Adding gabapentin to lithium.
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- Lithium is eliminated by the kidney for about 95%. Changes in the rate of excretion can cause unwanted effects.
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- Gabapentin is eliminated unchanged by the kidney for 100%.
- The advantages of gabapentin include the lack of interactions with other drugs in the cytochrome P450 system and the lack of protein binding. Since there is little risk of drug interactions, use with lithium is likely to be safe. 
- Start gabapentine according to the general dosing advice.
- Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects. 
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