1/15/2024 0 Comments Spironolactone migraine with auraThe influence of osmotic diuretics on lithium excretion in both animals 12 and humans 13 has been well documented. 10 These data, when combined with those from Saffer and Coppen, 11 suggest that loop diuretics are unlikely to significantly interact with lithium unless a confounding medical condition such as fluid imbalance or hemodynamic instability is present. A case study of 6 patients who received furosemide or ethacrynic acid reported decreases of 11% and 2%, respectively, in lithium clearance. 9Ĭlinical evidence that loop diuretics decrease lithium concentrations is limited. Close monitoring of lithium serum concentrations and careful observation for signs or symptoms of lithium intoxication are essential during the first week of treatment. ![]() 6-8 In order to manage this drug interaction, the recommended empiric lithium dosage reduction is 25% to 40% when thiazide diuretics are added to lithium therapy. In 3 separate studies, thiazide diuretics, when added to lithium therapy, increased lithium serum concentrations by 26.5%, 25%, and 23.3%, respectively. Nearly 75% of lithium ions are reabsorbed in the renal tubules by passive diffusion thus, medications with pharmacological action in the renal tubules can potentially interact with lithium. Lithium is eliminated primarily through glomerular filtration. In particular, drugs that affect sodium or water balance may result in interactions with lithium.ĭiuretics. Drugs with nephrotoxic potential should generally be avoided in patients who are receiving lithium.ĭrug-drug interactions may contribute to altered lithium serum concentrations and decreased efficacy or increased toxicity. Therefore, any drug that has the potential to reduce renal function may lead to accumulation of lithium. 3 Severe lithium intoxication may result in life-threatening cardiac arrhythmias and death.Īs an alkali metal and monovalent cation, lithium is not biotransformed or highly protein-bound but is excreted unchanged by the kidneys. Patients who take lithium should be instructed to discontinue the drug and contact the prescriber if such clinical signs of lithium toxicity as diarrhea, vomiting, tremor, mild ataxia, drowsiness, or muscular weakness occur. Recognition of potential drug interactions can minimize the risk of adverse effects and toxicity while maximizing therapeutic efficacy.īecause the therapeutic range for lithium is very narrow, careful serum concentration monitoring and dosage adjustments are required in order to maintain efficacy and prevent toxicity. Understanding the propensity of certain drugs to increase or decrease lithium concentrations is vitally important because this mood stabilizer is recommended as initial therapy in patients with bipolar disorder. Lithium is associated with clinically relevant drug interactions, which are summarized in the Table. 4 Although several antiepileptics and antipsychotics have been approved by the FDA for the treatment of bipolar disorder, lithium remains a first-line option. ![]() 3 This agent may act as a mood stabilizer by altering sodium transport in nerve and muscle cells, which results in enhanced intraneuronal metabolism of catecholamines. 2 Lithium was approved by the FDA in 1970 for the treatment of mania in bipolar disorder. The goal of maintenance therapy for bipolar disorder is to prevent relapses, reduce subthreshold symptoms, decrease suicide risk, reduce cycling frequency and mood instability, and improve overall functioning. ![]() 1 This psychiatric disorder was first described at the time of Hippocrates and is currently one of the most prevalent and severe mental illnesses in our society. Bipolar disorder (also known as manic-depressive illness) affects nearly 6 million adults in the United States.
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