Is it safe to prescribe high-dose lithium and aripiprazole (Abilify)?

From the Guidelines

Prescribing high-dose lithium with Abilify (aripiprazole) is not generally recommended without close monitoring and should only be considered by a psychiatrist who can evaluate individual patient factors and adjust dosages accordingly. This combination carries increased risks of toxicity, including tremor, confusion, seizures, kidney damage, and cardiac issues, as well as enhanced neurological side effects such as movement disorders, sedation, and cognitive changes 1.

Key Considerations

• High-dose lithium (typically above 1200mg daily or serum levels above 1.0 mEq/L) requires regular monitoring, including lithium level checks (every 3-6 months once stable, more frequently when starting or adjusting doses), kidney and thyroid function tests, and electrocardiograms 1.
• Patients should maintain consistent salt and fluid intake, avoid dehydration, and be educated about signs of lithium toxicity.
• The combination may be beneficial for certain bipolar disorder presentations where either medication alone provides insufficient mood stabilization, but the risks must be carefully weighed against potential benefits for each individual patient.

Monitoring Requirements

• Baseline laboratory assessment should include complete blood cell counts, thyroid function tests, urinalysis, blood urea nitrogen, creatinine, and serum calcium levels, and a pregnancy test in female adolescents 1.
• Regular monitoring of body mass index, waist circumference, blood pressure, fasting glucose, and fasting lipid panel is also recommended due to the risk of weight gain and metabolic problems associated with atypical antipsychotics like Abilify 1.

Conclusion is not allowed, so the answer just ends here.

From the FDA Drug Label

7.2 Drugs Having No Clinically Important Interactions with Aripiprazole Based on pharmacokinetic studies, no dosage adjustment of aripiprazole is required when administered concomitantly with ... lithium.

The combination of lithium and aripiprazole (Abilify) is considered to have no clinically important interactions.

• No dosage adjustment of aripiprazole is required when administered concomitantly with lithium. However, it is essential to note that this information does not explicitly address the safety of high-dose lithium with aripiprazole. Therefore, when prescribing high-dose lithium with aripiprazole, it is crucial to exercise caution and monitor the patient closely for any potential adverse effects 2.

From the Research

Safety of High-Dose Lithium and Aripiprazole

• The safety of prescribing high-dose lithium and aripiprazole (Abilify) is a complex issue, with several factors to consider, including the risk of lithium toxicity and the potential for drug interactions 3, 4, 5.
• Lithium has a narrow therapeutic index, and high doses can increase the risk of toxicity, particularly in patients with impaired kidney function 3, 4.
• Aripiprazole, on the other hand, has been shown to have no clinically significant effects on the pharmacokinetics of lithium, suggesting that the two drugs can be safely co-administered 5.
• However, the risk of lithium toxicity can be mitigated by careful monitoring of plasma lithium concentrations and adjusting the dose accordingly 3, 4.

Dosing Considerations

• The optimal dosing schedule for lithium is still a topic of debate, with some studies suggesting that single daily doses may be as effective as multiple daily doses, while minimizing the risk of long-term renal damage and increasing compliance 6.
• Low-dose lithium augmentation has been shown to be effective in treating resistant depression, with minimal risk of side effects and drug interactions 7.
• The co-administration of aripiprazole with lithium or valproate has been shown to have no clinically meaningful effects on the pharmacokinetics of either drug, suggesting that the combination is safe and effective 5.

Potential Risks and Interactions

• The combination of high-dose lithium and aripiprazole may increase the risk of adverse events, such as confusion, ataxia, or seizures, particularly in patients with impaired kidney function or other underlying medical conditions 3, 4.
• Regular monitoring of plasma lithium concentrations, kidney function, and thyroid function is essential to minimize the risk of adverse events and ensure safe and effective treatment 3, 4.