[Confusion caused by dietary supplement lithium orotate]

Area of Science:

• Pharmacology
• Infectious Diseases
• Gynecology

Background:

• A 38-year-old woman presented with pelvic inflammatory disease and a diagnosed tubo-ovarian abscess.
• Standard treatment indicated antibiotics like metronidazole and levofloxacin.
• The patient was reportedly taking lithium, necessitating alternative medication choices due to potential drug interactions.

Observation:

• The patient was initially prescribed clindamycin instead of metronidazole to avoid lithium interaction.
• Naproxen for pain management was also withheld due to the perceived lithium interaction.
• Upon investigation, the patient's lithium intake was identified as lithium orotate, a dietary supplement obtained online.

Findings:

• Serum lithium levels were found to be below the therapeutic threshold (<0.05 mmol/l).
• This low level indicated no significant risk of interaction with metronidazole or naproxen.
• Consequently, antibiotic therapy was adjusted back to metronidazole, and naproxen was initiated for pain relief.

Implications:

• Highlights the importance of verifying the exact form and source of 'lithium' intake in patients.
• Underscores the need for accurate medication reconciliation, especially with supplements.
• Demonstrates how misidentification of supplements can lead to unnecessary medication changes and delayed treatment.