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Q. Can Lithium and Ibuprofen interaction result in neurological toxicity without kidney damage?

Answered by
Dr. Nagaraj Patil
and medically reviewed by Dr. Sneha Kannan
This is a premium question & answer published on Jun 30, 2020
I want to know if it is possible for a young person (age 27) to experience neurological lithium toxicity WITHOUT showing evidence of kidney damage/problems.
I have been taking 1200mg of Lithium for 5 years. Last year I suffered an injury which required regular pain management. I was told to take Ibuprofen (NSAID) at a maximum dose every day. Within weeks, I developed ataxia, muscle weakness and spasticity, loss of memory, polyuria, incontinence, tremor, blue hands, chest pain, weakness, and the inability to lift my legs. I was referred for an evaluation for Multiple Sclerosis and Parkinsons Disease, but I was not diagnosed with either. The symptoms began to ease when I stopped taking NSAIDs. I was precribed them again at a maximum dose following surgey and I was hospitalized for the same symptoms. My kidney function was normal.
I was unaware until now that NSAIDs can cause serious complications for Lithium users- including toxicity. My symptoms match with those of Lithium toxicity but all lab tests during this time did not demonstrate any kidney problems.
I am a 27 year old female. Is it possible to have chronic medication interaction neurological toxicity (Lithium + NSAIDs) without kidneys showing evidence of this?

Dr. Nagaraj Patil

Diabetology General Medicine Internal Medicine
# Hi. this is pure drug drug interaction which is well known with Lithium. in fact Lithium interacts with many drugs and is one of the drugs with narrow therapeutic index. Symptoms of Lithium toxicity can develop even in absence of kidney damage as they are mainly due to increased lithium concentration in blood. You have not mentioned why u were prescribed lithium. In any case, anyone on Lithium is required to monitor its blood levels at regular intervals and not to take any medications without consulting doctor.

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