Does Lithium Interact With Turmeric And Bioperine?

In our latest question and answer, the pharmacist discusses the potential interaction between turmeric with Bioperine and lithium.

Question

I take 900mg of lithium ER daily. I am considering taking turmeric with 5mg Bioperine supplement but am concerned with interactions.

Asked by tom On May 12, 2019

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On May 13, 2019
Lithium With Text Title Image - With Turmeric

Overview

Lithium is well documented to have an abundant number of potential drug interactions since there are so many things (food and drugs alike) that can affect how our body utilizes it.[1]

Lithium is known as a 'monovalent cation', similar to sodium and potassium. All three of these are found on the periodic table:[2]

  • Li (Lithium)
  • Na (Sodium)
  • K (Potassium)

Concentrations of monovalent cations, such as lithium, can fluctuate greatly based on a number of factors.

Factors that can affect how lithium is metabolized, distributed and stored in our body include:[3]

  • Body water content
  • Total body mass
  • Sodium concentrations
  • Kidney function

Something as simple as altering the amount of caffeine or salt we consume while on lithium therapy could cause major complications.[4]

Making drug-interactions with lithium that much more serious is the fact that it is considered a 'narrow therapeutic index' drug. The means that there is a very fine line between sub-therapeutic, therapeutic and toxic levels.[5]

As it concerns turmeric with Bioperine (a patented black pepper extract), there are no documented case studies in which an interaction with lithium has been observed, but that doesn't necessarily mean there aren't any. In fact, there is a theoretical interaction between lithium and Bioperine.


What Is Turmeric With Bioperine?

Most turmeric nutritional supplements are paired with Bioperine, a patented form of black pepper extract. Bioperine has been shown in studies to significantly increase turmeric absorption (which is why it is included in supplements).[6]

So, if we are looking into potential drug interactions, we need to consider both turmeric and black pepper extract.


Interaction With Lithium

As stated, there has been no published evidence of a drug interaction between lithium and turmeric with Bioperine but there is a theoretical one based on the known properties of black pepper.

Bioperine (black pepper) is thought to have mild diuretic properties. Diuretics have been shown in studies to potentially increase lithium levels in those taking the drug, increasing the risk of toxicity.[7]

Turmeric (alone) is not thought to have diuretic properties and there are no other known mechanisms by which it may interact with lithium.

Again, this doesn't necessarily there isn't an interaction, we just don't have any studies that have evaluated the combination.

Since Bioperine may interact with lithium, if you are looking to avoid a drug interaction, you may want to look for a turmeric product without Bioperine (or other type of black pepper extract).


Signs Of Lithium Toxicity

It is important to be aware of the signs and symptoms of lithium toxicity due to the nature of the drug and the large list of potential interacting agents.

Symptoms of lithium toxicity include:[8]

  • Nausea
  • Vomiting
  • Diarrhea
  • Dental caries
  • Dry mouth
  • Metallic taste
  • Increased sweating
  • Increased salivation
  • Drowsiness
  • Hand tremor
  • Ringing in the ears
  • Incoordination

Final Words

It's unfortunate that we don't know much more regarding the potential interaction between lithium and Bioperine.

There are no published case studies suggesting that Bioperine has affected lithium levels in patients, but we do know there is a theoretical one based on the diuretic properties of the supplement. Whether or not this could be clinically significant isn't known.

You should be sure to discuss the use of any OTC drug or supplement with your doctor before taking, especially if you are taking a drug like lithium.

They can give you a suggestion for your particular medical situation and can monitor you appropriately if you do combine lithium with turmeric/Bioperine.


Summary

Bioperine, a patented black pepper extract, is commonly added to turmeric supplements to improve absorption. It may have mild diuretic properties which could potentially increase lithium concentrations, increasing the risk of toxicity.

References
  1. ^ Drug Interactions with Lithium: An Update. PubMed
  2. ^ Lithium side effects and toxicity: prevalence and management strategies. PubMed
  3. ^ LITHIUM IN THE TREATMENT OF BIPOLAR DISORDER: PHARMACOLOGY AND PHARMACOGENETICS. PubMed
  4. ^ An Oldie but Goodie: Lithium in the Treatment of Bipolar Disorder through Neuroprotective and Neurotrophic Mechanisms. PubMed
  5. ^ Every reason to discontinue lithium. PubMed
  6. ^ Recent Developments in Delivery, Bioavailability, Absorption and Metabolism of Curcumin: the Golden Pigment from Golden Spice. PubMed
  7. ^ Herbal diuretics and lithium toxicity. PubMed
  8. ^ Treatment of lithium intoxication: facing the need for evidence. PubMed

About the Pharmacist

Dr. Brian Staiger Pharm.D

Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of PharmacistAnswers.com. He graduated from the University At Buffalo with a Doctor of Pharmacy degree in 2010. He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs. Please feel free to reach out to him directly if you have any inquiries or want to connect! He's answered thousands of medication and pharmacy-related questions and he's ready to answer yours! Brian.Staiger@PharmacistAnswers.com Office: 716-389-3076

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