Which statement about NSAID use with lithium is true?

Which statement about NSAID use with lithium is true?

• A. NSAIDs can increase lithium levels; avoid or use acetaminophen
• B. NSAIDs are safe with lithium and do not affect levels
• C. Lithium should be discontinued when NSAIDs are used
• D. NSAIDs decrease lithium levels significantly

Answer: (A)

NSAIDs can raise lithium levels because both drugs involve the kidneys. Lithium is cleared by the kidneys and is reabsorbed in the proximal tubule like sodium. NSAIDs inhibit prostaglandin synthesis, which lowers renal blood flow and glomerular filtration. That reduction causes more lithium to be reabsorbed back into the bloodstream, elevating its serum concentration and increasing the risk of toxicity (tremor, confusion, ataxia, GI symptoms, etc.). Because of this interaction, NSAIDs are generally avoided or used with caution in someone taking lithium, and acetaminophen is often preferred for pain or fever. If NSAIDs are necessary, monitor lithium levels and patient for toxicity, and ensure adequate hydration. The other statements aren’t accurate because NSAIDs do affect lithium levels, lithium isn’t always discontinued with NSAID use, and NSAIDs do not decrease lithium levels.

NSAIDs can raise lithium levels because both drugs involve the kidneys. Lithium is cleared by the kidneys and is reabsorbed in the proximal tubule like sodium. NSAIDs inhibit prostaglandin synthesis, which lowers renal blood flow and glomerular filtration. That reduction causes more lithium to be reabsorbed back into the bloodstream, elevating its serum concentration and increasing the risk of toxicity (tremor, confusion, ataxia, GI symptoms, etc.). Because of this interaction, NSAIDs are generally avoided or used with caution in someone taking lithium, and acetaminophen is often preferred for pain or fever. If NSAIDs are necessary, monitor lithium levels and patient for toxicity, and ensure adequate hydration. The other statements aren’t accurate because NSAIDs do affect lithium levels, lithium isn’t always discontinued with NSAID use, and NSAIDs do not decrease lithium levels.