Frusemide and Lithium Toxicity

Te, Oh

doi:10.1177/0310057x7700500110

Cited by 13 publications

(2 citation statements)

References 12 publications

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“…In a recent study in young male volunteers we found no change in 24 hr lithium clearance following oral administration of 80 mg furosemide once daily for 7 days (Shalmi et al 1990). These two studies suggest that chronic furosemide administration may not influence the renal handling of lithium, whereas previous reports suggested that lithium intoxication may in fact be precipitated by furosemide (Hurtig & Dyson 1974;Oh 1977).…”

mentioning

confidence: 80%

Renal Adaptations to Continuous Administration of Furosemide and Bendroflumethiazide in Rats

Lunau¹,

Bak²,

Petersen³

et al. 1994

Pharmacology & Toxicology

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During continuous treatment with diuretics, the kidney adapts to the initial Na loss by activating antinatriuretic mechanisms which serve to prevent further Na and volume losses. To study the renal sites of adaptations to constant diuretic treatment, bendroflumethiazide (4 mg daily), furosemide (8 mg daily) or vehicle (0.24 ml daily) was infused intraperitoneally to female Wistar rats by implanted osmotic minipumps. Half of the animals (groups vol.) were randomized to receive a balanced saline solution to drink in addition to water in order to replace Na, K and volume losses. On the 6th day of treatment, clearances of inulin, Na, and Li were determined during four consecutive 6 hr periods. Circadian changes in renal excretions occurred in all groups with highest excretions of Na, Li and water in the dark period (6 p.m. to 6 a.m.). Renal changes induced by continuous infusion of diuretics were most pronounced in the dark period and would probably not have been disclosed if the clearance experiments had been restricted to the daytime. The average 24-hour clearance for inulin (glomerular filtration rate) was not different among groups, except for a 20% decrease in the furosemide group. The 24-hour fractional Na excretion, being approximately 0.5% in the vehicle group, increased to approximately 0.8% in group (bendroflumethiazide+vol) and to approximately 2.8% in group (furosemide+vol) but was not different from the vehicle group in the diuretic groups without volume replacement.(ABSTRACT TRUNCATED AT 250 WORDS)

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confidence: 80%

Renal Adaptations to Continuous Administration of Furosemide and Bendroflumethiazide in Rats

Lunau¹,

Bak²,

Petersen³

et al. 1994

Pharmacology & Toxicology

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“…Thiazide diuretics, predominantly through inducing sodium depletion, induce a decrease in lithium clearance of around 25% after a week of therapy [31]. Whilst other diuretics have been implicated in cases of lithium toxicity [32][33][34], there is less evidence that they consistently reduce FE Li [35]. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) [36,37] and Angiotensin Converting Enzyme inhibitors (ACEI's) [38] also reduce lithium excretion by around 25%.…”

Section: Coadministration Of Drugsmentioning

confidence: 99%

Lithium Toxicity: An Iatrogenic Problem in Susceptible Individuals

Oakley

Whyte

Carter

2001

Aust N Z J Psychiatry

100

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Severe lithium neurotoxicity occurs almost exclusively in the context of chronic therapeutic administration of lithium, and rarely results from acute ingestion of lithium, even in patients currently taking lithium. As such it is an iatrogenic illness, occurring in patients who have identifiable clinical risk factors: nephrogenic diabetes insipidus, older age, abnormal thyroid function and impaired renal function. Although administration of drugs which impair lithium clearance appeared to contribute minimally to chronic lithium poisoning in the absence of other factors, these drugs may well 'uncover' the predisposing risk factors and certainly should not be considered safe to use as a consequence of this study. The serious morbidity suffered by lithium toxic patients, and the cost to society due to long hospital stays, might be reduced by careful prescribing, vigilant monitoring and awareness of these factors, as they develop in otherwise stable patients. Review of existing therapeutic guidelines may be warranted.

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Drug Interactions with Lithium: An Update

Finley

2016

Clin Pharmacokinet

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Lithium has been used for the management of psychiatric illnesses for over 50 years and it continues to be regarded as a first-line agent for the treatment and prevention of bipolar disorder. Lithium possesses a narrow therapeutic index and comparatively minor alterations in plasma concentrations can have significant clinical sequelae. Several drug classes have been implicated in the development of lithium toxicity over the years, including diuretics and non-steroidal anti-inflammatory compounds, but much of the anecdotal and experimental evidence supporting these interactions is dated, and many newer medications and medication classes have been introduced during the intervening years. This review is intended to provide an update on the accumulated evidence documenting potential interactions with lithium, with a focus on pharmacokinetic insights gained within the last two decades. The clinical relevance and ramifications of these interactions are discussed.

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Frusemide and Lithium Toxicity

Abstract: Lithium toxicity following frusemide administration is reported. The clinical features, possible causative mechanisms, and mallagemellt of the intoxication are discussed.

Cited by 13 publications

References 12 publications

Renal Adaptations to Continuous Administration of Furosemide and Bendroflumethiazide in Rats

Renal Adaptations to Continuous Administration of Furosemide and Bendroflumethiazide in Rats

Lithium Toxicity: An Iatrogenic Problem in Susceptible Individuals

Drug Interactions with Lithium: An Update

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