Lithium with Cisplatin Interaction Details
Brand Names Associated with Lithium
- Eskalith®
- Eskalith® CR
- Lithium
- Lithobid®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 21, 2023
Interaction Effect
Reduced lithium plasma concentrations
Interaction Summary
In 2 case reports, concomitant use of CISplatin together with lithium resulted in a rapid decrease of serum lithium concentration with transient return to pretreatment levels after completion of chemotherapy. When concurrent use of CISplatin and lithium is warranted, monitor lithium levels and patient for signs of decreased lithium efficacy including mood lability and changes in sleep.
Severity
Moderate
Onset
Rapid
Evidence
Probable
How To Manage Interaction
Concurrent use of CISplatin and lithium may result in rapid reduction of serum lithium levels. Monitor lithium levels and patient for signs of decreased lithium efficacy including mood lability and changes in sleep during concurrent use of CISplatin and lithium.
Mechanism Of Interaction
Unknown
Literature Reports
A) Decreased serum lithium concentrations without psychiatric decompensation were reported within 24 hours of initiation of bleomycin, etoposide, and CISplatin (BEP) chemotherapy in a 33-year-old man with metastatic testicular cancer and bipolar affective disorder. The patient, who was institutionalized, had chronically been taking lithium carbonate 400 mg in the morning and 600 mg in the evening, with serum lithium levels of 0.6 to 0.9 mmol/L (therapeutic range, 0.3 to 1.3 mmol/L). Concomitant medications included biperidene 2 mg/day, promethazine 50 mg/day, carbamazepine 400 mg/day, temazepam 20 mg/day, haloperidol 10 mg/day, and disulfiram 500 mg/day when the chemotherapy regimen of etoposide 120 mg/m(2) on days 1 through 3, bleomycin 30 mg on day 2, and CISplatin 20 mg/m(2) on days 1 through 5 and the supportive agents ondansetron 8 mg IV three times daily on days 1 through 5 and hydration with normal saline 4.5 L/day that included calcium, magnesium, and potassium on days 1 through 5 began. On day 2 of BEP, lithium levels decreased from 0.61 mmol/L to 0.22 mmol/L and transiently increased back to baseline by day 8 without any change of lithium dosage. A similar, although less pronounced, pattern of decrease of lithium levels and transient increase back to near baseline by day 8 occurred during 3 subsequent courses of BEP .
B) Decreased serum lithium concentrations without psychiatric decompensation were reported within 24 hours of initiation of CISplatin in a 36-year-old woman with metastatic tongue cancer and bipolar affective disorder. The patient had chronically been taking lithium carbonate 300 mg four times daily, which maintained serum lithium levels at 1 mEq/L. No other medications were reported when one dose of CISplatin 100 mg/m(2) was given along with 24 hours of fluid hydration that included normal saline 1 L, mannitol 25 g bolus, mannitol 20% 1 L infusion, and D5NS 1 L with calcium, magnesium, and potassium supplementation. Lithium levels decreased from 1 mEq/L to 0.3mEq/L after administration of CISplatin and fluid load; no change of lithium dosage occurred and levels recovered to near baseline within 48 hours of chemotherapy. A similar decrease of lithium levels, although less pronounced (from 0.8 to 0.5 mEq/L), occurred during a second course of CISplatin therapy .
Lithium Overview
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Lithium is used to treat and prevent episodes of mania (frenzied, abnormally excited mood) in people with bipolar disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Lithium is in a class of medications called antimanic agents. It works by decreasing abnormal activity in the brain.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
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Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
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The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.