Interaction of indomethacin and ibuprofen with lithium in manic patients under a steady-state lithium level

The clinical effects of prostaglandin synthesis inhibitors were studied in lithium treated manic patients. While indomethacin increased plasma lithium concentration, the effect of ibuprofen was inconsistent. Adverse reactions included tremors unrelated to changes in plasma lithium levels; nausea and drowsiness in 1 ibuprofen treated patient possibly related to the slight increase in plasma lithium, and a syndrome consisting of running nose, malaise and generalized body aches in 1 indomethacin treated patient. Our findings are in support of an important interaction between prostaglandin synthesis inhibitors and especially indomethacin and lithium, which may result in an increase in adverse reactions.