Chapter 3 - Lithium
Section snippets
General Information
Lithium continues to be a first-line option for the treatment and prevention of mood episodes associated with bipolar disorder [1R,2R,3R]. It may have neuroprotective effects, is the only mood stabilizer with evidence that it reduces the risk of suicide, and is also effective as an adjunctive treatment option for major depressive disorder (MDD) [4R,5M,6H]. Some authors argue that it is underutilized, particularly for MDD [7A].
A large meta-analysis comparing the efficacy and tolerability of
Cardiovascular
Lithium's cardiovascular adverse effects, including bradycardia and pro-arrhythmic activity, have been well documented. However, other cardiovascular side effects, while rare, occur as well. One recent case report has proposed that lithium may have a direct toxic effect on cardiac myocytes. A 35-year-old African American woman with bipolar disorder was brought to the emergency room unresponsive with unstable cardiac vital signs, including hypotension (90/63 mmHg), bradycardia (35 bpm) and a
Pregnancy
Lithium, a known teratogen, poses a risk to the fetus in pregnant women on lithium therapy, but environmental lithium exposure may also be harmful with high concentrations in drinking water. In order to analyze the potential effects of lithium on fetal growth and development, Harari and colleagues designed a prospective population-based cohort study on maternal exposure to variable lithium concentrations in drinking water during pregnancy in Northern Argentina [33C].
Their findings support the
Susceptibility Factors
A retrospective cohort study using a laboratory information system was conducted by Shine and colleagues to determine the incidence of lithium-induced thyroid and parathyroid dysfunction along with any associated risk factors. The study included adult patients (≥ 18 years) who had at least two measurements of serum creatinine, thyrotropin, calcium, glycated hemoglobin (HbA1C), or lithium levels between October 1st, 1985 and March 31st, 2014. Patients with documented lithium levels (≥ 2 detectable
Mechanism of ADR
The mechanisms of both the therapeutic and adverse effects of lithium are not entirely clear, despite its many years of use. Petersein and colleagues evaluated lithium with antidepressants and found lithium to enhance pro-excitatory cytokine production (IL-1β, IL-2, IL-6, IL-17 and TNF-a), a new finding previously unreported. Therefore, lithium's pro-inflammatory effects may potentially explain autoimmune adverse effects like cutaneous skin reactions and Hashimoto thyroiditis [36c].
Diagnosis of Adverse Drug Reactions
Laboratory parameters such as serum creatinine have traditionally been used to assess patient's renal function. There is evidence that microcyst formation in the kidneys may cause the decreased glomerular filtration rate and subsequent increase in serum creatinine measured in lithium-related end-stage renal disease. The microcysts increase in number over time before the actual elevation in creatinine occurs, and there is an inverse relationship between the size of cysts and the GFR of the
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Cited by (1)
Lithium
2018, Side Effects of Drugs AnnualCitation Excerpt :Additional case studies on this topic can be found in these reviews [27R, 28R].