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212705 tn?1221620650

Taking lithium while txing?

Hi everybody,
I just met someone who is txing and his hep dr. prescribed lithium for bi-polar disorder. The person had been on it before diagnosis but was promptly taken off. Now his dr.s want him to go back on and he is concerned about the sx of that and is not taking it. He would like a 2nd opinion from another hep dr. but his insurance (state) will probably not cover it. This person is 4 weeks into txing and not doing very well. This person is very concerned with the effects lithium will have on his liver and other organs at this point. Is there anyone out there who is familiar with this or has personal experience with (lithium and sx while txing?) I am concerned as this person has stage 4 cirrhosis. All info would be greatly appreciated. Thanks!
Yvonne
10 Responses
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Avatar universal
Hi everyone - I was just buzzing through quickly and reading and saw this note on Lithium. I've only got a second on-line but wanted to help if I could.

Kit07 left some great info on Lithium.   Take her note seriously on Lithium.

It' is used with great success in many manic depressive patients (Bipolar).  For some, it's the only med that will manage them.   It is, however, a very serious drug and not without its risks and dangers in SOME (and with a compromised liver already ??  could make matters worse).  Most people on Lithium for bipolar need to be under close supervision because of the bipolar and the drug, Lithium.   The lithium levels have to be monitored;  the condition has to be monitored.   Lithium can be toxic to the liver, too.   It's not a drug to fool around with, but - neither is bipolar, unmanaged, or .... bipolar off meds.   With Hep C treatment, if the person is Bipolar, managed on Lithium, and the docs have been fooling around with the Lithium (on / off / on / off) - they are apt to have a tough tough time on treatment.  Just my personal opinion.   I hope they'll be OK.  

To answer Rosebud's question about the doctor -- the doctor's name is "Dr. Cecil."   He's always willing to give some words of his wisdom - might take some time on the forum or by email, but he might be able to give you / your friend some of his advice.  He's helped me before - answered some questions, and he's just a great person and a great doc in my opinion.  

His links are:  

http://www.hepatitisdoctor.com/

http://www.hcvinprison.org/new/phpbb/main.html

Best of luck!

Helpful - 0
212705 tn?1221620650
His pschiatrist and hep dr. advise him to take it now. When he was first diagnosed with hepc 1a, bx, stage 4 cirrhosis, his doc (I don't know which one?) took him off lithium. Now during txing they want him to continue the lithium. I was hoping someone would know of other less toxic meds and if they had helped them..so when he goes to dr..he can go informed. I understand how difficult this tx can be...what with people who are not normally taking ad's doing so while txing..i'm worried that this person, taking no meds could have very negative side effcts. Thanks for the info.
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Avatar universal
Lithium is fine to take. I sometimes get it at the health food store and take it myself. Lithium is a salt. It doesn't harm the liver. Since your friend is bipolar he had better take it.
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212705 tn?1221620650
you can get lithium at a health food store? that's interesting...i thought it might be a controlled substance. You probably think the friend is me, right? For real...it is someone I just met who really needs support. Thanks GrandmaA!
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Avatar universal
Yikes.  Lithium can be highly toxic and  should NEVER be taken without a presciption.  I posted some infomation below.  Yes lithium carbonate is technically a salt, and a naturally ocurring element that can be purchased without a prescription.  Arsenic and cyanide are also naturally occuring elements, but that sure doesn't make them safe.  Note that the first sentence in the information below says: "Lithium has a narrow therapeutic/toxic ratio - serum lithium concentrations must be measured regularly."  Which means that at a dose high enough to be effective it is nearly poisonous and should be monitored closely with frequent blood tests.  Also notice the long list of potential drug interactions.   Lithium can blow out your kidneys, among other things.  Perhaps that is wy his doctor advises against it.

Your friend should take his doctor VERY seriously in this matter.  

Many of the antidepressants prescribed to people on hep c treatment are also used to treat bipolar disorder, so perhaps your friend might have success with one of those.  Again, he should not mess around with this.  Advise him to listen to his doctor, and perhaps seek additional help from a psychiatrist.

Good luck
Kit

http://www.mentalhealth.com/drug/p30-l02.html

Lithium carbonate
Precautions:
Maintain patients on lithium therapy under careful clinical and laboratory control throughout treatment - periodic review and monitoring of kidney, cardiovascular and thyroid function is advisable.

Overdose
Lithium toxicity is closely related to the concentration of lithium in the blood and is usually associated with serum concentrations in excess of 2 mmol/L. Early signs of toxicity which may occur at lower serum concentrations were described under Adverse Effects and usually respond to reduction of dosage. Lithium intoxication has been preceded by the appearance or aggravation of the following symptoms: sluggishness, drowsiness, lethargy, coarse hand tremor or muscle twitchings, loss of appetite, vomiting, and diarrhea. Occurrence of these symptoms requires immediate cessation of medication and careful clinical reassessment and management. Signs and symptoms of lithium intoxication have already been described under Adverse Effects.

Side effects: Mild adverse effects can occur even if serum lithium levels are 1 mmol/L. Initial postabsorptive symptoms including g.i. discomfort, nausea, vertigo, muscle weakness, and a dazed feeling frequently disappear after stabilization of therapy. More common and persistent side effects: fine hand tremor, fatigue, thirst, polyuria. Mild to moderate toxic reactions occur at lithium levels of 1.5 to 2 mmol/L; moderate to severe reactions at levels > 2 mmol/L. Progressive intoxication may be manifest3ed by confusion, increasing disorientation, muscle twitchings, hyper-reflexia, nystagmus, seizures, diarrhea, vomiting, and eventually coma and death.

Interactions:
ACEIs, methyldopa, metronidazole, tetracycline, thiazide diuretics (increased risk of lithium toxicity), anticonvulsants (increased risk of CNS toxicity), calcium channel blockers (increased risk of neurotoxicity), NSAIDs (increased steady-state plasma lithium levels), SSRIs (increased risk of lithium toxicity or seratonin syndrome), haloperidol (encephalopathy resembling the malignant neuroleptic syndrome), iodides (increased hypothyroid effects), phenothiazines (neurotoxicity with thioridazine, lithium-induced reductions in plasma chlorpromazine levels, phenothiazine-induced increases in red blood cell uptake of lithium, chlorpromazine-induced increases in renal lithium excretion), sodium bicarbonate (enhanced lithium excretion). Lithium may prolong the action of neuromuscular blockers. Increased lithium doses may be required to maintain its effects in patients on theophylline.
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Avatar universal
Hopefully someone will get back to you cause I think there have been several on forum that have/are tx while taking meds for bi-polar disorder.
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212705 tn?1221620650
,,,,
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Avatar universal
didn't someone post about a very sympathetic hep c doc who works w/hep c in prison pop or something like that, that he will answer emails etc.  when i read that post several months ago i did go to the linked website.  he might be a good resource or other docs willing to respond, or fellow heppers can ask their tx doc's.  

lithium is a dangerous substance and does need to be monitered closely.  i would think tx would aggravate or intensify  bipolar as one of the most important issues when you have that disorder is maintaining a healthy  sleep schedule.  this is something that is hard to achieve on tx.

good luck
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Avatar universal
Your friend has a prescription for lithium from the doctor and the right dose for him. He should take it. As a bodyworker I can't tell anyone to raise or lower their dosage or stop their medications. It's beyond my scope of practice. In this case the doctor knows best.
Helpful - 0
212705 tn?1221620650
Has anyone been treated for bi-polar disorder and been prescribed other meds while txing or know of anyone who has gone through this. I really want to help this guy...with as much info as possible...so he can comfortably :) take his prescription with more ease. Has anyone reached SVR while taking lithium? My Dr. prescribed Paxil (Generic), sometimes (today) I feel like it helps, other times not. Thanks for any and all input. Yvonne
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