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Questions for Dr. Kennedy
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Lithium Carbonate Interactions
Posted by: Franz
Date: August 9, 2001 7:53 AM

I have a bipolar disorder type 1, mainly depressive birth (1944). I have now discovered Wellbutrin as the first medication that works for my permanent depression. Question: what are the impacts on my organs, if I add Lithium Carbonate to Wellbutrin SR (150 mg x 2/day) in order to prevent a possible switch to manic attacks?

RE: Lithium Carbonate Interactions
Posted by: Ron Kennedy, M.D.
Date: August 9, 2001 2:47 PM

First of all, the final word on how your drugs should be managed must be worked out between you and your doctor. I am not advising any course of action to you as you are not my patient. From what I can see on comparing the drug interactions of the two drugs which are known, they are not known to interact with each other. I draw this conclusion from the published information on the two drugs which I reproduce below. As To Wellbutrin: no systematic data have been collected on the consequences of the concomitant administration of bupropion (Wellbutrin) and other drugs. However, animal data suggest that bupropion may be an inducer of drug metabolizing enzymes. This may be of potential clinical importance because the blood levels of co-administered drugs may be altered. Alternatively, because bupropion is extensively metabolized, the co-administration of other drugs may affect its clinical activity. In particular, care should be exercised when administering drugs known to affect hepatic drug-metabolizing enzyme systems (e.g., carbamazepine, cimetidine, phenobarbital, phenytoin). Studies in animals demonstrate that the acute toxicity of buproprion is enhanced by the MAO inhibitor phenelzine.

Limited clinical data suggest a higher incidence of adverse experiences in patients receiving concurrent administration of bupropion and L-dopa. Administration of bupropion to patients receiving L-dopa concurrently should be undertaken with caution, using small initial doses and small gradual dose increases.

Concurrent administration of bupropion and agents which lower seizure threshold should be undertaken only with extreme caution. Low initial dosing and small gradual dose increases should be employed.

As To The Drug Interactions of Lithium Carbonate:

Thiazide diuretics, furosemide, spironolactone, methyldopa, indomethacin, phenylbutazone and piroxicam can increase lithium concentrations. Acetazolamide, sodium bicarbonate, sodium chloride, theophylline and mannitol can decrease lithium concentrations. Neurotoxicity may be increased by concomitant use of haloperidol, phenothiazines, carbamazepine or phenytoin.

RE: Lithium Carbonate Interactions
Posted by: Franz
Date: August 9, 2001 7:27 PM

Thank you for all the details as far as interactions are concerned. I am eager to know your personal opinion on a mineral salt like Lithium being consumed in (relatively ) large doses as needed to get hopefully the focused results. Even ordinary Mineral Water you consider to be most harmful to the body.

RE: Lithium Carbonate Interactions
Posted by: Ron Kennedy, M.D.
Date: August 9, 2001 7:55 PM

I do not recommend lithium in large unregulated doses. It has serious side effects. Athough it is found in nature as a salt, it is also toxic in high doses and should be considered a potent medicine. Other than that, I consider plant derived minerals the most bioavailable.



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