requirement
Nature:
absolute
Description:
Long-term lithium use can affect the parathyroid glands, sometimes leading to elevated blood calcium levels (hypercalcemia).
Actionable advice:
Periodically monitor serum calcium and parathyroid hormone (PTH) levels during long-term use.
Target id:
/biomarker/egfr
Target name:
Estimated Glomerular Filtration Rate (eGFR)
Severity:
major
Interaction type:
requirement
Nature:
absolute
Description:
Monitoring eGFR is critical as it directly reflects the kidney's ability to clear lithium; a decline indicates an increased risk of toxicity.
Actionable advice:
Monitor kidney function (eGFR, Creatinine) at baseline and at least annually, or more frequently if there are risk factors.