Drug & supplement interaction

Lithium + Aspirin, Chlorpheniramine, Phenylpropanolamine

Aspirin, Chlorpheniramine, Phenylpropanolamine brand name: Alka-Seltzer Plus Cold.

Major Interaction
Medically reviewed by · Updated September 2026
The bottom line Major

Aspirin, Chlorpheniramine, Phenylpropanolamine falls into 2 drug categories that Lithium can interact with; the most serious is rated major. Theoretically, taking lithium supplements with serotonergic drugs might both mask and increase the risk of serotonin syndrome.

Read the full interaction report
SeverityMajor
LikelihoodProbable
Interactions2
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Lithium and Aspirin, Chlorpheniramine, Phenylpropanolamine

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

Lithium interacts with whole categories of medication. Aspirin, Chlorpheniramine, Phenylpropanolamine falls into 2 of those categories, so it can interact with Lithium in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Major).

Major

SEROTONERGIC DRUGS

1 of 2

Why this applies to Aspirin, Chlorpheniramine, Phenylpropanolamine

Aspirin, Chlorpheniramine, Phenylpropanolamine falls under SEROTONERGIC DRUGS — the group Lithium interacts with.

Theoretically, taking lithium supplements with serotonergic drugs might both mask and increase the risk of serotonin syndrome.
In a case report, a 67-year-old female with depression and bipolar disorder using lithium in combination with selective serotonin reuptake inhibitors (SSRIs) and other medications developed serotonin syndrome with symptoms of deep tendon hyperreflexia, muscle rigidity, tremor, and hyperthermia. However, agitation, one classical symptom of serotonin syndrome, was lacking. This was thought to be due to masking by lithium toxicity. Lithium can increase serotonin levels, thus, combining serotonergic drugs with lithium might increase the risk of serotonergic side effects including serotonin syndrome and cerebral vasoconstrictive disorders. It is unclear if this interaction would occur with the smaller doses found in lithium supplements.
Severity Major Likelihood Probable Evidence D

Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

This combo cold product mixes aspirin (a pain reliever), chlorpheniramine (an antihistamine), and phenylpropanolamine (a decongestant). Of those three, chlorpheniramine has mild serotonin-related activity, and lithium can nudge serotonin levels up too. In theory, stacking them could add to your serotonin load and, very rarely, raise the risk of serotonin syndrome (think shakiness, muscle stiffness, sweating, fast heartbeat, or feeling overheated).

Honestly, this concern is based on pharmacology and a single case report involving prescription-strength lithium plus stronger serotonin drugs, not this exact mix. With the tiny amounts in lithium supplements, a real problem is unlikely. Still, it's worth a quick chat with your pharmacist before pairing them, especially if you take other mood medications.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Martindale W. Martindale the Extra Pharmacopoeia. Pharmaceutical Press, 1999.
  2. McEvoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.
  3. Landa E, Wagner S, Makkar A, Liu A, Jung D. An atypical presentation of serotonin syndrome. Cureus. 2021;13(2):e13377. PubMed
Moderate

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs)

2 of 2

Aspirin, Chlorpheniramine, Phenylpropanolamine also falls under NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs).

Theoretically, taking lithium supplements with NSAIDs might increase lithium levels and adverse effects.
NSAIDs can decrease the renal clearance of lithium and increase lithium levels. It is unclear if this interaction would be clinically significant with the smaller doses found in lithium supplements.
Severity Moderate Likelihood Probable Evidence D

Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

The cold combo you're asking about (Alka-Seltzer Plus Cold) contains aspirin, which acts as an NSAID. Here's the concern: NSAIDs like aspirin can make your kidneys hold onto lithium instead of clearing it out. That means lithium can slowly build up in your body. Since lithium has a narrow safety window, even a modest rise can tip you into trouble, with signs like nausea, hand tremor, unusual drowsiness, confusion, or slurred speech.

The good news is this concern is mostly theoretical and based on how these drugs behave, not strong clinical proof, and the low amounts in lithium supplements may not matter much. Still, aspirin isn't a prodrug here, so the direction holds: more lithium, not less. Please check with your pharmacist before combining them.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Martindale W. Martindale the Extra Pharmacopoeia. Pharmaceutical Press, 1999.
  2. McEvoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Lithium Also Interacts With Other Medications

Lithium has 258 major, 256 moderate known drug interactions in our database — the Aspirin, Chlorpheniramine, Phenylpropanolamine one above is among them. If you take anything else, check it against the full list below.

Major 258 Moderate 256 No known interaction 2,316 (incl. Aspirin, Chlorpheniramine, Phenylpropanolamine)
Taking anything else?

Check Another of Your Medications Against Lithium

Covers the 2,830 medications we’ve checked against Lithium. Pick one to open its full report.

From our Q&A

Questions About Lithium or Aspirin, Chlorpheniramine, Phenylpropanolamine

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Lithium or Aspirin, Chlorpheniramine, Phenylpropanolamine, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Aspirin, Chlorpheniramine, Phenylpropanolamine

This page covers Lithium only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Aspirin, Chlorpheniramine, Phenylpropanolamine page lists 372 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Asarabacca (major), Beer (major), Danshen (major) and Ephedra (major).

By severity: 16 major · 308 moderate · 48 minor.

Open the Aspirin, Chlorpheniramine, Phenylpropanolamine interaction page

One more smart check

Taking Lithium as Part of a Dietary Supplement Product? Check It for Interactions

We hold 330 real supplement products containing Lithium, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Lithium. Your product may carry other ingredients that interact with Aspirin, Chlorpheniramine, Phenylpropanolamine too, on top of Lithium — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Lithium and Aspirin, Chlorpheniramine, Phenylpropanolamine Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Lithium
Top 25%

#310 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Aspirin, Chlorpheniramine, Phenylpropanolamine
Top half

#1,102 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Lithium

What is Lithium?

Lithium
  • Mood support
  • Bipolar disorder (prescription)
  • Healthy mental function
  • Irritability or stress
  • Sleep support

Lithium is a naturally occurring metal that, in prescription form (lithium carbonate or citrate), is an FDA-approved, well-proven treatment for bipolar disorder. Low-dose supplement forms like lithium orotate are sold for mood support, but there is very little reliable evidence that they work, and even small amounts of lithium can be risky for some people. Always talk to a pharmacist or doctor before taking any lithium product.

Read the full Lithium monograph & all interactions
Keep checking

Other Drugs & Lithium

Browse every other medication we’ve checked against Lithium — both the ones with a known interaction and the ones without. Select any drug for the full detail.

258Major
256Moderate
0Minor
2,315No known interaction
258 Major 256 Moderate 2,315 No interaction
Major

258 interactions

Showing 60 of 258 major interactions — see all 258 on the Lithium page.

Moderate

256 interactions

Showing 60 of 256 moderate interactions — see all 256 on the Lithium page.

No interaction 2,315 drugs checked — show the list

We also checked Lithium against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,315 medications checked with no known interaction — see the full Lithium list.

See the full Lithium interactions page
See every supplement checked against Aspirin, Chlorpheniramine, Phenylpropanolamine, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Lithium monograph › Uses, safety, and every drug interaction in one place Aspirin, Chlorpheniramine, Phenylpropanolamine supplement interactions › Every supplement checked against Aspirin, Chlorpheniramine, Phenylpropanolamine, ranked by severity Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Lithium and Aspirin, Chlorpheniramine, Phenylpropanolamine Together: Common Questions

Can you take Lithium with Aspirin, Chlorpheniramine, Phenylpropanolamine?
This is rated a major interaction, so the combination is best avoided unless your doctor or pharmacist has specifically told you otherwise. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 2 interactions listed for Lithium and Aspirin, Chlorpheniramine, Phenylpropanolamine?
Aspirin, Chlorpheniramine, Phenylpropanolamine belongs to more than one drug category, and Lithium interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Lithium and Aspirin, Chlorpheniramine, Phenylpropanolamine interaction?
We rate it Major. This is a clinically significant combination that is generally best avoided, or used only under the direct supervision of your physician or pharmacist.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Aspirin, Chlorpheniramine, Phenylpropanolamine and Lithium?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.