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Indomethacin but not Aspirin Increases Plasma Lithium Ion Levels

Indomethacin but not Aspirin Increases Plasma Lithium Ion Levels Abstract • The pharmacokinetic drug interactions between lithium sulfate and the nonsteroidal anti-inflammatory drugs (NSAIDs) indomethacin and aspirin were studied in ten normal female volunteers restricted to 150-mEq/day of sodium. Indomethacin decreased renal lithium ion elimination by 23% and caused a 40% increase in steady state plasma lithium ion levels. In contrast, aspirin had no effect on plasma lithium ion levels and increased renal lithium ion elimination by only 6%. Renal prostaglandin E2 excretion was suppressed by 50% to 60% of control levels by indomethacin and by 65% to 70% by aspirin. A clinically important drug interaction with the risk of lithium intoxication can occur between lithium salts and indomethacin. However, aspirin did not affect steady state plasma levels of lithium ion and thus may be preferable for antirheumatic treatment of patients undergoing long-term therapy with lithium salts. Frequent monitoring of plasma lithium ion levels is absolutely necessary in patients receiving both lithium salts and NSAIDs. References 1. Thomsen K: Renal handling of lithium at non-toxic serum lithium levels: A review . Dan Med Bull 1978;25:106-115. 2. Corcoran AC, Taylor RD, Page JH: Lithium poisoning from the use of salt substitutes . JAMA 1949;139:685-688.Crossref 3. Tonks CM: Lithium-intoxication induced by dieting and saunas . Br Med J 1977;2:1396-1397.Crossref 4. Hansen HE, Amdisen A: Lithium intoxication: Report of 23 cases and review of 100 cases from the literature . Q J Med (New Series) 1978;47:123-144. 5. Lehmann K, Merten K: Die Elimination von Lithium in Abhängigkeit vom Lebensalter bei Gesunden und Niereninsuffizienten . Int J Clin Pharmacol 1974;10:292-298. 6. Hurtig H, Dyson W: Lithium toxicity enhanced by diuretics . N Engl J Med 1974;290:748-749. 7. Mac Fie AC: Lithium poisoning precipitated by diuretics . Br Med J 1975;1:1516. 8. Steele TH, Manuel MA, Newton M, et al: Renal lithium reabsorption in man: Physiologic and pharmacologic determinants . Am J Med Sci 1975; 269:349-363.Crossref 9. Ascione FJ: Evaluating drug interactions: Lithium with diuretics . Drug Ther 1977, pp 126-127. 10. Himmelhoch JM, Poust RJ, Mallinger AG, et al: Adjustment of lithium dose during lithium-chlorothiazide therapy . Clin Pharmacol Ther 1977;22:225-227. 11. König P, Küfferle B, Lenz G: Ein Fall von Lithiumintoxikation bei therapeutischen Lithiumdosen infolge zusätzlicher Gabe eines Diuretikums . Wien Klin Wochenschr 1978;90:380-382. 12. Jefferson JW, Kalin NH: Serum lithium levels and long-term diuretic use . JAMA 1979;241:1134-1136.Crossref 13. Jefferson JW: Diuretics are dangerous with lithium . Br Med J 1980;281:1217.Crossref 14. Singer J: Lithium and the kidney . Kidney Int 1981;19:374-387.Crossref 15. Donker AJM, Arisz L, Brentjens JRH, et al: The effect of indomethacin on kidney function and plasma renin activity in man . Nephron 1976; 17:288-296.Crossref 16. Frölich JC, Hollifield JW, Dormois JC, et al: Suppression of plasma renin activity by indomethacin in man . Circ Res 1976;39:447-452.Crossref 17. Stokes JB, Kokko JP: Inhibition of sodium transport by prostaglandin E2 across the isolated perfused rabbit collecting tubule . J Clin Invest 1977;59:1099-1104.Crossref 18. Roman RJ, Kauker ML: Renal effect of prostaglandin synthetase inhibition in rats: Micropuncture studies . Am J Physiol 1978;235:F111-F118. 19. Brater DC: Effect of indomethacin on salt and water homeostasis . Clin Pharmacol Ther 1979;25:322-330. 20. Kokko JP: The effect of prostaglandins on renal epithelial electrolyte transport . Kidney Int 1981;19:791-796.Crossref 21. Stokes JB: Effect of prostaglandin E2 on chloride transport across the rabbit thick ascending limb of Henle: Selective inhibition of the medullary portion . J Clin Invest 1979;64:495-502.Crossref 22. Higashihara E, Stokes JB, Kokko JP, et al: Cortical and papillary micropuncture examination of chloride transport in segments of the rat kidney during inhibition of prostaglandin production: A possible role for prostaglandins in the chloruresis of acute volume expansion . J Clin Invest 1979;64:1277-1287.Crossref 23. Tannenbaum J, Splawinski JA, Oates JA, et al: Enhanced renal prostaglandin production in the dog: I. Effects on renal function . Circ Res 1975;36:197-203.Crossref 24. Frölich JC, Leftwich R, Ragheb M, et al: Indomethacin increases plasma lithium . Br Med J 1979;1:1115-1116.Crossref 25. Ragheb M, Ban TA, Buchanan D, et al: Interaction of indomethacin and ibuprofen with lithium in manic patients under a steady-state lithium level . J Clin Psychiatry 1980;41:397-398. 26. Frölich JC, Wilson TW, Sweetman BJ, et al: Urinary prostaglandins: Identification and origin . J Clin Invest 1975;55:763-770.Crossref 27. Green K, Hamberg M, Samuelsson B, et al: Measurement of prostaglandins, thromboxanes, prostacyclin and their metabolites by gas liquid chromatography-mass spectrometry , in Frölich JC (ed): Methods in Prostaglandin Research . New York, Raven Press, 1978, pp 39-94. 28. Tucker SM, Boyd PJR, Thompson AE, et al: Automated assay of N-acetyl-β-glucosaminidase in normal and pathological human urine . Clin Chim Acta 1975;62:333-339.Crossref 29. Wellwood JM, Ellis BG, Price RG, et al: Urinary N-acetyl-β-Dglucosaminidase activities in patients with renal disease . Br Med J 1975; 3:408-411.Crossref 30. Dieppe PA, Doyle DV, Burry HC: Renal damage during treatment with antirheumatic drugs . Br Med J 1978;2:664.Crossref 31. Scherberich JE, Falkenberg FW, Mondorf AW, et al: Biochemical and immunological studies on isolated brush border membranes of human kidney cortex and their membrane surface proteins . Clin Chim Acta 1974;55:179-197.Crossref 32. Mondorf AW, Breier J, Hendus J, et al: Effect of aminoglycosides on proximal tubular menbranes of the human kidney . Eur J Clin Pharmacol 1978;13:133-142.Crossref 33. Knoll E, Wisser H, Rautenstrauch H: Vergleichende Untersuchung zur diagnostischen Wertigkeit von Diskelektrophorese der Urinproteine und N-Acetylglucosaminidaseausscheidung zur Erkennung von tubulären Nierenschädigungen bei chronischer Polyarthritis . J Clin Chem Clin Biochem 1980;18:53-58. 34. Diener U, Knoll E, Langer B, et al: Urinary excretion of N-acetyl-βD-glucosaminidase and alanine aminopeptidase in patients receiving amikacin or CIS-platinum . Clin Chim Acta 1981;112:149-157.Crossref 35. Snedecor GW, Cochran WG: Statistical Methods , ed 4. Ames, Iowa, Iowa State University Press, 1967. 36. Reimann JW, Frölich JC: Effects of diclofenac on lithium kinetics . Clin Pharmacol Ther 1981;30:348-352.Crossref 37. Imbs JL, Danion JM, Sebban M, et al: Influence des anti-inflammatoires sur la reabsorption tubulaire du lithium . J Pharmacol 1978;9:171-172. 38. Smith JB, Willis AL: Aspirin selectively inhibits prostaglandin production in human platelets . Nature New Biol 1971;321:235-237.Crossref 39. Vane JR: Inhibition of prostaglandin synthesis as a mechanism of action for aspirin-like drugs . Nature New Biol 1971;231:232-235.Crossref 40. Roth GR, Siok CJ: Acetylation of the NH2-terminal serine of prostaglandin synthetase by aspirin . J Biol Chem 1978;253:3782-3784. 41. Imbs JL, Singer L, Danion JM, et al: Urinary elimination of lithium: Drug interactions . Kidney Int 1979;16:96. 42. Imbs JL, Singer L, Danion JM, et al: Effects of indomethacin and methylprednisolone on renal elimination of lithium in the rat . Int Pharmacopsychiatry 1980;15:143-149. 43. Flower RJ, Moncada S, Vane JR: Analgesic-antipyretics and antiinflammatory agents: Drugs employed in the treatment of gout , in Goodman Gilman A, Goodman LS, Gilman A (eds): The Pharmacological Basis of Therapeutics , ed. 6. New York, Macmillan Publishing Co Inc, 1980, pp 682-728. 44. Merino J, Livio M, Rajtar G, et al: Salicylate reverses in vitro aspirin inhibition of rat platelet and vascular prostaglandin generation . Biochem Pharmacol 1980;29:1093-1096.Crossref 45. Peterson DA, Gerard JM, Rao GHR, et al: Salicylic acid inhibition of the irreversible effect of acetylsalicylic acid on prostaglandin synthetase may be due to competition for the enzyme cationic binding site . Prostaglandins Med 1981;6:161-164.Crossref 46. Siegel MJ, McConnell RT, Cuatrecasas P: Aspirin-like drugs interfere with arachidonate metabolism by inhibition of the 12-hydroperoxy-5, 8, 10, 14-eicosatetraenoic acid peroxidase activity of the lipoxygenase pathway . Proc Natl Acad Sci USA (Biochem) 1979;76:3774-3778.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Indomethacin but not Aspirin Increases Plasma Lithium Ion Levels

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American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-990X
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1598-3636
DOI
10.1001/archpsyc.1983.01790030053006
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Abstract

Abstract • The pharmacokinetic drug interactions between lithium sulfate and the nonsteroidal anti-inflammatory drugs (NSAIDs) indomethacin and aspirin were studied in ten normal female volunteers restricted to 150-mEq/day of sodium. Indomethacin decreased renal lithium ion elimination by 23% and caused a 40% increase in steady state plasma lithium ion levels. In contrast, aspirin had no effect on plasma lithium ion levels and increased renal lithium ion elimination by only 6%. Renal prostaglandin E2 excretion was suppressed by 50% to 60% of control levels by indomethacin and by 65% to 70% by aspirin. A clinically important drug interaction with the risk of lithium intoxication can occur between lithium salts and indomethacin. However, aspirin did not affect steady state plasma levels of lithium ion and thus may be preferable for antirheumatic treatment of patients undergoing long-term therapy with lithium salts. Frequent monitoring of plasma lithium ion levels is absolutely necessary in patients receiving both lithium salts and NSAIDs. References 1. Thomsen K: Renal handling of lithium at non-toxic serum lithium levels: A review . Dan Med Bull 1978;25:106-115. 2. Corcoran AC, Taylor RD, Page JH: Lithium poisoning from the use of salt substitutes . JAMA 1949;139:685-688.Crossref 3. Tonks CM: Lithium-intoxication induced by dieting and saunas . Br Med J 1977;2:1396-1397.Crossref 4. Hansen HE, Amdisen A: Lithium intoxication: Report of 23 cases and review of 100 cases from the literature . Q J Med (New Series) 1978;47:123-144. 5. Lehmann K, Merten K: Die Elimination von Lithium in Abhängigkeit vom Lebensalter bei Gesunden und Niereninsuffizienten . Int J Clin Pharmacol 1974;10:292-298. 6. Hurtig H, Dyson W: Lithium toxicity enhanced by diuretics . N Engl J Med 1974;290:748-749. 7. Mac Fie AC: Lithium poisoning precipitated by diuretics . Br Med J 1975;1:1516. 8. Steele TH, Manuel MA, Newton M, et al: Renal lithium reabsorption in man: Physiologic and pharmacologic determinants . Am J Med Sci 1975; 269:349-363.Crossref 9. Ascione FJ: Evaluating drug interactions: Lithium with diuretics . Drug Ther 1977, pp 126-127. 10. Himmelhoch JM, Poust RJ, Mallinger AG, et al: Adjustment of lithium dose during lithium-chlorothiazide therapy . Clin Pharmacol Ther 1977;22:225-227. 11. König P, Küfferle B, Lenz G: Ein Fall von Lithiumintoxikation bei therapeutischen Lithiumdosen infolge zusätzlicher Gabe eines Diuretikums . Wien Klin Wochenschr 1978;90:380-382. 12. Jefferson JW, Kalin NH: Serum lithium levels and long-term diuretic use . JAMA 1979;241:1134-1136.Crossref 13. Jefferson JW: Diuretics are dangerous with lithium . Br Med J 1980;281:1217.Crossref 14. Singer J: Lithium and the kidney . Kidney Int 1981;19:374-387.Crossref 15. Donker AJM, Arisz L, Brentjens JRH, et al: The effect of indomethacin on kidney function and plasma renin activity in man . Nephron 1976; 17:288-296.Crossref 16. Frölich JC, Hollifield JW, Dormois JC, et al: Suppression of plasma renin activity by indomethacin in man . Circ Res 1976;39:447-452.Crossref 17. Stokes JB, Kokko JP: Inhibition of sodium transport by prostaglandin E2 across the isolated perfused rabbit collecting tubule . J Clin Invest 1977;59:1099-1104.Crossref 18. Roman RJ, Kauker ML: Renal effect of prostaglandin synthetase inhibition in rats: Micropuncture studies . Am J Physiol 1978;235:F111-F118. 19. Brater DC: Effect of indomethacin on salt and water homeostasis . Clin Pharmacol Ther 1979;25:322-330. 20. Kokko JP: The effect of prostaglandins on renal epithelial electrolyte transport . Kidney Int 1981;19:791-796.Crossref 21. Stokes JB: Effect of prostaglandin E2 on chloride transport across the rabbit thick ascending limb of Henle: Selective inhibition of the medullary portion . J Clin Invest 1979;64:495-502.Crossref 22. Higashihara E, Stokes JB, Kokko JP, et al: Cortical and papillary micropuncture examination of chloride transport in segments of the rat kidney during inhibition of prostaglandin production: A possible role for prostaglandins in the chloruresis of acute volume expansion . J Clin Invest 1979;64:1277-1287.Crossref 23. Tannenbaum J, Splawinski JA, Oates JA, et al: Enhanced renal prostaglandin production in the dog: I. Effects on renal function . Circ Res 1975;36:197-203.Crossref 24. Frölich JC, Leftwich R, Ragheb M, et al: Indomethacin increases plasma lithium . Br Med J 1979;1:1115-1116.Crossref 25. Ragheb M, Ban TA, Buchanan D, et al: Interaction of indomethacin and ibuprofen with lithium in manic patients under a steady-state lithium level . J Clin Psychiatry 1980;41:397-398. 26. Frölich JC, Wilson TW, Sweetman BJ, et al: Urinary prostaglandins: Identification and origin . J Clin Invest 1975;55:763-770.Crossref 27. Green K, Hamberg M, Samuelsson B, et al: Measurement of prostaglandins, thromboxanes, prostacyclin and their metabolites by gas liquid chromatography-mass spectrometry , in Frölich JC (ed): Methods in Prostaglandin Research . New York, Raven Press, 1978, pp 39-94. 28. Tucker SM, Boyd PJR, Thompson AE, et al: Automated assay of N-acetyl-β-glucosaminidase in normal and pathological human urine . Clin Chim Acta 1975;62:333-339.Crossref 29. Wellwood JM, Ellis BG, Price RG, et al: Urinary N-acetyl-β-Dglucosaminidase activities in patients with renal disease . Br Med J 1975; 3:408-411.Crossref 30. Dieppe PA, Doyle DV, Burry HC: Renal damage during treatment with antirheumatic drugs . Br Med J 1978;2:664.Crossref 31. Scherberich JE, Falkenberg FW, Mondorf AW, et al: Biochemical and immunological studies on isolated brush border membranes of human kidney cortex and their membrane surface proteins . Clin Chim Acta 1974;55:179-197.Crossref 32. Mondorf AW, Breier J, Hendus J, et al: Effect of aminoglycosides on proximal tubular menbranes of the human kidney . Eur J Clin Pharmacol 1978;13:133-142.Crossref 33. Knoll E, Wisser H, Rautenstrauch H: Vergleichende Untersuchung zur diagnostischen Wertigkeit von Diskelektrophorese der Urinproteine und N-Acetylglucosaminidaseausscheidung zur Erkennung von tubulären Nierenschädigungen bei chronischer Polyarthritis . J Clin Chem Clin Biochem 1980;18:53-58. 34. Diener U, Knoll E, Langer B, et al: Urinary excretion of N-acetyl-βD-glucosaminidase and alanine aminopeptidase in patients receiving amikacin or CIS-platinum . Clin Chim Acta 1981;112:149-157.Crossref 35. Snedecor GW, Cochran WG: Statistical Methods , ed 4. Ames, Iowa, Iowa State University Press, 1967. 36. Reimann JW, Frölich JC: Effects of diclofenac on lithium kinetics . Clin Pharmacol Ther 1981;30:348-352.Crossref 37. Imbs JL, Danion JM, Sebban M, et al: Influence des anti-inflammatoires sur la reabsorption tubulaire du lithium . J Pharmacol 1978;9:171-172. 38. Smith JB, Willis AL: Aspirin selectively inhibits prostaglandin production in human platelets . Nature New Biol 1971;321:235-237.Crossref 39. Vane JR: Inhibition of prostaglandin synthesis as a mechanism of action for aspirin-like drugs . Nature New Biol 1971;231:232-235.Crossref 40. Roth GR, Siok CJ: Acetylation of the NH2-terminal serine of prostaglandin synthetase by aspirin . J Biol Chem 1978;253:3782-3784. 41. Imbs JL, Singer L, Danion JM, et al: Urinary elimination of lithium: Drug interactions . Kidney Int 1979;16:96. 42. Imbs JL, Singer L, Danion JM, et al: Effects of indomethacin and methylprednisolone on renal elimination of lithium in the rat . Int Pharmacopsychiatry 1980;15:143-149. 43. Flower RJ, Moncada S, Vane JR: Analgesic-antipyretics and antiinflammatory agents: Drugs employed in the treatment of gout , in Goodman Gilman A, Goodman LS, Gilman A (eds): The Pharmacological Basis of Therapeutics , ed. 6. New York, Macmillan Publishing Co Inc, 1980, pp 682-728. 44. Merino J, Livio M, Rajtar G, et al: Salicylate reverses in vitro aspirin inhibition of rat platelet and vascular prostaglandin generation . Biochem Pharmacol 1980;29:1093-1096.Crossref 45. Peterson DA, Gerard JM, Rao GHR, et al: Salicylic acid inhibition of the irreversible effect of acetylsalicylic acid on prostaglandin synthetase may be due to competition for the enzyme cationic binding site . Prostaglandins Med 1981;6:161-164.Crossref 46. Siegel MJ, McConnell RT, Cuatrecasas P: Aspirin-like drugs interfere with arachidonate metabolism by inhibition of the 12-hydroperoxy-5, 8, 10, 14-eicosatetraenoic acid peroxidase activity of the lipoxygenase pathway . Proc Natl Acad Sci USA (Biochem) 1979;76:3774-3778.Crossref

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Mar 1, 1983

References