Drugs and Conditions which Affect Serum Lithium Levels

Question

Which one of the following may affect blood levels of lithium?

A. NSAIDS

B. ACE inhibitors

C. Thiazide diuretics

D. Dehydration

Drugs Which Raise Serum Lithium

The following drugs increase lithium levels through a pharmacokinetic interaction:

DNA

DIURETICS, furosemide is the safest one.
NSAIDs, sulindac and aspirin are the safest ones.
ACEIs, ARBs, Antipsychotics.

Drugs Which Decrease Serum Lithium

The following drugs reduce lithium levels (also a pharmacokinetic interaction).

Sodium bicarbonate
Theophylline

The body reabsorbs lithium in competition with sodium from the kidney tubule. If the reabsorption of sodium increases, that of lithium decreases, and if the reabsorption of sodium decreases, that of lithium increases. Thiazide diuretics cause sodium diuresis, i.e.decreased reabsorption. In this way, thiazides lead to increase lithium levels. Lithium reabsorption also depends on water reabsorption. It moves in parallel with the water. If the reabsorption of water increases, lithium reabsorption also increases, and vice versa. With dehydration, the body reabsorbs water in larger quantities, which leads to increased lithium reabsorption and increased blood lithium.

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