Introduction Lithium is the gold standard in treating bipolar affective disorders. As patients become increasingly older, drug-drug interactions leading to decreased excretion of lithium represent a key issue in lithium safety. As no study considered the effect of comedications on lithium serum concentration in combination, we aimed to quantify the impact of drugs affecting renal blood flow and function and thus potentially interacting drugs (diuretics, ACE inhibitors, AT1 antagonists, and non-steroidal anti-inflammatory drugs) on lithium serum levels in addition to age, sex, and sodium and potassium serum levels as well as renal function. Methods Retrospective data of lithium serum levels were analyzed in 501 psychiatric inpatients (2008–2015) by means of linear regression modelling. Results The number of potentially interacting drugs was significantly associated with increasing serum levels of lithium in addition to the established factors of age, renal function, and sodium concentration. Additionally, absolute lithium levels were dependent on sex, with higher values in females. However, only NSAIDs were identified to increase lithium levels independently. Discussion Routine clinical practice needs to focus on drugs affecting renal blood flow and function, especially on NSAIDs as over-the-counter medication that may lead to an increase in lithium serum concentration. To prevent intoxications, clinicians should carefully monitor the comedications, and they should inform patients about possible intoxications due to NSAIDs.
Zusammenfassung: Ausbildungssysteme unterliegen dem Wandel der Zeit und sind dementsprechend immer und überall starker Kritik ausgesetzt. Dies ist gut so und führt im Idealfall zu Reformen, die die Ausbildung zeitgemäßer und berufsgerechter machen. Wird ein Reformmodell nicht für geeignet gehalten, diese Ziele zu erreichen, wird es abgelehnt, so wie 2005 in Deutschland die Parteien der Großen Koalition die Einführung des Bologna– Modells für die deutsche Juristenausbildung ablehnten. Damit war die Bologna–Debatte aber nicht etwa beendet, sie ging und geht vielmehr unvermindert weiter. Viele erhoffen sich von einer Reform im Sinne der Bologna–Beschlüsse die Beseitigung folgender immer wieder in der Öffentlichkeit formulierter Probleme: das zu hohe Alter der Absolventen, deren zu geringe Mobilität und Internationalität, die zu universelle Ausbildung. Das Bachelor–/Master–System wird hierbei als maßgeschneiderte Lösung empfunden, um alle diese Probleme auf einmal zu beseitigen. Die sich vor einer so einschneidenden Änderung aufdrängenden Fragen, wieso sich unsere derzeitige Ausbildung so entwickelt hat, warum sich in anderen Ländern abweichende Modelle gebildet haben und welche Erfahrungen man dort mit modularisierten Studiengängen gemacht hat, finden nahezu keine Beachtung. Deshalb hatte es sich die Trierer Tagung ‘Juristenausbildung in Europa zwischen Tradition und Reform’ unter der wissenschaftlichen Leitung von Christian Baldus (Heidelberg), Thomas Finkenauer (Tübingen) und Thomas Rüfner (Trier) zur Aufgabe gemacht, diesen Fragen nachzugehen. Wie Rüfner in seiner Begrüßung verdeutlichte, sollte mit der Tagung nicht die politische Diskussion fortgeführt, sondern eine wissenschaftliche Grundlegung für eine sachlichere Diskussion geschaffen werden. Abstract: As times change, so do educational systems. According to this they come under criticism anytime and anywhere. Criticism is a benefit and ideally causes contemporary and adequate reforms. If a reform is not considered as appropriate to achieve this objective, it gets refused. Correspondingly, 2005 the parties of the grand coalition refused to implement the Bologna reform to law studies in Germany. Nevertheless the public dispute on ‘Bologna’ continues to this day. Many people expect the Bologna model to be the tailor–made solution for the following problems, which are consistently verbalised in public: the old age of the alumni, their low mobility and internationality, the voluminous universality of studies. However, the bachelor/master system would be a drastic change and raises diverse questions: How did our present study system develop, why did other countries generate divergent systems and which experiences emerge from modularised programs of study? These questions so far attracted only marginal interest, for which reason the conference ‘Juristenausbildung in Europa zwischen Tradition und Reform’ under the academic direction of Christian Baldus (Heidelberg), Thomas Finkenauer (Tübingen) and Thomas Rüfner (Trier) entered into them. The conference’s aim was not to continue the political debate, but to create an academic basis for a realistic discussion, how Ruefner pointed out in his introduction.
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