ANTIPSYCHOTICS AND LITHIUM

Chlorpromazine levels can be reduced to subtherapeutic concentrations by lithium, and one study suggested that lithium may reduce olanzapine plasma levels. Lithium may increase amisulpride levels. The development of severe extrapyramidal adverse effects or severe neurotoxicity has been seen in one or more patients given lithium with amoxapine, chlorpromazine, chlorprothixene, clopenthixol, clozapine, flupen- tixol, fluphenazine, haloperidol, levomepromazine, loxapine, mesoridazine, molin- done, olanzapine, perphenazine, prochlorperazine, risperidone, sulpiride, thioridazine, tiotixene, trifluoperazine or zuclopenthixol. Sleep-walking has been described in some patients taking chlorpromazine-like drugs and lithium. Additive QT-prolonging effects also possible, see drugs that prolong the QT interval.
Monitor the outcome of concurrent use being aware that on occasion dosage adjustments may be needed to manage adverse effects. Withdraw one or both drugs if severe neurotoxicity occurs.
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