Adding lithium to topiramate.
- Topiramate induces CYP3A4 and is an inhibitor of CYP2C19.
- Lithium is eliminated by the kidney for about 95%. Changes in the rate of excretion can cause unwanted effects.
- This combination of drugs may have possible synergistic effects. However, this combination will also have additive side effects. Dose adaptation will be recommended for this combination.
- Start lithium according to the general dosing advice.
- Elevated and toxic lithium levels have been reported with higher (800 mg/d) doses of topiramate, but not with 500 mg/d. 
- Pharmacologic response and serum lithium levels should be monitored closely in particular after change of dosage or discontinuation of topiramate.
The editors of psychiatrienet.nl take the greatest care to provide up-to-date and accurate information on this site. Nevertheless, mistakes and omissions cannot be entirely excluded. No rights devolve from the information provided. The editors and other providers of information to this site accept no responsibility for the content of this site or for the information provided therein; neither do they accept responsibility for possible damages which may derive from the use of the information on this site or from the linked sites. The editorial board accepts no responsibility for the content of the (linked) sites, for access to them, or for the products and services on these sites, nor for the occurrence of errors, viruses, and/or disruptions in service.