bipolar
3 interactions related to bipolar
alcohol + lithium
Lithium has a narrow therapeutic window and is cleared almost entirely by the kidneys. Alcohol promotes urination and dehydration, which can reduce renal lithium clearance and push serum lithium levels higher — toward the toxic range (tremor, confusion, unsteadiness, vomiting). Alcohol also independently destabilizes mood in bipolar disorder, and its early intoxication signs can mask the early warning signs of lithium toxicity.
grapefruit + quetiapine
Quetiapine is metabolized primarily by CYP3A4. Grapefruit juice irreversibly inhibits intestinal CYP3A4 and can substantially increase quetiapine plasma concentrations. A published case report describes quetiapine toxicity in a young woman who consumed a large volume of grapefruit juice over a single day while on a stable dose, with sedation, low blood pressure, and ECG changes that resolved once the juice was stopped.
energy drinks + lithium
The caffeine in energy drinks increases how fast the kidneys clear lithium, so swings in caffeine intake can shift serum lithium in either direction. Heavy or rising caffeine intake can pull lithium toward the lower, less effective end of its narrow range, while abruptly cutting or stopping caffeine while on a stable lithium dose can push serum lithium up into the toxic range. Because lithium has one of the narrowest therapeutic windows in psychiatry, the variability of energy drink use is the real hazard.