Q: Interactions between Lithium and Tetracycline?
My husband recently had a tetracycline antibiotic injected into his gums during
a dental procedure at 10:00 am. Within 9 hours I observed a "slight" shift in
him toward agitation and mild hypomania; by the next morning (21 hours later) I
observed a significant worsening of his existing depression; by that evening
extreme agitation and irrational, reactive and almost paranoid thinking toward
me.
He is taking only 600 mg lithium per day, usually at night. On this particular
instance, he had forgotten to take it the night before the dental procedure, and
took the dosage in the morning, approx. 2-3 hours before the gum injection.
I've researched all I can find and although I find that tetracycline can elevate
lithium serum levels, possibly resulting in lithium toxicity, I see nothing that
would indicate this rapid and severe mood shift after tetracycline is
introduced.
I've spoke to our psychiatrist and her view is that the elevated lithium level
would not have triggered this mood shift. She doesn't seem to believe me,
although she does want him to increase his lithiumm to 900.
What is your opinion on this? Are you aware of any cases like this? I should
add that my husband's chemistry is very sensitive to medications: a small amount
of anything impacts him strongly. I was there and I saw this significant mood
shift, which, after 2 days came back to where it was the 3 days before the
dental injection.
Background: Diagnosed 2.5 years ago w/Cyclothymia at age 47. Family history:
sibling BPI; first cousin BPII; father. First psychiatrist inappropriately put
him on Lexapro, which indused hypomania and mania and HUGE UPEHAVAL IN OUR
LIVES. Then we found new doctor who prescribed Lithium. Husband stabilized on
450 mg, for almost 2 years, for the most part. Seven months ago due to high
stress, had a hypomanic episode which was also missed by psychotherapist
resulting in worsening conditions and continued destabilization for several
months. So, I'm aware that when the dental injection was given my husband was
already in a "vulnerable" place, however, there absolutely was a HUGE mood
swing, very rapid.
Thank you
Dear April --
As you probably did, I did literature search for tetracycline mania (Google and
Pub Med). Did not find anything there. However, by your account one would have
to strongly suspect that the antibiotic did indeed precipitate a mood swing. As
one of my primary care doctor friends says, "medications are guilty until proven
innocent" . I am certainly going to file it in my head that way, but no, I have
never seen another case like this.
Dr. Phelps
Published October, 2007
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