Question: Why are you so down on Luvox? It has worked well for me in the past. Also, I use 1200 of Lithium and my creatinine is 1.2. I have used it 10 years. At what creatinine level should Lithium be stopped? I would try Abilify but am diabetic. – John
Answer: I wouldn’t say I’m “down” on Luvox. I do have a few patients who seem to do well on it. The reason I try other serotonin reuptake inhibitors is that Luvox has the most drug-drug interactions in that group of meds (Prozac, Zoloft, Paxil, Celexa, Lexapro, low dose Effexor XR 37.5-75). For example, Luvox blocks the metabolism of caffeine – which may be the reason it causes more insomnia. It can cause more daytime sedation. It also blocks the metabolism of all the meds (and hormones) in the 3A4 category (the biggest group), so that can make things very complicated.
Prolonged use of Lithium can lead to some type of kidney impairment, probably inflammatory. It’s more likely if serum levels are higher (1.0 and above) and may be more likely in individuals that have frequent urination and thirst. It usually develops after years of use, and so far in my experience, it has not progressed to be a severe problem. But usually the Lithium itself was stopped.
I don’t routinely monitor creatinine levels. They only start going up if kidney function is reduced by 75% or more. If that occurs, the serum Lithium will go up without a change in dose or decrease in sodium intake or excess sodium loss (e.g. taking diuretics, vomiting, or diarrhea).
The normal creatinine range is 0.7 to 1.3. One high value could be some minor issue, so it needs to be repeated. Other tests are more specific (e.g. 24 urine creatinine or creatinine clearance). One easy test is to restrict water and see if you can concentrate your urine (becomes dark). Urine can also be tested with a dipstick available over-the-counter for specific gravity (level of concentration), glucose, protein, inflammatory cells, etc.
The fact that you have Diabetes is a bigger concern as regards your kidneys. I’m sure your doctor has counseled you about the importance of maintaining good blood sugar levels. There shouldn’t be any sugar in your urine.
I don’t think you should rule out Abilify because you have Diabetes. The FDA has required all meds in the atypical group (Abilify, Geodon, Risperdal, Seroquel, Zyprexa, and Symbyax) to list Diabetes as a possible side effect. But actual reported cases with Abilify have been extremely rare.
As with all meds, the decision comes down to benefit vs. risks, and in your case, Abilify might be a good option.
