About William J. Walker, Pharm.D. Expertise Homeopathic, alternative, herbal, natural, adverse drug reactions, side effects, risks, outcomes, research, medication, rational therapeutics, infectious diseases, cardiology, pain management, nutrition, psychopharmacology, oncology, pediatrics, sleep disorders, tropical diseases, HIV, drug interactions, substance abuse, illicit drugs of abuse, geriatrics
Experience
Past/Present clients State of California Department of Youth Authority
State of California Department of Mental Health
County of San Luis Obispo Public Defenders Office
County of San Luis Obispo District Attorney Office
TenetHealth Corporation
Boy Scouts of America
Better Life Institute
Campus Crusade for Christ
Volunteers in Medical Evangelism
His Healing Hands, Inc.
AskMe.com
Kiwanis International
Question I've had a patient who has been on lithium for 14 years and for the last 7 months he has been withdrawing and for the past four days he's been without any lithium, a doctor has just prescribed ibuprofen 400mg tid for a tension headache, i was wondering if the ibuprofen was still ok to give as unsure whether he would of completely cleared the lithium out his system and whether there would still be a potential problem for the kidneys or other problems
Answer If he has been off of the lithium for several days then the immediate risks of combining ibuprofen are negligible as this pertains to an actual interaction and interference with the clearance of lithium. Which by now is totally cleared out of the patient's system. The long term issue here depends really on how long the ibuprofen regimen is continued. Since the renal effects of NSAIDS are more a reflection of total cumulative dosage over time. There are also some concerns about some of the more longer lasting effects of prostaglandin inhibition that could make the reintroduction of lithium at some point worthy of a conservative approach.
On the other side of this is the concern for how long the patient was on lithium. We have noted that therapies that exceed several years duration have resulted in some degree of nephrotoxicity and diminished renal capacity. That would tend to make one cautious in using NSAIDS at least at maximum dosages. To be quite certain that there are no reasons to suspect an increased risk in NSAID induced nephrotoxicity I would urge you to use moderation. The present regimen of 1200 mg daily of ibuprofen is certainly moderation. I would not be concerned at this time.
We have actually had quite a bit of success in cases like this one. Have not seen any evident cases of frank renal disease as a result. You have used a wise approach thus far. It would be prudent to monitor renal function regularly however.
If you want to remove a large portion of the concern in this case you could opt for sulindac in place of ibuprofen as this one NSAID agent seems to be lacking in any lithium interactions. Not necessarily true for the NSAID effects directly on the nephrons themselves. But a choice we regularly make in our patients to be as safe as possible.
