Adding lithium to topiramate.
- Topiramate induces CYP3A4 and is an inhibitor of CYP2C19.
- Lithium is eliminated by the kidney for about 95%. Changes in the rate of excretion can cause unwanted effects.
- This combination of drugs may have possible synergistic effects. However, this combination will also have additive side effects. Dose adaptation will be recommended for this combination.
- Start lithium according to the general dosing advice.
- Elevated and toxic lithium levels have been reported with higher (800 mg/d) doses of topiramate, but not with 500 mg/d.  
- Pharmacologic response and serum lithium levels should be monitored closely in particular after change of dosage or discontinuation of topiramate.
- Farmacotherapeutisch Kompas - topiramaat (dutch)
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- Pinninti at al, Does topiramate elevate serum lithium levels? J Clin Psychopharmacol. 2002 Jun;22(3):340.
- Abraham at al, Topiramate can cause lithium toxicity. J Clin Psychopharmacol. 2004 Oct;24(5):565-7
- Interactions between lithium and topiramate on drugs.com
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