Lithium monitoring before and after the distribution of clinical practice guidelines

Eagles, John M.; McCann, I. Lisa; Neil, Thomas C.; MacLeod, Natalie; Paterson, Neil

doi:10.1034/j.1600-0447.2000.101005349.x

Cited by 38 publications

(34 citation statements)

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“…The serum concentration of lithium is therefore a valid biomarker to guide treatment with lithium and attain highest possible effi cacy and safety. It is well documented that serum concentrations correlate with clinical improvement and side effects (Collins et al, 2010;Eagles et al, 2000;N. Gupta, 2001;Sharma et al, 2009;Wilting et al, 2009).…”

Section: Drug and Metabolite Concentrations In Blood Biomarkers For mentioning

confidence: 96%

The value of drug and metabolite concentration in blood as a biomarker of psychopharmacological therapy

Hefner¹,

Laib²,

Sigurdsson³

et al. 2013

International Review of Psychiatry

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Desirable and undesirable effects of a drug are related to its concentration at various sites of actions. For many psychotropic drugs, it has been shown that drug concentration in brain correlates with concentration in blood. The latter is also an available estimate of clearance and bioavailability. Its monitoring enables identification of multiple factors that have an impact on clinical outcomes, especially uncertain compliance and pharmacokinetic peculiarities. For this review we analysed for antidepressants if drug concentration in blood can be used as biomarker for psychopharmacological treatment. Systematic review of the literature revealed for new and old antidepressant drugs that drug and metabolite concentrations in blood are measures of the pharmacokinetic phenotype and related differentially to occupancy of primary target structures, therapeutic effects and unwanted anticholinergic, cardiac and other side effects. Drug concentration in blood can therefore be used as biomarker in clinical practice to guide psychopharmacological treatment with established antidepressant drugs. Monitoring of drug concentration is suitable to improve efficacy and safety of the pharmacotherapy, especially in elderly patients who require complex pharmacological therapies.

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Section: Drug and Metabolite Concentrations In Blood Biomarkers For mentioning

confidence: 96%

The value of drug and metabolite concentration in blood as a biomarker of psychopharmacological therapy

Hefner¹,

Laib²,

Sigurdsson³

et al. 2013

International Review of Psychiatry

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“…The data collected for each practice are the proportions of patients receiving lithium who have had their thyroid and renal function checked in the previous 15 months (mental health standard 4) and have had a serum lithium level within the therapeutic range documented in the previous 6 months (mental health standard 5). Despite the existence of explicit standards for monitoring patients who are prescribed lithium, a number of local audits conducted in different areas of the UK over the last 20 years have found this monitoring to be suboptimal [8-11]. There are no published audits that are UK-wide or that post-date the publication of the NICE guideline for the management of bipolar disorder.…”

Section: Introductionmentioning

confidence: 99%

Standards of lithium monitoring in mental health trusts in the UK

et al. 2010

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BackgroundLithium is a commonly prescribed drug with a narrow therapeutic index, and recognised adverse effects on the kidneys and thyroid. Clinical guidelines for the management of bipolar affective disorder published by The National Institute for Health and Clinical Excellence (NICE) recommend checks of renal and thyroid function before lithium is prescribed. They further recommend that all patients who are prescribed lithium should have their renal and thyroid function checked every six months, and their serum lithium checked every three months. Adherence to these recommendations has not been subject to national UK audit.MethodsThe Prescribing Observatory for Mental Health (POMH-UK) invited all National Health Service Mental Health Trusts in the UK to participate in a benchmarking audit of lithium monitoring against recommended standards. Data were collected retrospectively from clinical records and submitted electronically.Results436 clinical teams from 38 Trusts submitted data for 3,373 patients. In patients recently starting lithium, there was a documented baseline measure of renal or thyroid function in 84% and 82% respectively. For patients prescribed lithium for a year or more, the NICE standards for monitoring lithium serum levels, and renal and thyroid function were met in 30%, 55% and 50% of cases respectively.ConclusionsThe quality of lithium monitoring in patients who are in contact with mental health services falls short of recognised standards and targets. Findings from this audit, along with reports of harm received by the National Patient Safety Agency, prompted a Patient Safety Alert mandating primary care, mental health and acute Trusts, and laboratory staff to work together to ensure systems are in place to support recommended lithium monitoring by December 2010.

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“…Mild and moderate symptoms of toxicity approximately correlate with lithium levels of [1.5 and [2.5 mmol/L, respectively [18]. Despite the fact that lithium toxicity is associated with increased mortality, standards of lithium monitoring have been reported to be generally poor [19,20].…”

Section: Discussionmentioning

confidence: 99%

The incidence and clinical correlates of lithium toxicity: a retrospective review

et al. 2011

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Lithium monitoring before and after the distribution of clinical practice guidelines

Abstract: Standards of lithium monitoring require further improvement. Locally agreed practice guidelines are helpful but patients on lithium should be in continuing contact with an experienced psychiatrist.

Cited by 38 publications

References 0 publications

The value of drug and metabolite concentration in blood as a biomarker of psychopharmacological therapy

The value of drug and metabolite concentration in blood as a biomarker of psychopharmacological therapy

Standards of lithium monitoring in mental health trusts in the UK

The incidence and clinical correlates of lithium toxicity: a retrospective review

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