Are the renal effects of lithium modified by frequency of administration?

Abraham, G; Waldron, J. J.; Lawson, J. S.

doi:10.1111/j.1600-0447.1995.tb09553.x

Cited by 14 publications

(7 citation statements)

References 26 publications

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“…In a nonrandomized controlled trial of 17 patients initially on once- or twice-daily lithium dosing for >1 month, who were switched to the alternate regimen and then to 3 to 4 times daily dosing, Umax and urine volume did not differ between groups. 64 In 3 cross-sectional studies, though, patients receiving once-daily lithium dose had less urine volume. Twice-daily versus Once- or thrice-daily dosing led to increased polyuria (2.7 vs 1.9 L/d, P < .01) in 1 study.…”

Section: Resultsmentioning

confidence: 99%

The Effects of Lithium on Renal Function in Older Adults—A Systematic Review

Rej

Herrmann

Shulman

2012

J Geriatr Psychiatry Neurol

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Chronic renal failure (CRF) and nephrogenic diabetes insipidus (NDI) are potential consequences of chronic lithium use, while acute renal failure (ARF) has been described in lithium intoxication. We performed a systematic review of all studies pertaining to the effects of lithium on the kidney in older adults. The ARF incidence was 1.5% per person-year and concurrent loop diuretic and angiotensin-converting enzyme inhibitor use with lithium increased the risk. The CRF prevalence estimates varied from 1.2% to 34%, with risk factors including age, previous lithium intoxication, polyuria, previously impaired renal function, and decreased maximal urine osmolality. The prevalence of NDI varied widely from 1.8% to 85%. Risk factors included lithium duration, dose, level, slow-release formulation, and clinical nonresponse. Except for amiloride use in NDI, there is little evidence for treatment of other lithium-induced adverse renal effects. Currently, there is no compelling evidence to suggest that lithium should be avoided in elderly patients for fear of renal side effects.

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Section: Resultsmentioning

confidence: 99%

The Effects of Lithium on Renal Function in Older Adults—A Systematic Review

Rej

Herrmann

Shulman

2012

J Geriatr Psychiatry Neurol

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“…In summarizing the literature, we find variable results, with some trials showing a reduction in urine volume with SDD, 5,[17][18][19][20][21]29 and some trials showing no change. 16,[24][25][26][27][28] However, no single trial found any worsening with SDD.…”

Section: Discussionmentioning

confidence: 99%

“…26,27 A small number of individual patients in the trials were bothered by new adverse effects with SDD, such as tremor. 25 Overall, SDD regimens were well tolerated, although most of the trials may be biased in this regard as they studied patients who were already known to tolerate lithium therapy.…”

Section: Discussionmentioning

confidence: 99%

“…They were followed for 1 month, and then switched to SDD. A similar study 25 was again conducted in 1995, adding a multiple (3 or 4) daily dose group to the crossover design. No difference was found in the depression or mania rating scales used, urine volume, or adverse effect severity or frequency overall, although 2 individual patients in the later study did not tolerate the SDD regimen, 1 due to diarrhea, and 1 due to headache and tremor associated with significantly elevated serum lithium levels.…”

Section: Crossover Trialsmentioning

confidence: 99%

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An Updated Review of the Optimal Lithium Dosage Regimen for Renal Protection

2013

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Objective: Despite several decades of research, there is still uncertainty regarding the optimal lithium dosage regimen associated with a decreased risk of renal effects, such as polyuria, in patients with bipolar affective disorder. We present an updated review of the literature to provide an informed dosing regimen recommendation for prescribers. Method:Major databases MEDLINE and Embase were searched using terms, such as lithium, drug administration schedule, dose-response relationship, once daily, twice daily, and sustained release. In addition, the bibliographies of related publications were manually searched.Results: A total of 20 trials were included. Some trials showed a reduction in urine volume with single daily dosing (SDD), while others showed no change. The only trial evaluating patients newly started on lithium found a reduction in urinary frequency with SDD after 21 days. Trials examining renal biopsy results found that multiple daily doses were associated with more pathologic damage to the kidneys. SDD regimens were generally well tolerated, and no reduction in efficacy was noted in any of the trials. Conclusions:The available evidence is contradictory as to whether SDD of lithium reduces polyuria; however, no trial has demonstrated any downfall of SDD in terms of prophylactic efficacy or adverse effects. Given the added benefits of SDD, such as improved compliance, we recommend patients newly started on lithium should be converted to a SDD of lithium at bedtime once an appropriate daily dose is determined. W W WUne revue mise à jour de la posologie optimale du lithium pour la protection rénale Objectif : Malgré plusieurs décennies de recherche, il y a encore de l'incertitude concernant la posologie optimale du lithium associée au risque réduit d'effets rénaux, comme la polyurie, chez les patients souffrant du trouble bipolaire affectif. Nous présentons une revue mise à jour de la littérature afin d'offrir aux prescripteurs une recommandation éclairée de régime posologique.Méthode : Cette recherche a été menée à partir des grandes bases de données MEDLINE et Embase à l'aide de termes comme : lithium, horaire d'administration des médicaments, relation dose-réponse, une fois par jour, deux fois par jour, et libération prolongée. En outre, les bibliographies de publications connexes ont fait l'objet d'une recherche manuelle.Résultats : Un total de 20 essais ont été inclus. Certains essais montraient une réduction du volume d'urine avec une dose unique quotidienne (DUQ), alors que d'autres n'indiquaient aucun changement. Le seul essai qui évaluait les patients qui commençaient le lithium a observé une réduction de la fréquence urinaire avec la DUQ après 21 jours. Les essais examinant les résultats de biopsie rénale ont constaté que les doses multiples quotidiennes étaient associées à plus de dommages pathologiques aux reins. Les posologies de DUQ étaient généralement bien tolérées, et aucune réduction d'efficacité n'a été notée dans tous les essais. Conclusions :Les données probantes disponibles sont...

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“…İzlem çalışmalarının çoğunda ise tübüler işlevlerdeki bozulmanın zaman içinde ilerleyici nitelikte olmadığı ve konsantrasyon yeteneğindeki bozulmanın belirgin olarak tedavinin ilk yıllarında ortaya çıktığı sonucuna varılmıştır. [94,95] Nefrojenik diyabet insipitus varlığında lityumun ile tedavinin sonlandırıp sonlandırılmayacağı kararı poliürinin miktarına göre değil oluşturduğu sıkıntı ve yarattığı işlev sorunlarına göre (örneğin seyahat edememe veya idrar nedeniyle uykuların sık bölünmesi) verilmelidir.…”

Section: Klinik çAlışmalarunclassified

Lityumun Metabolik Yan Etkileri

Eker¹,

Eker²

2014

Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry

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Lithium is an alkaline ion being used since 19th century. After its widespread use in psychiatric disorders, observed side effects caused skepticism about its therapeutic efficacy. Despite several disadvantages, lithium is one of the indispensible drugs used in affective disorders, especially in bipolar disorder. It became a necessity for physicians to recognize its side effects since lithium is still accepted as a gold standard in the treatment of bipolar disorder. Adverse effects of chronic administration of lithium on several organ systems are widely known. In this article metabolic effects of lithium on thyroid and parathyroid glands, body mass index and kidneys will be discussed along with their mechanisms, clinical findings, possible risk factors and treatment. One of the most common side effect of lithium is hypothyroidism. It has the same clinical and biochemical properties as primary hypothyroidism and observed as subclinical hypothyroidism in the first place. Hypothyroidism, even its subclinical form, may be associated with non-response or inadequate response and is indicated as a risk factor for development of rapid cycling bipolar disorder. Therefore, hypothyroidism should be screened no matter how severe it is and should be treated with thyroid hormone in the presence of clinical hypothyroidism. Weight gain due to lithium administration disturbs the compliance to treatment and negatively affects the course of the illness. Increased risk for diabetes, hypertension, ischemic heart disease and stroke because of weight gain constitute other centers of problem. Indeed, it is of importance to determine the risk factors before treatment, to follow up the weight, to reorganize nutritional habits and to schedule exercises. Another frequent problematic side effect of lithium treatment is renal dysfunction which clinically present as nephrogenic diabetes insipidus with the common symptoms of polyuria and polydipsia. Nephrogenic diabetes insipidus develops because of urinary concentration defects due to the detrimental effects of lithium on re-absorption of water and sodium at the level of collector tubules. Close screening of renal functions is very important in the prevention of renal damage during treatment with lithium. Moreover, it is also of importance to screen serum lithium levels as lithium intoxication episodes may increase the risk of renal failure. As a conclusion lithium still preserves its indispensability in affective disorders. Clinicians should have current knowledge about the side effects of lithium and take preventive measures to apply such an important treatment to the patients.

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Are the renal effects of lithium modified by frequency of administration?

Cited by 14 publications

References 26 publications

The Effects of Lithium on Renal Function in Older Adults—A Systematic Review

The Effects of Lithium on Renal Function in Older Adults—A Systematic Review

An Updated Review of the Optimal Lithium Dosage Regimen for Renal Protection

Lityumun Metabolik Yan Etkileri

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