lithium and haloperidol incompatibility

lithium and haloperidol incompatibility

Joined: April 1st, 2004, 4:56 pm

May 6th, 2007, 2:28 pm #1

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<FONT size=-1>Am J Psychiatry 1981; 138:818-821
Copyright © 1981 by American Psychiatric Association </FONT>

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New data on lithium and haloperidol incompatibility
<STRONG>G Spring and M Frankel </STRONG>
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The authors describe a case of combined lithium and haloperidol toxicity characterized by hyperpyrexia, severe rigidity, mutism, and development of irreversible tardive dyskinesia. This case is similar to four other cases described in the literature and to the neuroleptic malignant syndrome. The authors postulate that two types of combined lithium-neuroleptic toxicity occur: a neuroleptic malignant extrapyramidal syndrome and a lithium toxicity that occurs in combination with phenothiazines, primarily thioridazine. Possible mechanisms and preventive measures are discussed. </VARDEF><BR clear=all>[font=][/font]<BR clear=all><BR clear=all><A name=otherarticles><!-- null --></A>
<FONT size=+2><STRONG>This article has been cited by other articles:</STRONG></FONT> (<FONT color=#004586>Search Google Scholar for Other Citing Articles</FONT>)

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<FONT face=verdana,arial,helvetica size=-1>M. P. Freeman and A. L. Stoll
<STRONG>Mood Stabilizer Combinations: A Review of Safety and Efficacy</STRONG>
Am J Psychiatry, January&nbsp;1,&nbsp;1998; 155(1): 12 - 21.
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Joined: April 1st, 2004, 4:56 pm

May 6th, 2007, 2:33 pm #2

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<TD class=content_box_item vAlign=center><FONT color=#004586>General Topics in Psychiatry</FONT> </TD></TR></TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE><FONT size=-1>Psychosomatics 42:370, August 2001
© 2001 <FONT color=#004586>The Academy of Psychosomatic Medicine</FONT> </FONT>

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Olanzapine-Lithium Encephalopathy <STRONG>Conrad M. Swartz, Ph.D., M.D., Department of Psychiatry, Southern Illinois University School of Medicine, Springfield, Illinois </STRONG>

<STRONG>Key Words:</STRONG> Olanzapine • Lithium • Encephalopathy
T<FONT size=-1>O</FONT> T<FONT size=-1>HE</FONT> E<FONT size=-1>DITOR</FONT>: In a recent case we successfully treated haloperidol-lithium interaction encephalopathy by haloperidol discontinuation alone. Encephalopathy reappeared when olanzapine was added to lithium.
<FONT size=+1><STRONG>Case Report</STRONG></FONT>
Mr. F, a 59-year-old white man, was admitted to a university hospital in St. Louis, Missouri, for persistent obsessive thoughts that people were plotting against him and that his bowels were constipated. Mr. F. identified these thoughts as incorrect and said they recurred frequently and he could not stop them. He described compulsions to move his bowels, and he often requested and ingested laxatives to the point that he developed diarrhea and incontinence. On interview, Mr. F. displayed no delusions or hallucinations, only obsessions; he showed no sadness or apathy. His attention and memory were impaired, and he was unable to recall his recent hospitalization for painful pancreatitis from divalproex. He showed neither ambulation difficulty nor motor weakness.
Although Mr. F. had past manic episodes, none appeared during this hospitalization. He regularly took lithium (900 mg/day), haloperidol (20 mg/day), and carbamazepine. An EEG on admission was abnormal, with sharp transient wave activity, right frontotemporal-cortical irritability and slowing, interpreted as encephalopathy with a tendency to seizures. Other admission laboratory exams were noncontributory [e.g., SGOT was normal, carbamazepine (6.5 µg/mL), and lithium (0.8 mEq/L)]. Vital signs were normal.
Haloperidol was stopped. Three days later, without other intervention, the obsessions disappeared and his attention and concentration were good. CT scan and sleep-deprived EEG awake and asleep were normal, the latter without any of the pathology previously reported. After four additional days to ensure stability, Mr. F. was discharged. His thoughts at that time remained under control.
Four weeks after discharge olanzapine (5 mg/day) was started when Mr. F. presented with persistent worries about his girlfriend's fidelity and his bowels. He was not disoriented and no delusions were noted. After another 3 weeks he was found to be disoriented. He had prepared a Thanksgiving dinner although it was only mid-October. The treating outpatient psychiatrist declined to order an EEG or neuropsychological assessment. Olanzapine was continued and the patient remained disoriented.
<FONT size=+1><STRONG>Discussion</STRONG></FONT>
An encephalopathic syndrome with confusion can result from concurrent haloperidol and lithium.<FONT color=#004586>1</FONT>,<FONT color=#004586>2</FONT> Despite an average 37% decrease in haloperidol blood levels by carbamazepine,<FONT color=#004586>3</FONT> haloperidol (20 mg/day) plainly had substantial effects on Mr. F. Neuroleptic malignant syndrome, which does not require lithium exposure, was excluded by the normal vital signs and absence of weakness. Reappearance of encephalopathy when olanzapine was added to lithium suggests a similarity in mechanism with lithium-haloperidol encephalopathy. Because the original encephalopathy resolved with haloperidol discontinuation alone, the course suggests that lithium discontinuation might not always be necessary. It might be incidental that obsessive-compulsive disorder has an excess incidence in bipolar patients.<FONT color=#004586>4</FONT>
<FONT size=+1><STRONG>REFERENCES</STRONG></FONT>

<OL compact><A name=R429231><!-- null --></A>
<LI value=1>Cohen WJ, Cohen NH: Lithium carbonate, haloperidol, and irreversible brain damage. JAMA 1974; 230:1283-1287<!-- HIGHWIRE ID="42:4:370:1" --><FONT color=#004586>[CrossRef]</FONT><FONT color=#004586>[Medline]</FONT><!-- /HIGHWIRE --> <A name=R429232><!-- null --></A>
<LI value=2>Goldman SA: Lithium and neuroleptics in combination: is there enhancement of neurotoxicity leading to permanent sequelae? J Clin Pharmacol 1996; 36:951-962<!-- HIGHWIRE ID="42:4:370:2" --><NOBR><FONT color=#004586>[Abstract/</FONT><FONT color=#cc0000>Free</FONT><FONT color=#004586>&nbsp;Full&nbsp;Text]</FONT></NOBR><!-- /HIGHWIRE --> <A name=R429233><!-- null --></A>
<LI value=3>Hirokane G, Someya T, Takahashi S, et al: Interindividual variation of plasma haloperidol concentrations and the impact of concomitant medications: the analysis of therapeutic drug monitoring data. Ther Drug Monit 1999; 21:82-86<!-- HIGHWIRE ID="42:4:370:3" --><FONT color=#004586>[CrossRef]</FONT><FONT color=#004586>[Medline]</FONT><!-- /HIGHWIRE --> <A name=R429234><!-- null --></A>
<LI value=4>Krüger S, Cooke RG, Hasey GM, et al: Comorbidity of obsessive compulsive disorder in bipolar disorder. J Affect Disord 1995; 34:117-120<!-- HIGHWIRE ID="42:4:370:4" --><FONT color=#004586>[CrossRef]</FONT><FONT color=#004586>[Medline]</FONT><!-- /HIGHWIRE --> </LI>[/list]<BR clear=all>[font=][/font]<BR clear=all><BR clear=all><BR clear=all>
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