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Nonsteroidal anti-inflammatory drugs (standard or coxibs) - prescribing issues - Management
What should I do for a person who requires lithium and an NSAID?
- Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce the excretion of lithium, causing serum lithium levels to rise and increasing the risk of lithium toxicity.
- The concomitant use of lithium and NSAIDs (especially indometacin) should therefore be avoided.
- Seek specialist advice if this combination of drugs is considered necessary.
- With concomitant use of lithium and an NSAID, serum lithium levels must be very closely monitored and the lithium dose reduced as necessary.
- In view of the severity of the interaction, people taking lithium plus an NSAID should be warned to watch for the symptoms of lithium toxicity:
- Ataxia, blurred vision, coarse tremor, giddiness, muscle twitching, tinnitus, and a large output of dilute urine.
Basis for recommendation
- These recommendations are based on information in an authoritative reference manual on drug interactions and the British National Formulary [Baxter, 2006; BNF 55, 2008].
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