MajorNon-steroidal anti-inflammatory drugs (NSAIDs)×Psycholeptics. Lithium
Updated · Methodology
Mechanism
Ibuprofen reduces lithium renal clearance by inhibiting prostaglandin synthesis in the proximal tubule. Lithium plasma concentration rises 25–60%, leading to intoxication. Lithium has a narrow therapeutic index (target 0.6–1.0 mmol/L, toxic above 1.5).
Symptoms
Within 5–10 days: nausea, vomiting, diarrhea, tremor, confusion, drowsiness. Severe toxicity: seizures, coma, renal injury, arrhythmia.
Management
In bipolar disorder, paracetamol is the first-line analgesic. If an NSAID is needed, use a short course (up to 5 days); check lithium level 4–7 days after NSAID start and 4–7 days after stop. Reduce lithium by 50% and titrate to level.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Lithium carbonate prescribing information (2022)– ; DailyMed setid b839ff4b-f62d-41ab-a823-550a756d58ec
- FDA: Lithium carbonate tablet (Glenmark Pharmaceuticals Inc., USA) – Prescribing Information (2016)– ; DailyMed setid 1b65d27e-5086-4a87-8387-c49f3d060978
- AEMPS: Ficha técnica: Ibuprofeno (nº registro 63597), sección 4.5 (2025)– AEMPS, CIMA, nº registro 63597, revisión 04/2025, sección 4.5
- AEMPS: Ficha técnica: Litio (nº registro 48932), sección 4.5 (2025)– AEMPS, CIMA, nº registro 48932, revisión 04/2025, sección 4.5