Lithium with Dehydroepiandrosterone 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 effectiveness of lithium
Interaction Summary
Dehydroepiandrosterone (DHEA) in a single case report was noted to cause mania in a patient with no previous personal or family history of bipolar disorder. Elevated DHEA levels have been found in patients with mental disorders; DHEA suppression has lead to improvement in psychotic symptoms . Patients taking medication for bipolar disorder or patients with a personal and/or family history of bipolar disorder should not take DHEA until further data is available to characterize this drug-herb interaction.
Severity
Moderate
Onset
Delayed
Evidence
Theoretical
How To Manage Interaction
Concomitant use of dehydroepiandrosterone (DHEA) with lithium may cause a return of manic symptoms. Patients with a personal or family history of bipolar disorder should be advised to avoid DHEA use.
Mechanism Of Interaction
Proserotonergic activity of dehydroepiandrosterone may predispose patients to manic episodes; dehydroepiandrosterone is a precursor to androgenic steroids, which in high doses may precipitate mania
Literature Reports
A) A 68 year-old male with no documented psychiatric history initiated dehydroepiandrosterone (DHEA) 100 milligrams (mg) daily and increased the dose to 200 to 300 mg daily for 6 months. Within 3 months, family members noted the onset of odd behavior with prominent symptoms of agitation, delusional thinking, decreased sleep and appetite, and spending sprees. The patient was not taking any prescribed medication but did ingest alcohol in amounts up to 1 case of beer daily. Another 3 months elapsed, leading to involuntary inpatient admission secondary to rapid, loud, pressured speech with grandiose thoughts. At admission, the patient reported that he had decreased alcohol intake to 2 beers daily due to family concerns about his behavior changes. There was no family history of bipolar disorder. Urinary drug screen was negative. Over the seven-day hospital stay, with the institution of valproic acid 500 mg twice daily, the patient's behavior and sleep patterns improved, and the patient believed DHEA led to his symptoms. There were no ethanol withdrawal symptoms. The patient was discharged with follow-up care from his primary care physician with a diagnosis of substance-induced mood disorder .
B) A 24-year-old female diagnosed with schizophrenia was resistant to daily doses of haloperidol 20 milligrams (mg), fluphenazine 40 mg, lithium carbonate 1200 mg, and lithium carbonate 900 mg plus thioridazine 300 mg. The patient appeared Cushinoid with moon face, acne, facial hair, abdominal hair, and a 40 pound weight gain in the previous 8 months. Dehydroepiandrosterone (DHEA) measured as part of an endocrine panel was 725 micrograms/deciliter (mcg/dL) (normal: 100 to 400 mcg/dL). Dexamethasone 1 mg orally at bedtime resulted in substantial improvement within one week. The patient appeared calmer, more alert with improved psychotic symptoms and ability to concentrate. At two weeks, a repeated DHEA level was within normal range (328 mcg/dL). The author concluded that elevated DHEA levels were associated with severe psychosis resistant to conventional antipsychotic therapy .
C) A 13-year-old male decompensated with a subsequent two-year period of emotional problems accompanied by heavy use of LSD, hashish, barbiturates, and alcohol. His mental status included bizarre, disorganized, delusional thinking, auditory and visual hallucinations, paranoia, lack of attention to personal hygiene, agitation, and combativeness. He was diagnosed with chronic paranoid schizophrenia; schizophrenia, chronic undifferentiated type, and schizoaffective disorder, excited type. He was resistant to daily doses of trifluoperazine 40 mg, chlorpromazine 400 mg, and imipramine 100 mg. He was also resistant to combination therapy with chlorpromazine 400 mg with thiothixene 80 mg, thioridazine 1000 mg, perphenazine 48 mg with lithium carbonate 1200 mg, clonazepam 4 mg, and carbamazepine 1200 mg daily. Baseline DHEA level exceeded 900 mcg/dL. A seven-day suppression test with dexamethasone 1 mg orally at bedtime resulted in a normal DHEA level of 200 mcg/dL. By day 5, psychosis improved and the patient was well-oriented, conversational, and was making good eye contact. Once dexamethasone was discontinued, rapid decompensation and florid psychosis ensued despite "substantial amounts of psychotropic medications." DHEA increased to 536 mcg/dL. The author concluded that elevated DHEA levels were associated with florid psychosis resistant to conventional antipsychotic therapy .
Lithium Overview
-
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.
Return To Our Drug Interaction Homepage
Feedback, Question Or Comment About This Information?
Ask Dr. Brian Staiger, PharmD, our medical editor, directly! He's always more than happy to assist.
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.
Where Does Our Information Come From?
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.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.