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Eskalith-CR and Zorvolex

Determining the interaction of Eskalith-CR and Zorvolex and the possibility of their joint administration.

Check result:

Eskalith-CR <> Zorvolex

Relevance: 09.11.2023 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Diclofenac may significantly increase the blood levels of lithium in some patients and cause lithium intoxication. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. Let your doctor know if you experience drowsiness, dizziness, diarrhea, vomiting, muscle weakness, muscle incoordination, tremor, blurred vision, ringing in the ear, excessive thirst, and/or increased urination, as these may be symptoms of excessive lithium levels. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR CLOSELY: Coadministration with nonsteroidal anti-inflammatory drugs (NSAIDs) may increase serum lithium levels and induce toxicity in some patients. The exact mechanism of interaction is unknown, but is thought to involve inhibition of renal prostaglandin synthesis by NSAIDs, resulting in decreased renal blood flow and lithium excretion. There have been numerous published reports of lithium toxicity, including severe cases, following the introduction of various NSAIDs including diclofenac, ibuprofen, indomethacin, ketorolac, mefenamic acid, piroxicam, and COX-2 inhibitors. However, pharmacokinetic studies have been somewhat inconsistent, with no significant effects reported for benoxaprofen and etodolac, and up to a 58% increase in serum lithium levels reported for indomethacin. Both decreased serum concentrations of lithium and no effect have been reported for sulindac and aspirin. The interaction is apparently subject to marked interpatient variability.

MANAGEMENT: Caution is advised when lithium is used concurrently with NSAIDs. Patients should have serum lithium levels checked every 4 to 5 days after starting an NSAID until the extent of any potential interaction can be evaluated. A reduction in lithium dosage may be needed in some cases. Patients should be advised to seek medical attention if they experience potential signs and symptoms of lithium toxicity such as drowsiness, dizziness, confusion, weakness, ataxia, tremor, tinnitus, blurred vision, vomiting, diarrhea, thirst, and increased urination.

References

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Eskalith-CR

Generic Name: lithium

Brand name: Eskalith, Lithobid, Lithonate, Lithotabs, Eskalith-CR

Synonyms: Eskalith-CR (Oral)

What is Eskalith-CR?

Zorvolex

Generic Name: diclofenac

Brand name: Cambia, Cataflam, Voltaren-XR, Zipsor, Zorvolex, Voltaren, Dyloject, also Cambia

Synonyms: n.a.

What is Zorvolex?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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