Do Lithium & Trileptal Interact?
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Q:  Do Lithium & Trileptal Interact?

Is it common for lithium and trileptal to interact with one another? Hi I have son with a dual dx of bipolar/PDD. He will be 10 in September. He has been through so many psychiatrist, 7 inpatients. And he is seeing a new psychiatrist because his last one wouldn't up his seroquel said it was high enough. So gave us one that specialize in bipolar. So far he has increase his seroquel from 100,150,200. Now is taking 200, 200, 400 doses of Seroquel. He also is taking Trileptal 3 times a day total of 900mg a day. A week a half ago he start lithobid 300 mg twice a day. And also start on synthyroid because he had already had problems with his T4 which is low. And when he was on lithobid before he develop hypthyroid. So if it was to be used again he had to be put back on thryoid meds. Well on Sunday he start to vomit most of the day. By Monday he was complaining of severe dizziness and extreme sensitivity to light. I call the psychiatrist. But he did not call me back until Friday. After I left 2 messages for him to call me back. He could not walk to the bathroom, I had to help him walk to the bathroom. He watch tv with the lights off and wore sunglasses in the house. Tuesday he seem better still had a little bit dizziness and some light sensitivity. Well when his psychiatrist call on Friday he said that it is the lithium that may have cause it and wants us to wean him off the lithium. So yesterday he only got his morning dose and today only the morning dose. And tomorrow will have his morning dose. Then on Monday he will be completely off his lithium. We see the psychiatrist on Wednesday. I have notice with the lithium reduce his moods and aggression are getting worst. His last psychiatrist said our son is a very difficult case to treat. And was very leary on using medications that are not tested for children with bipolar. One of the reason we went to see this new one. I still think that the lithium raised the blood levels of trileptal to higher doses which cause the dizziness and light sensitivity. But his theory is that   he didn't have this problem before the lithium was added. I guess I am not happy with Trileptal we have been using it since July of last year. And don't see much benefit from it. Seroquel on the other hand has help alot since it has been raised. But may need some tweaking or adjustments during the day. 


Dear Robin --
As you explained, "I still think that the lithium raised the blood levels of trileptal to higher doses which cause the dizziness and light sensitivity. But his theory is that he didn't have this problem before the lithium was added."  

As you've asked, there's another explanation, namely that the two are interacting.  There is a known interaction between carbamazepine (as you know, Trileptal is oxcarbazapine, very closely related) and lithium with symptoms very much as you describe.  The interaction is not a raising of Trileptal levels by lithium, though, because there's no direct interaction between the two in terms of how the body clears them out (Trileptal, liver, primarily; lithium, kidney exclusively); it's some direct effect on the brain.  

However, what this means is that lithium might be a good agent for your son, just not in the presence of Trileptal.  People like your son are likely to end up trying many different medications. It's important to note which ones appeared to have some benefit for consideration in combinations later on.  Sounds like lithium might go in that category, and perhaps even Trileptal -- but not together, obviously. 

Dr. Phelps

Published September, 2004


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