Lithium treatment: a comparison of once‐and twice‐daily dosing

Abraham, G; Delva, Nicholas J.; Waldron, J. J.; Lawson, J. S.; Owen, James

doi:10.1111/j.1600-0447.1992.tb01444.x

Cited by 22 publications

(10 citation statements)

References 29 publications

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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%

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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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Section: Discussionmentioning

confidence: 99%

“…18 Two other crossover studies have since been published. In 1992, Abraham et al 24 recruited 20 patients on existing lithium therapy of either SDD or MDD who were then converted to BID. They were followed for 1 month, and then switched to SDD.…”

Section: Crossover Trialsmentioning

confidence: 99%

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

2013

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“…However, none of the known risk factors for renal disease included in our regression models explain the observed risk. Given that once-daily dosing may have other advantages in terms of toxicity, with no known impact on efficacy or pharmacokinetics (Abraham et al, 1992;Perry et al, 1981), and has the additional likely advantage of improved adherence (Bae et al, 2012;Laliberte et al, 2013), we would argue that once-daily dosing should represent the default approach to treatment.…”

Section: Dosing and Concomitant Medications As Risk Factorsmentioning

confidence: 99%

Stratifying Risk for Renal Insufficiency Among Lithium-Treated Patients: An Electronic Health Record Study

Castro

Roberson

McCoy

et al. 2015

Neuropsychopharmacol

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Although lithium preparations remain first-line treatment for bipolar disorder, risk for development of renal insufficiency may discourage their use. Estimating such risk could allow more informed decisions and facilitate development of prevention strategies. We utilized electronic health records from a large New England health-care system between 2006 and 2013 to identify patients aged 18 years or older with a lithium prescription. Renal insufficiency was identified using the presence of renal failure by ICD9 code or laboratory-confirmed glomerular filtration rate below 60 ml/min. Logistic regression was used to build a predictive model in a random two-thirds of the cohort, which was tested in the remaining one-third. Risks associated with aspects of pharmacotherapy were also examined in the full cohort. We identified 1445 adult lithium-treated patients with renal insufficiency, matched by risk set sampling 1 : 3 with 4306 lithium-exposed patients without renal insufficiency. In regression models, features associated with risk included older age, female sex, history of smoking, history of hypertension, overall burden of medical comorbidity, and diagnosis of schizophrenia or schizoaffective disorder (p<0.01 for all contrasts). The model yielded an area under the ROC curve exceeding 0.81 in an independent testing set, with 74% of renal insufficiency cases among the top two risk quintiles. Use of lithium more than once daily, lithium levels greater than 0.6 mEq/l, and use of first-generation antipsychotics were independently associated with risk. These results suggest the possibility of stratifying risk for renal failure among lithium-treated patients. Once-daily lithium dosing and maintaining lower lithium levels where possible may represent strategies for reducing risk.

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“…12 A crossover-designed study, in which each patient served as their own control subjects, revealed similar frequency of the side effects under the 2 different study conditions (single or multiple daily dosing schedule). 21 A double-blind comparative study (comparing once-daily immediate-release lithium salt preparation and twice-daily sustained-release lithium salt preparation) revealed that gastrointestinal symptoms were more frequent in the multiple daily dosing group, and the other side effects were similar in both groups. 30 Cerebral intoxication should be explained in relation to plasma lithium concentration, brain lithium concentration, and lithium dosing schedules.…”

Section: Single Daily Dosing Of Lithiummentioning

confidence: 99%

“…17,19,20 On the contrary, in vivo studies unexpectedly showed the absence of a significant difference in average steady state, 12-hour lithium serum concentrations when patients were switched from multiple to a single daily regimen treated with similar total doses of the same lithium preparation. 16,21,22 Comparative studies, where applied total daily doses were higher in the multiple dose group, revealed: 2 different groups of patients without switching multiple to single dosing schedule, and 2 different lithium salt preparations applied in each group.…”

Section: Single Daily Dosing Of Lithiummentioning

confidence: 99%