Lithium Carbonate and Feprazone: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Lithium Carbonate
Feprazone
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased lithium exposure and an increased risk of lithium toxicity
Interaction Deep Dive
NSAIDs may affect renal function and increase serum lithium concentrations. If concomitant use is necessary, reduce the initial lithium dosage and titrate slowly to clinical response. Monitor serum lithium levels frequently and observe for signs and symptoms of lithium toxicity1. The mean minimum lithium concentration increased by 15%, and the renal clearance decreased by approximately 20% 7.
Why it happens (mechanism)
Inhibition of renal prostaglandin synthesis; reduced renal lithium clearance
Literature reports
6 reports — tap to read
a) In a study conducted in healthy subjects, mean pre-dose lithium concentration and AUC were increased by 21% in subjects receiving lithium doses ranging from 804 to 1072 mg twice daily with meloxicam tablets 15 mg once per day every day as compared to subjects receiving lithium alone 2.
b) A 64-year-old woman with bipolar disorder who was maintained on lithium carbonate 300 mg 4 times daily (steady-state serum lithium level of 0.99 mEq/L) became lithium toxic following the concomitant administration of ibuprofen 400 mg 3 times daily. Upon transfer to a long-term facility, the patient had a serum lithium level of 0.33 mEq/L, and was switched to lithium citrate syrup 600 mg 2 times daily. No lithium level was measured after the medication change; however, the patient appeared to be responding favorably to therapy. Six weeks after the medication change, ibuprofen was initiated and within 24 hours the patient experienced nausea, anorexia, tremor, and hyperreflexia. The serum lithium reached a maximum of 2.84 mEq/L 3.
c) The influence of the NSAID diclofenac on lithium kinetics was studied in five normal women on a 150 mmol sodium diet. Diclofenac decreased lithium renal clearance by 23% and increased lithium plasma levels by 26%. Renal prostaglandin synthesis was suppressed by 53% of control values 4.
d) Five healthy males participated in a study to determine the effects of ketorolac on lithium serum and RBC levels. All subjects ingested lithium 900 mg daily on days 1 through 13, and ketorolac 10 mg 4 times daily on days 8 through 12. Each subject served as their own control. A 24% increase in the serum lithium AUC was seen on day 13 (concomitant lithium and ketorolac therapy) as compared to day 7 (lithium monotherapy). This AUC increase correlated to a 21% decrease in lithium clearance. The mean increase in RBC lithium AUC was 27% at day 13. In addition, the Cmax of serum lithium and lithium RBC increased by 29% and 37%, respectively, with concurrent ketorolac therapy. An increased incidence and severity of lithium adverse effects were also reported during coadministration with ketorolac 5.
e) Nine healthy male volunteers completed a prospective, crossover, 3-phase study examining the effects of over-the-counter doses of acetaminophen and naproxen sodium on plasma levels of lithium. All participants received lithium carbonate 300 mg every 12 hours for 7 days during phase 1. During phase 2, either naproxen sodium 220 mg every 8 hours or acetaminophen 650 mg every 6 hours was coadministered with lithium for 5 days. A 2-day washout period elapsed between phase 2 and 3. The final phase consisted of lithium being given with the alternate drug that was not received during phase 2 for 5 days. Mean plasma concentrations of lithium were 0.4 mEq/L during phase one, 0.41 mEq/L while receiving lithium and acetaminophen, and 0.43 mEq/L during lithium and naproxen therapy. All subjects had good renal function and subtherapeutic steady-state levels of lithium, so they were at minimal risk of lithium toxicity 6.
f) NSAIDs have produced elevations in plasma lithium levels and reductions in renal lithium clearance. The mean minimum lithium concentration increased by 15%, and the renal clearance decreased by approximately 20% 7.
Common questions
Can I take Lithium Carbonate and Feprazone together?
Increased lithium exposure and an increased risk of lithium toxicity Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lithium Carbonate and Feprazone interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Lithium Carbonate or Feprazone need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (7)
- Product Information: LITHOBID(R) oral extended release tablets, lithium carbonate oral extended release tablets. ANI Pharmaceuticals, Inc. (per FDA), Baudette, MN, 2016. DailyMed
- Product Information: SYMBRAVO(R) oral tablet, meloxicam rizatriptan oral tablet. Axsome Therapeutics Inc (per FDA), New York, NY, 2025. DailyMed
- Bailey CE, Stewart JT, & McElroy RA: Ibuprofen-induced lithium toxicity (letter). South Med J 1989; 82:1197. PubMed
- Reimann IW & Frolich JC: Effects of diclofenac on lithium kinetics. Clin Pharmacol Ther 1981; 30:348-352. DOI
- Cold JA, ZumBrunnen TL, Simpson MA, et al: Increased lithium serum and red blood cell concentrations during ketorolac coadministration. J Clin Psychopharmacol 1998; 18:33-37. PubMed
- Levin GM, Grum C, & Eisele G: Effect of over-the-counter dosages of naproxen sodium and acetaminophen on plasma lithium concentrations in normal volunteers, J Clin Psychopharmacol 1998; 18:237-240. DOI
- Product Information: COMBOGESIC(R) oral tablets, acetaminophen ibuprofen oral tablets. AFT Pharmaceuticals Inc (per FDA), Highland, MD, 2023. DailyMed
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