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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Jade on July 30, 2000, at 10:21:13
How do you deal with these meds when a person is nauseous?
Is it ok to stop the Lithium for a day or two but continue the Olanzapine?
What is the best approach with this combo?
Thanks
Jade
Posted by Cam W. on July 30, 2000, at 11:55:22
In reply to Olanzapine-Lithium and Emesis, posted by Jade on July 30, 2000, at 10:21:13
Jade - How long have you been taking the lithium and what is the dose you are taking? Are you taking the lithium with a meal? Do you have any other side effects (eg diarrhea, vertigo, muscle weakness)? Are your lithium blood levels within a normal range? Are you taking the regular or long acting form of lithium?
Don't stop the lithium. Ask your doc if you can split the lithium dose (am & pm) or maybe try taking the lithium and olanzapine at least an hour or two apart. Taking a long acting form of lithium (eg Duralith - in Canada) can decrease some of the nausea, as can taking it with food.
The nausea should go away with use, within the first month. Stick with it, but also ask your doc for his/her suggestions.
Hope this helps - Cam.
Posted by Jade on July 30, 2000, at 14:22:37
In reply to Re: Olanzapine-Lithium and Emesis » Jade, posted by Cam W. on July 30, 2000, at 11:55:22
> Jade - How long have you been taking the lithium and what is the dose you are taking? Are you taking the lithium with a meal? Do you have any other side effects (eg diarrhea, vertigo, muscle weakness)? Are your lithium blood levels within a normal range? Are you taking the regular or long acting form of lithium?
Cam,
It is my son who is currently taking 1500mg Lithium (regular) & 10mg Olanzapine hs and not with a meal. He has been on this for 7mths.
He had no diarrhea etc. I think he just caught a bug. He does not currently have a doctor as he is moving around, so don't know what his blood levels are. He has not seen a doctor for 1.5 mths and I'm working on him getting this organized.
He did not take the lithium for the one night because he felt it would just make him more sick but I did convince to take the Olanzapine. I'm dealing with long distance, spur of the moment kind of situations.
So, what is the best strategy for a situation where one is ill. Only take a smaller dose of Lithium or to take full dose in the a.m., or skip to the next regular dose?
Thanks
Jade
Posted by Cam W. on July 30, 2000, at 20:00:35
In reply to Re: Olanzapine-Lithium and Emesis, posted by Jade on July 30, 2000, at 14:22:37
Jade - not to sound like a run-of-the-mill, old medical poop, but you should really have your son's lithium level checked at least 3 to 6 times a year (twice a year for adults) when stabilized. Lithium has a very small therapeutic window (difference between the minimal medically effective dose and the toxic dose). There are a number of situations that can change lithium blood levels, leading to some significant problems (fever, dehydration, vomiting, crash diets, and sodium restricted diets; among other things, usually dealing with reduced body fluid volumes).
Signs of toxicity with lithium are: worsening tremor, slurred speech, muscle weakness &/or twitching, and difficulty walking. It does not sound like your son is toxic, but he may be close.
If you had to do something and since the nausea is most likely due to the lithium, I would probably split the dose to morning and evening doses (breakfast and supper), with the larger dose in the evenings. Also, take the lithium with meals, but his olanzapine can be taken at bedtime.
I am not a doctor. You really should see a doctor and get a requisition for a blood test. He will eventually need one for a refill for his medications. I wouldn't decrease the lithium dose until you talk to a doctor, as well. If you lower the dose too much, you could drop his lithium blood levels below the effective concentration and place your son in a situation where he could have a relapse.
As for the nausea and vomiting, maybe try sipping ginger ale (stir the bubbles out), ginger from a health food store, peppermint candies, dry toast, crackers, or a little Gravol.
Good luck and keep us posted. - Cam
Posted by Sunnely on July 30, 2000, at 20:19:57
In reply to Re: Olanzapine-Lithium and Emesis, posted by Jade on July 30, 2000, at 14:22:37
> I think he just caught a bug.
> So, what is the best strategy for a situation where one is ill. Only take a smaller dose of Lithium or to take full dose in the a.m., or skip to the next regular dose?
If indeed he has a flu ("bug"), this may spell trouble for someone on lithium. Flu syndrome can raise the blood level of lithium significantly. This in turn could lead to a clinical picture of being lithium toxic. Without first-hand knowledge of your son's condition, I can't tell you what to do with his lithium dose. However, if your son becomes unusually lethargic, weak, confused, tremolous, I strongly suggest that you hold that lithium dose and get that lithium level checked, ASAP. These are usual signs of lithium toxicity. Not trying to cause you undue alarm, but uncontrolled lithium toxicity can lead to more serious complications such as seizures, coma, and even death. At times, even when the condition is corrected, residual effects for example, continued incoordination, unsteadiness (cerebellar effects), and tremors, have been reported.
BTW, make sure he is adequately nourished and hydrated.
Posted by Jade on July 30, 2000, at 23:22:39
In reply to Re: Olanzapine-Lithium and Emesis, posted by Sunnely on July 30, 2000, at 20:19:57
Thank you for your responses!
He has no symptoms of toxicity so far but I will try to watch more carefully.
He is somewhat aware of his symptoms and watches for diahrrea as a toxic sign. He is currently an hour away from home but is not cooperative with suggestions etc. I am trying my best to get him to see a doctor but his last visit was at an emerg where he was prescribed 2 mths of meds and he is trying to find a home etc. at this point.
Considering his absolute insistance on independence to the extreme and his relative instability, perhaps it would be best for him to be on a different med than Lithium? He may be ammenable to this. I have not seen a significant improvement with the Lithium.
Thanks again
Jade
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