Drug interactions
Lithium + Tolmetin
Severity: Major
Lithium and Tolmetin: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Tolmetin can raise serum lithium concentrations and cause lithium toxicity, with tremor, confusion, vomiting, ataxia and in severe cases seizures. The risk is greatest in the elderly and those with renal impairment or dehydration.
What this interaction means in plain words
Lithium and Tolmetin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Lithium belongs to Central Nervous System; Tolmetin belongs to Musculoskeletal.
Why it happens
NSAID-induced reduction in renal prostaglandins lowers renal blood flow and lithium clearance.
What to do
Measure lithium levels at baseline and within about a week of starting or stopping tolmetin, and reduce the lithium dose as needed. Prefer an alternative analgesic such as acetaminophen where possible.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Tolmetin
- Ketorolac intranasal + Tolmetin Contraindicated
- Ketorolac + Tolmetin Contraindicated
- Aceclofenac + Tolmetin Major
- Acemetacin + Tolmetin Major
- Alteplase + Tolmetin Major
- Amlodipine-hydrochlorothiazide-valsartan + Tolmetin Major
Other interactions of Lithium
- Lithium + Thioridazine Contraindicated
- Lithium + Vandetanib Contraindicated
- Aceclofenac + Lithium Major
- Acemetacin + Lithium Major
- Amisulpride + Lithium Major
- Amlodipine-benazepril + Lithium Major
Frequently asked questions
Can I take Lithium with Tolmetin?
MediHelp rates the interaction as major. Lithium and Tolmetin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Tolmetin can raise serum lithium concentrations and cause lithium toxicity, with tremor, confusion, vomiting, ataxia and in severe cases seizures. The risk is greatest in the elderly and those with renal impairment or dehydration.
How serious is the interaction between Lithium and Tolmetin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Measure lithium levels at baseline and within about a week of starting or stopping tolmetin, and reduce the lithium dose as needed. Prefer an alternative analgesic such as acetaminophen where possible.
What other medicines interact with Tolmetin?
MediHelp also lists interactions of Tolmetin with, for example, Ketorolac intranasal, Ketorolac, Aceclofenac. The full list is on the Tolmetin page.
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