Lithium with Guarana 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
Alterations in serum lithium levels
Interaction Summary
The primary ingredient of guarana is caffeine. The caffeine content may increase lithium excretion. Dosage adjustments for lithium may need to be made if caffeine content is consistently maintained. Upon discontinuation of caffeine intake or if the patient elects to significantly decrease caffeine intake, the patient may experience lithium toxicity if the lithium dosage is not decreased accordingly.
Severity
Moderate
Onset
Delayed
Evidence
Theoretical
How To Manage Interaction
Patients should be advised of the caffeine content of guarana and treat it similarly to coffee in regards to their lithium therapy. Optimally, patients will avoid guarana use while taking lithium. If patients elect to use guarana and then discontinue therapy abruptly, they should be monitored for symptoms of lithium toxicity (e.g., nausea, diarrhea, muscular weakness, drowsiness, tremor).
Mechanism Of Interaction
Since approximately 95% of lithium is renally excreted and since caffeine increases urine formation, it appears that when caffeine consumption is discontinued, less lithium is excreted
Literature Reports
A) Abrupt discontinuation of caffeine intake resulted in a 24% increase in lithium blood levels in a study of 11 patients (10 patients with bipolar disorder; one patient with schizoaffective disorder). These patients (four men and seven women) whose mean age was 42.5 +/- 9.1 years (range: 33 to 65 years) consumed four to eight cups of coffee daily (5.3 +/- 0.7 cups daily) for at least 10 years and had been maintained on lithium (600 to 1200 mg daily) with no other psychotropic drugs. Patients were assessed at baseline (while on regular caffeine consumption), two weeks after a caffeine-free diet, and two weeks after resuming regular caffeine consumption (estimating a quantity of 70 mg to 120 mg caffeine per cup of coffee). Eight of the 11 (73%) patients experienced increases in lithium blood levels upon caffeine discontinuation. At baseline, lithium levels were 0.46 +/- 0.04 milliequivalents/liter (mEq/L) which increased to 0.57 +/- 0.03 mEq/L (p less than 0.05) upon caffeine withdrawal, representing a 24% increase. When caffeine was resumed, lithium levels decreased to 0.45 +/- 0.03 mEq/L (p less than 0.01) .
B) Increased lithium levels secondary to caffeine withdrawal has resulted in tremor. A 38-year-old woman had been maintained on lithium 1500 mg daily with serum lithium levels of 1.04, 1.1 and 0.99 millimoles/liter (mmol/L). Because of anxiety and a mild tremor, she agreed to eliminate caffeine from her diet so she abruptly discontinued drinking 17 cups of coffee daily. Within days her tremor was much worse and her lithium level had increased by approximately 50% to 1.52 mmol/L. With dosage reduction to 1200 mg daily, serum lithium level decreased to 1.0 mmol/L and the tremor markedly decreased in intensity .
C) A 63-year-old woman with bipolar affective disorder taking 450 mg of controlled-release lithium daily reported mild tremor. She discontinued her coffee intake of four cups to several pots daily. She experienced headache within one day that was gone by the next day, and an increase in tremor lasting for one month. Tremor resolved when the lithium dose was decreased . Serum lithium levels were not obtained but the symptoms suggest lithium toxicity occurred upon caffeine discontinuation .
D) Increased lithium urinary excretion was observed in subjects who ingested caffeine in a single dose, the same as occurred with a one gram dose of another methylxanthine, aminophylline . Six subjects who consumed caffeine 800 mg daily did not experience any significant changes in renal lithium clearance .
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.