of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.clomipramineMonitor Closely (2)clomipramine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely. lithium and clomipramine both increase QTc interval. Use Caution/Monitor.Minor (1)lithium, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.clozapineMonitor Closely (1)lithium, clozapine. 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)clozapine and lithium both increase QTc interval. Avoid or Use Alternate Drug.cocaine topicalMonitor Closely (1)cocaine topical and lithium both increase serotonin levels. Use Caution/Monitor.crizotinibSerious - Use Alternative (1)crizotinib and lithium both increase QTc interval. Avoid or Use Alternate Drug.cyclopenthiazideMonitor Closely (1)cyclopenthiazide increases toxicity of lithium by decreasing elimination. Use Caution/Monitor.dapagliflozinMonitor Closely (1)dapagliflozin decreases levels 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.daridorexantMonitor Closely (1)lithium and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. dasatinibMonitor Closely (1)dasatinib and lithium both increase QTc interval. Use Caution/Monitor.degarelixMonitor Closely (1)degarelix and lithium both increase QTc interval. Use Caution/Monitor.desfluraneSerious - Use Alternative (1)desflurane and lithium both increase QTc interval. Avoid or Use Alternate Drug.desipramineMonitor Closely (2)desipramine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely. lithium and desipramine both increase QTc interval. Use Caution/Monitor.Minor (1)lithium, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.desvenlafaxineSerious - Use Alternative (1)lithium and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.deutetrabenazineMonitor Closely (1)deutetrabenazine and lithium both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).dexfenfluramineMonitor Closely (1)dexfenfluramine and lithium both increase serotonin levels. Use Caution/Monitor.dextroamphetamineMonitor Closely (1)dextroamphetamine and lithium both increase serotonin levels. Use Caution/Monitor.dextroamphetamine transdermalMonitor Closely (1)lithium, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).dextromethorphanMonitor Closely (1)dextromethorphan and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.diclofenacMonitor Closely (1)diclofenac increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.difelikefalinMonitor Closely (1)difelikefalin and lithium both increase sedation. Use Caution/Monitor.diflunisalMonitor Closely (1)diflunisal increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.dihydroergotamineMonitor Closely (1)dihydroergotamine and lithium both increase serotonin levels. Use Caution/Monitor.dihydroergotamine intranasalMonitor Closely (1)dihydroergotamine intranasal and lithium both increase serotonin levels. Use Caution/Monitor.diltiazemMonitor Closely (1)diltiazem increases toxicity of lithium by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of neurotoxicity.disopyramideSerious - Use Alternative (1)lithium and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.dofetilideSerious - Use Alternative (1)lithium and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.dolasetronMonitor Closely (1)dolasetron and lithium both increase QTc interval. Use Caution/Monitor.donepezilSerious - Use Alternative (1)donepezil and lithium both increase QTc interval. Avoid or Use Alternate Drug.dosulepinMinor (1)lithium, dosulepin. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.doxepinMonitor Closely (2)doxepin and lithium both increase QTc interval. Use Caution/Monitor. doxepin and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)lithium, doxepin. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.dronedaroneContraindicated (1)lithium and dronedarone both increase QTc interval. Contraindicated.droperidolSerious - Use Alternative (1)lithium and droperidol both increase QTc interval. Avoid or Use Alternate Drug.dulaglutideMonitor Closely (1)dulaglutide, lithium. Other (see comment). Use Caution/Monitor. Comment: Dulaglutide slows gastric emptying and may impact absorption of concomitantly administered oral medications; be particularly cautious when coadministered with drugs that have a narrow therapeutic index.duloxetineMonitor Closely (1)duloxetine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)duloxetine, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.efavirenzMonitor Closely (1)efavirenz and lithium both increase QTc interval. Use Caution/Monitor.eletriptanMonitor Closely (1)eletriptan and lithium both increase serotonin levels. Use Caution/Monitor.eliglustatSerious - Use Alternative (1)lithium and eliglustat both increase QTc interval. Avoid or Use Alternate Drug.empagliflozinMonitor Closely (1)empagliflozin decreases levels 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.enalaprilMonitor Closely (1)enalapril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule.encorafenibSerious - Use Alternative (1)encorafenib and lithium both increase QTc interval. Avoid or Use Alternate Drug.entrectinibSerious - Use Alternative (1)entrectinib and lithium both increase QTc interval. Avoid or Use Alternate Drug.eprosartanSerious - Use Alternative (1)eprosartan increases toxicity of lithium by decreasing renal clearance. Avoid or Use Alternate Drug.ergotamineMonitor Closely (1)ergotamine and lithium both increase serotonin levels. Use Caution/Monitor.eribulinSerious - Use Alternative (1)eribulin and lithium both increase QTc interval. Avoid or Use Alternate Drug.ertugliflozinMonitor Closely (1)ertugliflozin decreases levels 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.erythromycin baseSerious - Use Alternative (1)lithium and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.erythromycin ethylsuccinateSerious - Use Alternative (1)lithium and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.erythromycin lactobionateSerious - Use Alternative (1)lithium and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.erythromycin stearateSerious - Use Alternative (1)lithium and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.escitalopramMonitor Closely (2)lithium and escitalopram both increase QTc interval. Use Caution/Monitor. escitalopram and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)escitalopram, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.ethotoinMinor (1)ethotoin increases toxicity of lithium by unknown mechanism. Minor/Significance Unknown.etodolacMonitor Closely (1)etodolac increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.felodipineMinor (1)felodipine increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.fenfluramineMonitor Closely (1)fenfluramine and lithium both increase serotonin levels. Use Caution/Monitor.fenoprofenMonitor Closely (1)fenoprofen increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.ferric maltolMonitor Closely (1)ferric maltol, lithium. Either increases levels of the other by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Coadministration of ferric maltol with certain oral medications may decrease the bioavailability of either ferric maltol and some oral drugs. For oral drugs where reductions in bioavailability may cause clinically significant effects on its safety or efficacy, separate administration of ferric maltol from these drugs. Duration of separation may depend on the absorption of the medication concomitantly administered (eg, time to peak concentration, whether the drug is an immediate or extended release product).fexinidazoleSerious - Use Alternative (1)fexinidazole and lithium both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.fingolimodMonitor Closely (1)fingolimod and lithium both increase QTc interval. Use Caution/Monitor.flecainideSerious - Use Alternative (1)lithium and flecainide both increase QTc interval. Avoid or Use Alternate Drug.fluconazoleMonitor Closely (1)lithium and fluconazole both increase QTc interval. Use Caution/Monitor.fluoxetineMonitor Closely (2)fluoxetine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely. lithium and fluoxetine both increase QTc interval. Use Caution/Monitor.Minor (1)fluoxetine, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.fluphenazineMonitor Closely (3)lithium, fluphenazine. Other (see comment). Use Caution/Monitor. Comment: Risk of neurotoxicity. Multiple mechanisms involved. lithium, fluphenazine. 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). lithium and fluphenazine both increase QTc interval. Use Caution/Monitor.flurbiprofenMonitor Closely (1)flurbiprofen increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.fluvoxamineMonitor Closely (2)lithium and fluvoxamine both increase QTc interval. Use Caution/Monitor. fluvoxamine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.foscarnetSerious - Use Alternative (1)lithium and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.fosinoprilMonitor Closely (1)fosinopril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule.fosphenytoinMinor (1)fosphenytoin increases toxicity of lithium by unknown mechanism. Minor/Significance Unknown.fostemsavirMonitor Closely (1)lithium and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir. frovatriptanMonitor Closely (1)frovatriptan and lithium both increase serotonin levels. Use Caution/Monitor.gemifloxacinMonitor Closely (1)gemifloxacin and lithium both increase QTc interval. Use Caution/Monitor.gemtuzumabMonitor Closely (1)lithium and gemtuzumab both increase QTc interval. Use Caution/Monitor.gilteritinibMonitor Closely (1)gilteritinib and lithium both increase QTc interval. Use Caution/Monitor.glasdegibSerious - Use Alternative (1)lithium and glasdegib both increase QTc interval. Avoid or Use Alternate Drug.goserelinSerious - Use Alternative (1)lithium and goserelin both increase QTc interval. Avoid or Use Alternate Drug.granisetronMonitor Closely (1)granisetron and lithium both increase QTc interval. Use Caution/Monitor.green teaMinor (1)green tea increases levels of lithium by unspecified interaction mechanism. Minor/Significance Unknown. Lithium levels may increase following abrupt caffeine withdrawal.haloperidolMonitor Closely (3)lithium, haloperidol. Other (see comment). Use Caution/Monitor. Comment: Risk of neurotoxicity. Multiple mechanisms involved. lithium, haloperidol. 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). lithium and haloperidol both increase QTc interval. Use Caution/Monitor.histrelinMonitor Closely (1)lithium and histrelin both increase QTc interval. Use Caution/Monitor.hydrochlorothiazideMonitor Closely (1)hydrochlorothiazide increases toxicity of lithium by decreasing elimination. Use Caution/Monitor.hydroxychloroquine sulfateSerious - Use Alternative (1)lithium and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.hydroxyzineMonitor Closely (1)hydroxyzine and lithium both increase QTc interval. Use Caution/Monitor.ibuprofenMonitor Closely (1)ibuprofen increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.ibuprofen IVMonitor Closely (1)ibuprofen IV increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.ibutilideSerious - Use Alternative (1)lithium and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.iloperidoneMonitor Closely (1)lithium, iloperidone. 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 iloperidone both increase QTc interval. Avoid or Use Alternate Drug.imidaprilMonitor Closely (1)imidapril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule.imipramineMonitor Closely (2)imipramine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely. lithium and imipramine both increase QTc interval. Use Caution/Monitor.Minor (1)lithium, imipramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.indapamideMonitor Closely (2)indapamide increases toxicity of lithium by decreasing elimination. Use Caution/Monitor. lithium and indapamide both increase QTc interval. Use Caution/Monitor.indomethacinMonitor Closely (1)indomethacin increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.inotuzumabSerious - Use Alternative (1)lithium and inotuzumab both increase QTc interval. Avoid or Use Alternate Drug.insulin aspartMonitor Closely (1)lithium, insulin aspart. unspecified interaction mechanism. Use Caution/Monitor. Lithium salts may cause either hypoglycemia or hyperglycemia. Insulin dosage adjustment and increased glucose monitoring may be required.insulin aspart protamine/insulin aspartMonitor Closely (1)lithium, insulin aspart protamine/insulin aspart. unspecified interaction mechanism. Use Caution/Monitor. Lithium salts may cause either hypoglycemia or hyperglycemia. Insulin dosage adjustment and increased glucose monitoring may be required.insulin degludecMonitor Closely (2)lithium, insulin degludec. unspecified interaction mechanism. Use Caution/Monitor. Lithium salts may cause either hypoglycemia or hyperglycemia. Insulin dosage adjustment and increased glucose monitoring may be required. lithium, insulin degludec. Other (see comment). Modify Therapy/Monitor Closely. Comment: Lithium may either increase or decrease the blood glucose lowering effect of antidiabetic agents.insulin degludec/insulin aspartMonitor Closely (1)lithium, insulin degludec/insulin aspart. Other (see comment). Modify Therapy/Monitor Closely. Comment: Lithium may either increase or decrease the blood glucose lowering effect of antidiabetic agents.insulin