Lithium with Phenelzine Interaction Details
Brand Names Associated with Lithium
- Eskalith®
- Eskalith® CR
- Lithium
- Lithobid®
Brand Names Associated with Phenelzine
- Nardil®
- Phenelzine
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 21, 2023
Interaction Effect
An increased risk of malignant hyperpyrexia
Interaction Summary
Two patients experienced a fatal malignant hyperpyrexia syndrome following concomitant therapy with lithium and phenelzine. Although a direct causal relationship has not been established, it is advisable to avoid this combination if possible.
Severity
Major
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Avoid the concomitant administration of lithium and non-selective monoamine oxidase inhibitors (MAOI). Allow two weeks to elapse between the discontinuation of the MAOI and the initiation of lithium therapy.
Mechanism Of Interaction
Increased 5-hydroxytryptamine in the brain
Literature Reports
A) A 42-year-old woman experienced a sudden onset of restlessness, sweating, and confusion. Medication therapy included lithium 800 mg daily, L-tryptophan 1 g daily, diazepam 6 mg daily, and triazolam 0.25 mg daily. Six weeks prior to the onset of symptoms, phenelzine 15 mg three times daily had been started. On admission, her lithium level was 0.38 mmol/L (therapeutic range 0.5 to 1.0 mmol/L). Within three hours of the onset of symptoms, the woman was comatose and a diagnosis of neuroleptic malignant syndrome was made. She was treated with intravenous dantrolene 60 mg three times daily with no success. Acute renal failure and severe disseminated intravascular coagulation followed, and the patient died on the sixth day of hospitalization .
B) A fatal malignant hyperpyrexia syndrome occurred in a 48-year-old female being treated with chlorpromazine 600 mg daily, lithium 800 mg daily, L-tryptophan 6 g daily, and phenelzine 45 mg daily. Symptoms of incoherent speech, reduced consciousness, muscular rigidity, nystagmus, and hyperreflexia occurred within a few weeks of the initiation of phenelzine therapy. She was diagnosed with neuroleptic malignant syndrome and treated with procyclidine. Respiratory and cardiac arrest soon followed, and the patient died. The timing of her death points to the effect of combined phenelzine, lithium, and L-tryptophan, since lithium and L-tryptophan had been coadministered for the previous four months before phenelzine was started .
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.
Phenelzine Overview
-
Phenelzine is used to treat depression in people who have not been helped by other medications. Phenelzine is in a class of medications called monoamine oxidase inhibitors (MAOIs). It works by increasing the amounts of certain natural substances that are needed to maintain mental balance.
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.