Does Lithium Interact With Turmeric And Bioperine?

tom asked

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

Answer

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.