Lithium: A classic drug—Frequently discussed, but, sadly, seldom prescribed!

Zivanovic, O.

doi:10.1177/0004867417695889

Cited by 29 publications

(19 citation statements)

References 111 publications

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“…It would be of interest to assess reasons of health care professionals to monitor or not to monitor these parameters. Variability in monitoring between respondents can be a consequence of a lack of resources, difference in education, type of patient population, a different opinion on the need for monitoring or differences in recommendations in guidelines (Zivanovic 2017 ). The number of responses was not sufficient to compare responses between subgroups such as countries, type of health care professional or to determine guideline adherence.…”

Section: Discussionmentioning

confidence: 99%

Monitoring of patients treated with lithium for bipolar disorder: an international survey

Nederlof

Heerdink

Egberts

et al. 2018

Int J Bipolar Disord

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BackgroundAdequate monitoring of patients using lithium is needed for optimal dosing and for early identification of patients with (potential) ADEs. The objective was to internationally assess how health care professionals monitor patients treated with lithium for bipolar disorder.MethodsUsing networks of various professional organizations, an anonymous online survey was conducted among health care professionals prescribing lithium. Target lithium serum levels and frequency of monitoring was assessed together with monitoring of physical and laboratory parameters. Reasons to and not to monitor and use of guidelines and institutional protocols, and local monitoring systems were investigated.ResultsThe survey was completed by 117 health care professionals incorporating responses from twenty-four countries. All prescribers reported to monitor lithium serum levels on a regular basis, with varying target ranges. Almost all (> 97%) monitored thyroid and renal function before start and during maintenance treatment. Reported monitoring of other laboratory and physical parameters was variable. The majority of respondents (74%) used guidelines or institutional protocols for monitoring. In general, the prescriber was responsible for monitoring, had to request every monitoring parameter separately and only a minority of patients was automatically invited.ConclusionsLithium serum levels, renal and thyroid function were monitored by (almost) all physicians. However, there was considerable variation in other monitoring parameters. Our results help to understand why prescribers of lithium monitor patients and what their main reasons are not to monitor patients using lithium.Electronic supplementary materialThe online version of this article (10.1186/s40345-018-0120-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Monitoring of patients treated with lithium for bipolar disorder: an international survey

Nederlof

Heerdink

Egberts

et al. 2018

Int J Bipolar Disord

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“…Lithium is the gold standard in treating bipolar disorders, showing established effectiveness in the treatment of acute mania as well as prevention of manic and depressive episodes along with antisuicidal effects [1][2][3][4][5]. While overall prescription rates have recently decreased, possibly related to issues of toxicity and side effects, polypharmacy involving lithium has increased [1,6]. Since lithium is not metabolized but renally excreted, drug-drug interactions due to impairment of renal function are of special concern [7].…”

Section: Introductionmentioning

confidence: 99%

Drug-Drug Interactions Between Lithium and Cardiovascular as Well as Anti-Inflammatory Drugs

et al. 2020

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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.

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“…Lithium ist zudem die einzige Substanz in Deutschland, für die ein uneingeschränkter Zulassungsstatus hinsichtlich der Phasenprophylaxe Bipolarer Störungen besteht. Nichtsdestotrotz wurde Lithium in den letzten Jahren in vielen, wenn auch nicht allen Ländern [7] zunehmend durch andere Medikamente (v. a. Valproat, Lamotrigin, Olanzapin, Quetiapin, Aripiprazol) in der klinischen Praxis ersetzt [8]. Diese Entwicklung, die der vorliegenden Evidenz widerspricht, wurde in letzter Zeit kritisch reflektiert und Lithiums einzigartige Stellung in der Behandlung Bipolarer Störungen betont [8][9][10][11].…”

Section: Introductionunclassified

“…Nichtsdestotrotz wurde Lithium in den letzten Jahren in vielen, wenn auch nicht allen Ländern [7] zunehmend durch andere Medikamente (v. a. Valproat, Lamotrigin, Olanzapin, Quetiapin, Aripiprazol) in der klinischen Praxis ersetzt [8]. Diese Entwicklung, die der vorliegenden Evidenz widerspricht, wurde in letzter Zeit kritisch reflektiert und Lithiums einzigartige Stellung in der Behandlung Bipolarer Störungen betont [8][9][10][11]. Wir möchten dies zum Anlass nehmen, einen aktuellen Überblick über die Evidenz für den Einsatz von Lithium in der Phasenprophylaxe Bipolarer Störungen, die Prädiktion für das Ansprechen auf Lithium, weitere Wirkungen Lithiums und dessen potentielle Nebenwirkungen zu geben.…”

Section: Introductionunclassified

Update – Lithium in der Phasenprophylaxe Bipolarer Störungen

Petzold

Bauer

Severus

2018

Fortschr Neurol Psychiatr

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ZusammenfassungLithium ist der Goldstandard in der Phasenprophylaxe Bipolarer Störungen und das einzige Medikament für das es eine überzeugende suizidpräventive Wirkung bei affektiven Erkrankungen gibt. Unter Berücksichtigung eines regelmäßigen Monitorings ist Lithium eine zumeist gut verträgliche und sichere Phasenprophylaxe, die nach sorgfältiger Risiko-Nutzen-Abwägung auch eine off-label Therapieoption in Schwangerschaft und Stillzeit darstellt. Darüber hinaus gibt es Hinweise, dass Lithium neuroprotektiv wirken mag und möglicherweise das Risiko für eine Alzheimer-Demenz und Schlaganfälle senken kann. Perspektivisch könnten Biomarker zur Verfügung stehen, mit denen man das Ansprechen auf Lithium voraussagen kann und damit personalisiertere Therapien entwickeln könnte.

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Lithium: A classic drug—Frequently discussed, but, sadly, seldom prescribed!

Cited by 29 publications

References 111 publications

Monitoring of patients treated with lithium for bipolar disorder: an international survey

Monitoring of patients treated with lithium for bipolar disorder: an international survey

Drug-Drug Interactions Between Lithium and Cardiovascular as Well as Anti-Inflammatory Drugs

Update – Lithium in der Phasenprophylaxe Bipolarer Störungen

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