Addition of lithium carbonate to carbamazepine: hematological and thyroid effects

Article Abstract:

Carbamazepine is an anticonvulsant drug which is currently receiving much attention as an alternative to lithium carbonate in treating bipolar affective disorder (manic depression). Benefits have been observed when a combination of these two drugs has been used to treat patients who are otherwise resistant to treatment with either drug alone. Conflicting reports exist, however, with some indicating that the side effects of this combination treatment are highly toxic. To further investigate the effects of combination treatment on the blood and the activity of the thyroid gland, a group of 23 patients with affective disorders was examined. The patients had been previously resistant to both drugs when administered alone. All subjects were screened for the presence of seizures and other related disorders. Some patients were given gradually increasing doses of carbamazepine, while others were given a placebo. Supplementation with lithium was given to the patients at an average of 39 days after carbamazepine or placebo was begun. Blood samples were taken and analyzed throughout treatment, and several clinical changes that involved the blood and thyroid function were evident after the addition of lithium. Carbamazepine therapy alone was associated with lower total white blood cell counts, and lower neutrophils and lymphocytes. When lithium was added, the total white blood cell counts increased to levels higher than when treatment began. Antithyroidal effects where also observed during the combination treatment period, with lower thyroid hormone levels than were measured with carbamazepine treatment only. Slightly higher levels of TSH (thyroid-stimulating hormone) were noted when lithium was added to treatment. Clinical and theoretical implications of these findings are discussed. Combination treatment may be warranted and effective in patients who are resistant to more conventional therapy, but these patients should be carefully monitored for signs of neurotoxicity. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Affective disorders, Mood disorders

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Less frequent lithium administration and lower urine volume

Article Abstract:

Lithium is the preferred drug for treating mania and several types of severe depression. Its use requires careful monitoring, since high blood levels of lithium can cause serious adverse effects. A major concern in relation to the long-term use of lithium is the possibility of kidney damage, which can lead to excessive urination (polyuria), dehydration and increased risk for lithium toxicity. To see whether patients maintained on lithium administered once daily have lower urine output volume than patients receiving multiple doses of lithium throughout the day, 85 lithium clinic patients were studied. All the patients had taken lithium for an average of six years and for a minimum of one year. None had ever experienced lithium toxicity or had taken psychotropic drugs other than lithium for at least one month prior to the study. The patients were on stratified lithium schedules: 26 took it once daily, 42 twice daily, 15 three times daily, and two patients took it four times daily. All patients were admitted to the hospital for 24-hour urine collections and kidney function testing. Analysis of the data revealed that patients who took relatively low levels of lithium or who received lithium once daily were less likely to develop polyuria than those who took multiple daily doses. However, since patients with mood disorders who have never taken lithium are also sometimes prone to polyuria, the interactions between lithium dosage, scheduling and polyuria may include factors not directly related to the drug's direct effect on the kidneys. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Risk factors, Dosage and administration, Kidney diseases, Urination disorders

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Nefazodone-induced carbamazepine toxicity

Article Abstract:

Carbamazepine toxicity induced by nefazodone treatment has been reported in bipolar disorder patients who had previously exhibited stable carbamazepine levels. One patient who had been maintained on a regimen of carbamazepine and risperidone as well as extended trials of sertraline, paroxetine and fluoxetine consistently exhibited stable carbamazepine serum levels. After fluoxetine treatment was discontinued and nefazodone was started, however, the patient's carbamazepine serum level increased significantly.

Complications and side effects, Antidepressants, Letter to the Editor, Nefazodone (Medication)

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