Medical Health Encyclopedia

There have been reports of interactions between lithium and certain drugs commonly used in combination, including the following:

• Antipsychotics.
• Anticonvulsants.
• Calcium-channel blockers.

It should be noted that the risks associated with these drugs are very low, but caution is needed.

Other Factors That Affect Lithium Levels. In addition to drugs, other factors may affect lithium levels, including the following:

• Seasonal change. For instance, one study of men with bipolar disorder suggested that lithium levels may be higher in summer.
• Menstrual cycle. Lithium levels may drop during the premenstrual phase.
• Weight loss.
• Changes in salt intake.
• Dehydration.
• Diarrhea.

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Patients should be sure to contact their doctor if they have any suspicious symptoms or illnesses.

Valproate and Other Anti-Seizure Drugs

Valproate. The anti-epileptic drug valproate (valproic acid, divalproex sodium, Depakene, Depakote) has been used with some success. It controls pain and reduces the frequency of attacks by more than half in many people with episodic or chronic cluster headaches. Side effects include nausea, vomiting, heartburn, increased appetite with weight gain, hand tremors, irritability, and temporary hair thinning and loss (taking zinc and selenium supplements may help reduce this effect). It can also cause birth defects and, in rare cases, liver toxicity.

Topiramate. Other, newer anti-seizure drugs that have fewer side effects are being investigated for chronic headaches. Studies on topiramate (Topamax) are promising. In small trials of topiramate, up to 87% of patients achieved remission and 60% achieved a complete response. Still, about 25% of patients stop using it, either because it doesn't work or because the side effects are intolerable. They can include drowsiness, mood changes, tremor, and confusion.