toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).lithium and trifluoperazine both decrease QTc interval. Use Caution/Monitor.trimipraminetrimipramine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.lithium and trimipramine both increase QTc interval. Use Caution/Monitor.triptorelinlithium and triptorelin both increase QTc interval. Use Caution/Monitor.ustekinumabustekinumab, lithium. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of ustekinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.valbenazinevalbenazine and lithium both increase QTc interval. Use Caution/Monitor.valerianvalerian and lithium both increase sedation. Use Caution/Monitor.vardenafillithium and vardenafil both increase QTc interval. Use Caution/Monitor.venlafaxinevenlafaxine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.lithium and venlafaxine both decrease QTc interval. Use Caution/Monitor.voclosporinlithium and voclosporin both increase QTc interval. Use Caution/Monitor.voriconazolelithium and voriconazole both increase QTc interval. Use Caution/Monitor.vorinostatlithium and vorinostat both increase QTc interval. Use Caution/Monitor.xipamidexipamide increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.ziprasidonelithium, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).zolmitriptanzolmitriptan and lithium both increase serotonin levels. Use Caution/Monitor.Minor (53)alprazolamalprazolam increases levels of lithium by decreasing renal clearance. Minor/Significance Unknown.amitriptylinelithium, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.amlodipineamlodipine increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.amoxapinelithium, amoxapine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.atracuriumlithium increases effects of atracurium by unknown mechanism. Minor/Significance Unknown.cadexomer iodinecadexomer iodine, lithium. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive hypothyroid effects.cisatracuriumlithium increases effects of cisatracurium by unknown mechanism. Minor/Significance Unknown.clevidipineclevidipine increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.clomipraminelithium, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.desipraminelithium, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.dosulepinlithium, dosulepin. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.doxepinlithium, doxepin. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.duloxetineduloxetine, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.escitalopramescitalopram, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.ethotoinethotoin increases toxicity of lithium by unknown mechanism. Minor/Significance Unknown.felodipinefelodipine increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.fluoxetinefluoxetine, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.fosphenytoinfosphenytoin increases toxicity of lithium by unknown mechanism. Minor/Significance Unknown.green teagreen tea increases levels of lithium by unspecified interaction mechanism. Minor/Significance Unknown. Lithium levels may increase following abrupt caffeine withdrawal.imipraminelithium, imipramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.iodinated glyceroliodinated glycerol, lithium. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive hypothyroid effects.iodineiodine, lithium. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive hypothyroid effects.isradipineisradipine increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.levomilnacipranlevomilnacipran, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.lofepraminelithium, lofepramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.maprotilinelithium, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.methyldopamethyldopa increases toxicity of lithium by unknown mechanism. Minor/Significance Unknown.metronidazolemetronidazole increases levels of lithium by decreasing metabolism. Minor/Significance Unknown.milnacipranmilnacipran, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.nefazodonenefazodone, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.nicardipinenicardipine increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.nifedipinenifedipine increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.nisoldipinenisoldipine increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.nortriptylinelithium, nortriptyline. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.onabotulinumtoxinAlithium increases effects of onabotulinumtoxinA by unknown mechanism. Minor/Significance Unknown.pancuroniumlithium increases effects of pancuronium by unknown mechanism. Minor/Significance Unknown.paroxetineparoxetine, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.phenytoinphenytoin increases toxicity of lithium by unknown mechanism. Minor/Significance Unknown.protriptylinelithium, protriptyline. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.rapacuroniumlithium increases effects of rapacuronium by unknown mechanism. Minor/Significance Unknown.rocuroniumlithium increases effects of rocuronium by unknown mechanism. Minor/Significance Unknown.sargramostimlithium increases effects of sargramostim by pharmacodynamic synergism. Minor/Significance Unknown.sertralinesertraline, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.sodium chloridesodium chloride, lithium. Other (see comment). Minor/Significance Unknown. Comment: High sodium intake decreases lithium concentration; low sodium may increase lithium levels. Mechanism: Lithium excretion is proportional to salt intake.sodium polystyrene sulfonatesodium polystyrene sulfonate decreases levels of lithium by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.succinylcholinelithium increases effects of succinylcholine by unknown mechanism. Minor/Significance Unknown.theophyllinetheophylline decreases levels of lithium by increasing renal clearance. Minor/Significance Unknown.trazodonelithium, trazodone. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.trazodone, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.trimipraminelithium, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.vasopressinlithium decreases effects of vasopressin by pharmacodynamic antagonism. Minor/Significance Unknown.vecuroniumlithium increases effects of vecuronium by unknown mechanism. Minor/Significance Unknown.venlafaxinevenlafaxine, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.verapamilverapamil increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.5-HTPMonitor Closely (1)5-HTP and lithium both increase serotonin levels. Use Caution/Monitor.aceclofenacMonitor Closely (1)aceclofenac increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.acemetacinMonitor Closely (1)acemetacin increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.albuterolMonitor Closely (1)albuterol and lithium both increase QTc interval. Use Caution/Monitor.alfuzosinMonitor Closely (1)alfuzosin and lithium both increase QTc interval. Use Caution/Monitor.almotriptanMonitor Closely (1)almotriptan and lithium both increase serotonin levels. Use Caution/Monitor.alprazolamMinor (1)alprazolam increases levels of lithium by decreasing renal clearance. Minor/Significance Unknown.amiodaroneSerious - Use Alternative (1)lithium and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.amisulprideSerious - Use Alternative (2)amisulpride and lithium both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered. lithium and amisulpride both increase QTc interval. Avoid or Use Alternate Drug.amitriptylineMonitor Closely (2)lithium and amitriptyline both increase QTc interval. Use Caution/Monitor. amitriptyline and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)lithium, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.amlodipineMinor (1)amlodipine increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.amoxapineMonitor Closely (1)amoxapine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)lithium, amoxapine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.anagrelideSerious - Use Alternative (1)lithium and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.apomorphineMonitor Closely (1)apomorphine and lithium both increase QTc interval. Use Caution/Monitor.arformoterolMonitor Closely (1)arformoterol and lithium both increase QTc interval. Use Caution/Monitor.aripiprazoleMonitor Closely (2)lithium, aripiprazole. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction). aripiprazole and lithium both increase QTc interval. Use Caution/Monitor.arsenic trioxideSerious - Use Alternative (1)lithium and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.artemetherSerious - Use Alternative (1)artemether and lithium both increase QTc interval. Avoid or Use Alternate Drug.artemether/lumefantrineSerious - Use Alternative (1)artemether/lumefantrine and lithium both increase QTc interval. Avoid or Use Alternate Drug.asenapineMonitor Closely (1)lithium, asenapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).Serious - Use Alternative (1)lithium and asenapine both increase QTc interval. Avoid or Use Alternate Drug.asenapine transdermalSerious - Use Alternative (1)asenapine transdermal and lithium both increase QTc interval. Avoid or Use Alternate Drug.aspirinMonitor Closely (1)aspirin increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.aspirin rectalMonitor Closely (1)aspirin rectal increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.aspirin/citric acid/sodium bicarbonateMonitor Closely (1)aspirin/citric acid/sodium bicarbonate increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.atomoxetineMonitor Closely (1)atomoxetine and lithium both increase QTc interval. Use Caution/Monitor.atracuriumMinor (1)lithium increases effects of atracurium by unknown mechanism. Minor/Significance Unknown.azilsartanSerious - Use Alternative (1)azilsartan increases toxicity of lithium by decreasing renal clearance. Avoid or Use Alternate Drug.azithromycinSerious - Use Alternative (1)lithium and azithromycin both increase QTc interval. Avoid or Use Alternate Drug.bedaquilineSerious - Use Alternative (1)bedaquiline and lithium both increase QTc interval. Avoid or Use Alternate Drug.benazeprilMonitor Closely (1)benazepril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule. Monitor lithium levels.bendroflumethiazideMonitor Closely (1)bendroflumethiazide increases toxicity of lithium by decreasing elimination. Use Caution/Monitor.bexagliflozinMonitor Closely (1)bexagliflozin decreases effects of lithium by Other (see comment). Use Caution/Monitor. Comment: Concomitant use of an SGLT2 inhibitor with lithium may decrease serum lithium concentrations; monitor serum lithium concentration more frequently during therapy initiation and dosage changes.bremelanotideSerious - Use Alternative (1)bremelanotide will decrease the level or effect of lithium by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.buprenorphineSerious - Use Alternative (1)lithium and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine buccalSerious - Use Alternative (1)buprenorphine buccal and lithium both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine subdermal implantSerious - Use Alternative (1)buprenorphine subdermal implant and lithium both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine transdermalSerious - Use Alternative (1)buprenorphine transdermal and lithium both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine, long-acting injectionSerious - Use Alternative (1)buprenorphine, long-acting injection and lithium both increase QTc interval. Avoid or Use Alternate Drug.buspironeMonitor Closely (1)buspirone and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.cadexomer iodineMinor (1)cadexomer iodine, lithium. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive hypothyroid effects.canagliflozinMonitor Closely (1)canagliflozin decreases levels of lithium by Other (see comment). Use Caution/Monitor. Comment: SGLT2 inhibitors with lithium may decrease serum lithium concentrations; monitor serum lithium concentration more frequently during therapy initiation and dosage changes.candesartanSerious - Use Alternative (1)candesartan increases toxicity of lithium by decreasing renal clearance. Avoid or Use Alternate Drug.captoprilMonitor Closely (1)captopril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule. Monitor lithium levels.carbamazepineMonitor Closely (1)carbamazepine, lithium. Mechanism: unknown. Use Caution/Monitor. Risk of neurotoxicity.cariprazineMonitor Closely (1)lithium, cariprazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).celecoxibMonitor Closely (1)celecoxib increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.ceritinibSerious - Use Alternative (1)ceritinib and lithium both increase QTc interval. Avoid or Use Alternate Drug.chloroquineSerious - Use Alternative (1)chloroquine and lithium both increase QTc interval. Avoid or Use Alternate Drug.chlorothiazideMonitor Closely (1)chlorothiazide increases toxicity of lithium by decreasing elimination. Use Caution/Monitor.chlorpromazineMonitor Closely (1)lithium, chlorpromazine. Other (see comment). Use Caution/Monitor. Comment: Risk of neurotoxicity. Multiple mechanisms involved.Serious - Use Alternative (1)lithium and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.chlorthalidoneMonitor Closely (1)chlorthalidone increases toxicity of lithium by decreasing elimination. Use Caution/Monitor.choline magnesium trisalicylateMonitor Closely (1)choline magnesium trisalicylate increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.ciprofloxacinMonitor Closely (1)lithium and ciprofloxacin both increase QTc interval. Use Caution/Monitor.cisatracuriumMinor (1)lithium increases effects of cisatracurium by unknown mechanism. Minor/Significance Unknown.citalopramMonitor Closely (1)citalopram, lithium. Mechanism: unknown. Use Caution/Monitor. Lithium may enhance the serotonergic effects of citalopram, caution should be exercised when citalopram and lithium are coadministered.Serious - Use Alternative (1)citalopram and lithium both increase QTc interval. Avoid or Use Alternate Drug.clarithromycinSerious - Use Alternative (1)clarithromycin and lithium both increase QTc interval. Avoid or Use Alternate Drug.clevidipineMinor (1)clevidipine increases toxicity