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Kaczmarczyk M, Batke M, Wingenfeld K, Deuter CE, Otte C. Causes, clinical characteristics, and outcomes of high lithium levels and intoxications: Retrospective analysis of patient records. J Psychopharmacol 2023; 37:1082-1090. [PMID: 37942551 DOI: 10.1177/02698811231209208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND The mood stabilizer lithium has a narrow therapeutic index with a relevant risk of intoxication. We used real-world hospital data to identify causes, treatment courses, and outcomes of high lithium levels and intoxications. METHODS Retrospective chart review of patients with a lithium concentration of ⩾1.1 mmol/L, who were treated at Charité University Medical Center Berlin. RESULTS We identified 136 patients (58% women; mean age: 54.7 years) with high lithium levels or intoxication. 66.9% were chronic (stable lithium dose but changes in other variables such as co-medication). 40.4% took at least one risk medication with a relative contraindication for concurrent lithium treatment. 11.1% of the cases with a high therapeutic level showed moderate to severe intoxications. Feverish infections were significantly associated with severe intoxications. Overall, 97.1% (132/136) of patients fully recovered, two had residual but mild symptoms and two died during hospitalization (unlikely related to the intoxication). In 37.5% of patients, no psychiatrist was involved in the management of high lithium levels or intoxication. In these patients, lithium treatment was adjusted or discontinued in 37.3% of the cases compared to 64.7% when a psychiatrist was involved (χ²(1) = 9.683, p = 0.002). CONCLUSIONS Patients and medical doctors should be aware of the increased risk of lithium intoxication already within the high therapeutic range and should consider alternative medications without relative contraindications for concurrent lithium use. Involving psychiatrists during or after an intoxication event is associated with more frequent adjustment of the maintenance lithium dose and should be considered in most cases.
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Affiliation(s)
- Michael Kaczmarczyk
- Department of Psychiatry and Neurosciences Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Madeleine Batke
- Department of Psychiatry and Neurosciences Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katja Wingenfeld
- Department of Psychiatry and Neurosciences Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Eric Deuter
- Department of Psychiatry and Neurosciences Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Otte
- Department of Psychiatry and Neurosciences Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Spatola L, Maringhini S, Canale C, Granata A, D'Amico M. Lithium poisoning and renal replacement therapy: pathophysiology and current clinical recommendations. Int Urol Nephrol 2023; 55:2501-2505. [PMID: 36940005 DOI: 10.1007/s11255-023-03558-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/12/2023] [Indexed: 03/21/2023]
Abstract
Lithium intoxication is still an undefined and underestimated disease, especially those cases requiring extracorporeal treatment. Lithium is a monovalent cation with small molecular mass of 7 Da that has been regularly and successfully used since 1950 in the treatment of mania and bipolar disorders. However, its careless assumption can lead to a wide spectrum of cardiovascular, central nervous system and kidney diseases in case of acute, acute on chronic and chronic intoxications. In fact, lithium serum range is strict between 0.6 and 1.3 mmol/L, with a mild lithium toxicity observed at the steady-state of 1.5-2.5 mEq/L, moderate toxicity when lithium reaches 2.5-3.5 mEq/L, and severe intoxication with observed serum levels > 3.5 mEq/L. Its favorable biochemical profile allows the complete filtration and partial reabsorption in the kidney due to the similarity to sodium and also the complete removal by renal replacement therapy, that should be considered in specific poisoning conditions. In this narrative and updated review we discussed a clinical case of lithium intoxication, the different pattern of diseases attributable to excessive lithium load and the current indications for extracorporeal treatment.
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Affiliation(s)
- Leonardo Spatola
- Division of Nephrology and Dialysis, Ospedale Sant' Antonio Abate, AspTrapani, via Cosenza, Erice, TP, Italy.
| | | | - Carmelinda Canale
- Division of Nephrology and Dialysis, Ospedale Sant' Antonio Abate, AspTrapani, via Cosenza, Erice, TP, Italy
| | - Antonio Granata
- Division of Nephrology and Dialysis, Ospedale Cannizzaro, Via Messina, Catania, CT, Italy
| | - Maria D'Amico
- Division of Nephrology and Dialysis, Ospedale Sant' Antonio Abate, AspTrapani, via Cosenza, Erice, TP, Italy
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Calabrese EJ, Pressman P, Hayes AW, Dhawan G, Kapoor R, Agathokleous E, Calabrese V. Lithium and hormesis: Enhancement of adaptive responses and biological performance via hormetic mechanisms. J Trace Elem Med Biol 2023; 78:127156. [PMID: 36958112 DOI: 10.1016/j.jtemb.2023.127156] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Abstract
Biomedical and consumer interest in the health-promoting properties of pure single entities of known or unknown chemical constituents and mixtures has never been greater. Since its "rediscovery" in the 1950s, lithium is an example of such a constituent that represents an array of scientific and public health challenges and medical potentials that may now be understood best when seen through the lens of the dose-response paradigm known as hormesis. The present paper represents the first review of the capacity of lithium to induce hormetic dose responses in a broad range of biological models, organ systems, and endpoints. Of significance is that the numerous hormetic findings occur with extensive concentration/dose response evaluations with the optimal dosing being similar across multiple organ systems. The particular focus of these hormetic dose-response findings was targeted to research with a broad spectrum of stem cell types and neuroprotective effects. These findings suggest that lithium may have critically valuable systemic effects with respect to those therapeutically treated with lithium as well as for exposures that may be achieved via dietary intervention.
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Affiliation(s)
- Edward J Calabrese
- Environmental Health Sciences Division, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA.
| | - Peter Pressman
- Saba University School of Medicine, Caribbean, the Netherlands
| | - A Wallace Hayes
- Center for Environmental Occupational Risk Analysis and Management College of Public Health, University of South Florida, Tampa, FL, USA
| | | | - Rachna Kapoor
- Saint Francis Hospital and Medical Center; Hartford, CT, USA
| | - Evgenios Agathokleous
- School of Applied Meteorology, Nanjing University of Information Science & Technology, Nanjing 210044, China
| | - Vittorio Calabrese
- Department of Biomedical and Biotechnological Sciences; School of Medicine University of Catania, Via Santa Sofia 97, Catania 95123, Italy
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4
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Abstract
SUMMARY
Lithium is a gold standard maintenance treatment in bipolar affective disorder. It has a narrow therapeutic range, and at higher serum lithium levels there is a risk of adverse effects and toxicity. There are three patterns of lithium intoxication: acute, acute-on-chronic and chronic. We describe risk factors for lithium intoxication, mechanisms of toxicity and clinical symptoms seen in lithium intoxication. We describe both the acute and chronic effects of lithium toxicity. Lithium intoxication may be life-threatening and associated with longer-term sequelae. The management of lithium intoxication involves determining the type of intoxication. We discuss treatment strategies aimed at reducing absorption and increasing elimination of lithium. We discuss clinical indications for extracorporeal methods such as dialysis, which are used to limit the time and degree of exposure of the central nervous system to toxic lithium concentrations. Haemodialysis is the most rapid method of eliminating lithium from the body, but careful monitoring is required. Preventive strategies to mitigate the risk for lithium intoxication are discussed.
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Ates N, Caglayan A, Balcikanli Z, Sertel E, Beker MC, Dilsiz P, Caglayan AB, Celik S, Dasdelen MF, Caglayan B, Yigitbasi T, Ozbek H, Doeppner TR, Hermann DM, Kilic E. Phosphorylation of PI3K/Akt at Thr308, but not MAPK kinase, mediates lithium-induced neuroprotection against cerebral ischemia in mice. Exp Neurol 2022; 351:113996. [PMID: 35122865 DOI: 10.1016/j.expneurol.2022.113996] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/31/2021] [Accepted: 01/27/2022] [Indexed: 11/30/2022]
Abstract
Lithium, in addition to its effect on acute and long-term bipolar disorder, is involved in neuroprotection after ischemic stroke. Yet, its mechanism of action is still poorly understood, which was only limited to its modulatory effect on GSK pathway. Therefore, we initially analyzed the dose-dependent effects of lithium on neurological deficits, infarct volume, brain edema and blood-brain barrier integrity, along with neuronal injury and survival in mice subjected to focal cerebral ischemia. Thereafter, we investigated the involvement of the PI3K/Akt and MEK signal transduction pathways and their components. Our observations revealed that 2 mmol/kg lithium significantly improved post-ischemic brain tissue survival. Although, 2 mmol/kg lithium had no negative effect on brain microcirculation, 5 and 20 mmol/kg lithium reduced brain perfusion. Furthermore, supratherapeutic dose of lithium in 20 mmol/kg lead to animal death. In addition, improvement of brain perfusion with L-arginine, did not change the effect of 5 mmol/kg lithium on brain injury. Additionally, post-stroke blood-brain barrier leakage, hemodynamic impairment and apoptosis have been reversed by lithium treatment. Interestingly, lithium-induced neuroprotection was associated with increased phosphorylation of Akt at Thr308 and suppressed GSK-3β phosphorylation at Ser9 residue. Lithium upregulated Erk-2 and downregulated JNK-2 phosphorylation. To distinguish whether neuroprotective effects of lithium are modulated by PI3K/Akt or MEK, we sequentially blocked these pathways and demonstrated that the neuroprotective activity of lithium persisted during MEK/ERK inhibition, whereas PI3K/Akt inhibition abolished neuroprotection. Collectively, we demonstrated lithium exerts its post-stroke neuroprotective activity via the PI3K/Akt pathway, specifically via Akt phosphorylation at Thr308, but not via MEK/ERK.
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Affiliation(s)
- Nilay Ates
- Istanbul Medipol University, Regenerative and Restorative Medical Research Center, Istanbul, Turkey; Istanbul Medipol University, Faculty of Medicine, Dept. of Pharmacology, Istanbul, Turkey
| | - Aysun Caglayan
- Istanbul Medipol University, Regenerative and Restorative Medical Research Center, Istanbul, Turkey; Istanbul Medipol University, Faculty of Medicine, Dept. of Physiology, Istanbul, Turkey
| | - Zeynep Balcikanli
- Istanbul Medipol University, Regenerative and Restorative Medical Research Center, Istanbul, Turkey; Istanbul Medipol University, Faculty of Medicine, Dept. of Physiology, Istanbul, Turkey
| | - Elif Sertel
- Istanbul Medipol University, Regenerative and Restorative Medical Research Center, Istanbul, Turkey; Istanbul Medipol University, Faculty of Medicine, Dept. of Physiology, Istanbul, Turkey
| | - Mustafa Caglar Beker
- Istanbul Medipol University, Regenerative and Restorative Medical Research Center, Istanbul, Turkey; Istanbul Medipol University, Faculty of Medicine, Dept. of Physiology, Istanbul, Turkey
| | - Pelin Dilsiz
- Istanbul Medipol University, Regenerative and Restorative Medical Research Center, Istanbul, Turkey; Istanbul Medipol University, Faculty of Medicine, Dept. of Pharmacology, Istanbul, Turkey
| | - Ahmet Burak Caglayan
- Istanbul Medipol University, Regenerative and Restorative Medical Research Center, Istanbul, Turkey; Istanbul Medipol University, Faculty of Medicine, Dept. of Physiology, Istanbul, Turkey
| | - Süleyman Celik
- Istanbul Medipol University, Regenerative and Restorative Medical Research Center, Istanbul, Turkey; Istanbul Medipol University, Faculty of Medicine, Dept. of Physiology, Istanbul, Turkey
| | - Muhammed Furkan Dasdelen
- Istanbul Medipol University, Regenerative and Restorative Medical Research Center, Istanbul, Turkey; Istanbul Medipol University, Faculty of Medicine, Dept. of Physiology, Istanbul, Turkey
| | - Berrak Caglayan
- Istanbul Medipol University, Regenerative and Restorative Medical Research Center, Istanbul, Turkey; Istanbul Medipol University, International School of Medicine, Dept. of Medical Biology, Istanbul, Turkey
| | - Türkan Yigitbasi
- Istanbul Medipol University, Faculty of Medicine, Dept. of Biochemistry, Istanbul, Turkey
| | - Hanefi Ozbek
- Istanbul Medipol University, Faculty of Medicine, Dept. of Pharmacology, Istanbul, Turkey
| | - Thorsten Roland Doeppner
- Istanbul Medipol University, Regenerative and Restorative Medical Research Center, Istanbul, Turkey; University Medical Center Göttingen, Department of Neurology, Göttingen, Germany
| | - Dirk Matthias Hermann
- University Hospital Essen, University of Duisburg-Essen, Department of Neurology, Essen, Germany
| | - Ertugrul Kilic
- Istanbul Medipol University, Regenerative and Restorative Medical Research Center, Istanbul, Turkey; Istanbul Medipol University, Faculty of Medicine, Dept. of Physiology, Istanbul, Turkey.
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Maideen NMP, Balasubramanian R, Muthusamy S, Nallasamy V. An Overview of Clinically Imperative and Pharmacodynamically Significant Drug Interactions of Renin-Angiotensin-Aldosterone System (RAAS) Blockers. Curr Cardiol Rev 2022; 18:e110522204611. [PMID: 35546745 PMCID: PMC9893153 DOI: 10.2174/1573403x18666220511152330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 02/26/2022] [Accepted: 03/28/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Hypertension is a leading cause of cardiovascular disease and chronic kidney disease, resulting in premature death and disability. The Renin-Angiotensin-Aldosterone System (RAAS) blockers, including Angiotensin-Converting Enzyme (ACE) inhibitors or Angiotensin Receptor Blockers (ARBs), are used as first-line antihypertensive therapy to treat hypertensive patients with comorbidities, including diabetes, ischemic heart disease, heart failure, and chronic kidney disease. The use of RAS blockers is associated with the risks, such as hyperkalemia, angioedema, etc. The drugs potentiating them interact pharmacodynamically, resulting in adverse consequences. This review article focuses on the clinically important drug interactions of RAAS blockers. MATERIALS AND METHODS The electronic databases, such as Medline/PubMed Central/PubMed, Google Scholar, ScienceDirect, Cochrane Library, Directory of Open Access Journals (DOAJ), Embase, and reference lists were searched to identify relevant articles. RESULTS The risk of hyperkalemia may be enhanced potentially in patients receiving a RAS blocker and potassium-sparing diuretics, potassium supplements, trimethoprim, adrenergic betablockers, antifungal agents, calcineurin inhibitors, pentamidine, heparins or an NSAID, concomitantly. The patients taking ACE inhibitors and mTOR inhibitors, DPP4 inhibitors, alteplase, or sacubitril/valsartan concurrently may be at increased risk of developing angioedema. CONCLUSION Clinicians, pharmacists, and other healthcare practitioners should be accountable for medication safety. To avoid adverse implications, prescribers and pharmacists must be aware of the drugs that interact with RAAS blockers.
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Affiliation(s)
| | | | - Sudha Muthusamy
- Department of Pharmacology, J.K.K. Nattraja College of Pharmacy, Komarapalayam- 638 183, India
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Parkin GM, McCarthy MJ, Thein SH, Piccerillo HL, Warikoo N, Granger DA, Thomas EA. Saliva testing as a means to monitor therapeutic lithium levels in patients with psychiatric disorders: Identification of clinical and environmental covariates, and their incorporation into a prediction model. Bipolar Disord 2021; 23:679-688. [PMID: 34536974 PMCID: PMC9291088 DOI: 10.1111/bdi.13128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The narrow therapeutic window of lithium medications necessitates frequent serum monitoring, which can be expensive and inconvenient for the patient. Compared to blood, saliva collection is easier, non-invasive, requires less processing, and can be done without the need for trained personnel. This study investigated the utility of longitudinal salivary lithium level monitoring. METHODS We measured salivary lithium levels using ICP-OES in n = 169 passive drool samples, collected both as single observations and longitudinally for up to 18 months, from a multi-center cohort of n = 75 patients with bipolar disorder or other psychiatric conditions. RESULTS Saliva and serum lithium levels were highly correlated. Adjustment for daily lithium dose, diabetes, and smoking improved this relationship (r = 0.77). Using the adjusted intersubject equation and a patient's salivary lithium value, we observed a strong correlation between the predicted vs. observed serum lithium levels (r = 0.70). Most patients had highly stable saliva/serum ratios across multiple visits, with longitudinal variability significantly greater with age. Use of the intrasubject saliva/serum ratio from a single prior observation had similar predictive power to the use of the adjusted intersubject equation. However, the use of the mean intrasubject ratio from three prior observations could robustly predict serum lithium levels (predicted vs. observed r = 0.90). CONCLUSIONS These findings strongly suggest that saliva could be used for lithium monitoring, and open the door for the development and implementation of a point-of-care salivary lithium device for use at home or the clinic. We propose that the use of saliva will dramatically improve treatment opportunities for patients with mood disorders.
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Affiliation(s)
- Georgia M. Parkin
- Department of EpidemiologyUniversity of California IrvineIrvineCaliforniaUSA,Institute for Interdisciplinary Salivary Bioscience ResearchUniversity of California IrvineIrvineCaliforniaUSA
| | - Michael J. McCarthy
- Department of PsychiatryUniversity of California San DiegoSan DiegoCaliforniaUSA,VA San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - Soe H. Thein
- Department of Psychiatry and Behavioral SciencesUC Davis Health SystemSacramentoCaliforniaUSA
| | - Hillary L. Piccerillo
- Institute for Interdisciplinary Salivary Bioscience ResearchUniversity of California IrvineIrvineCaliforniaUSA
| | | | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience ResearchUniversity of California IrvineIrvineCaliforniaUSA,Johns Hopkins University School of NursingBloomberg School of Public Health, and School of MedicineBaltimoreMarylandUSA
| | - Elizabeth A. Thomas
- Department of EpidemiologyUniversity of California IrvineIrvineCaliforniaUSA,Institute for Interdisciplinary Salivary Bioscience ResearchUniversity of California IrvineIrvineCaliforniaUSA
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8
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Uwai Y, Yamaguchi R, Nabekura T. Analysis of sex difference in the tubular reabsorption of lithium in rats. Physiol Res 2021; 70:655-659. [PMID: 34062068 PMCID: PMC8820543 DOI: 10.33549/physiolres.934568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 04/22/2021] [Indexed: 11/25/2022] Open
Abstract
Lithium is used in the treatment of bipolar disorder. We previously demonstrated that two types of transporters mediate the tubular reabsorption of lithium in rats, and suggested that sodium-dependent phosphate transporters play a role in lithium reabsorption with high affinity. In the present study, we examined sex differences in lithium reabsorption in rats. When lithium chloride was infused at 60 µg/min, creatinine clearance and the renal clearance of lithium were lower, and the plasma concentration of lithium was higher in female rats. These values reflected the higher fractional reabsorption of lithium in female rats. In rats infused with lithium chloride at 6 µg/min, the pharmacokinetic parameters of lithium examined were all similar in both sexes. The fractional reabsorption of lithium was decreased by foscarnet, a representative inhibitor of sodium-dependent phosphate transporters, in male and female rats when lithium chloride was infused at the low rate. Among the candidate transporters mediating lithium reabsorption examined herein, the mRNA expression of only PiT2, a sodium-dependent phosphate transporter, exhibited sexual dimorphism. The present results demonstrated sex differences in the tubular reabsorption of lithium with low affinity in rats.
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Affiliation(s)
- Y Uwai
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan.
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9
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Antidepressant Augmentation: A Review of the Literature and a Review of the Pharmacoeconomic Considerations. J Clin Psychopharmacol 2021; 40:396-400. [PMID: 32639292 DOI: 10.1097/jcp.0000000000001236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Antidepressant augmentation strategies for treatment-resistant depression (TRD) are discussed here with an analysis of patient out-of-pocket costs for various medications. The choice of agent ranges from newer atypical antipsychotics (aripiprazole, brexpiprazole, quetiapine) to older agents including buspirone, liothyronine (T3), and lithium. We sought to better understand the differences among these agents to aid in clinical decision making. METHODS We conducted a focused review of the support for each of the aforementioned agents in antidepressant augmentation. We then compared the approximate out-of-pocket cost for each medication during a typical augmentation trial using the typical prescription costs on ClinCalc.com derived from the Medical Expenditure Panel Survey. We calculated the cost to achieve response for one patient with TRD based on the number needed to treat (NNT). FINDINGS We observed significant variance in cost to achieve response based on the NNT derived from our review of each of the medications. For example, the overall out-of-pocket cost for one patient to achieve response with aripiprazole (the costliest generic agent) could cover lithium prescriptions for 4 to 5 patients with TRD to achieve response. Although brexpiprazole was estimated separately because of its brand name cost, we estimated that 324 patients receiving lithium could achieve response for same cost of single patient receiving brexpiprazole. IMPLICATIONS These findings suggest that among augmentation agents, there are differences in cost that may be highly important in clinical decision making. Other issues of medication monitoring may incur additional costs, and brand name medications offer significantly greater complexity and potential out-of-pocket costs to patients. The use of lithium as a first-line agent for TRD should be considered based on low cost, lowest NNT, and data in support of its efficacy.
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Tobita S, Sogawa R, Murakawa T, Kimura S, Tasaki M, Sakamoto Y, Monji A, Irie H. The importance of monitoring renal function and concomitant medication to avoid toxicity in patients taking lithium. Int Clin Psychopharmacol 2021; 36:34-37. [PMID: 32541381 DOI: 10.1097/yic.0000000000000320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lithium, which is used for bipolar disorder, can cause toxicity. There are two categories of lithium toxicity, namely, overdose-related and not overdose-related. However, the treatment and prognosis of each type of toxicity are not clearly understood. We, therefore, compared the clinical characteristics of patients with overdose-related and not overdose-related lithium toxicity. Relevant data were obtained from the medical records of 16 patients with lithium toxicity, and renal function and concomitant medications were retrospectively compared between the two groups. We also compared the treatment for, manifestations of, and duration of hospitalization between the two types of lithium toxicity. The not overdose-related group more frequently had a low creatinine clearance (<50 mL/min) than did the overdose-related group (P = 0.01). Multivariable regression analysis demonstrated that creatinine clearance <50 mL/min was a significant predictor of lithium toxicity in the not overdose-related group (P = 0.01). Tremor and dysarthria occurred only in the not overdose-related group, and duration of hospitalization was significantly longer in the not overdose-related than overdose-related group (P = 0.01). Clinicians must monitor the renal function of patients taking lithium, even when in compliance with the prescribed dosage, because they are at long-term risk of lithium toxicity.
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Affiliation(s)
| | | | - Toru Murakawa
- Psychiatry Department, Faculty of Medicine, Saga University
| | | | | | | | - Akira Monji
- Psychiatry Department, Faculty of Medicine, Saga University
| | - Hiroyuki Irie
- Pharmacy Department, Saga University Hospital
- Radiology Department, Faculty of Medicine, Saga University, Japan
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11
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Courault P, Demarquay G, Zimmer L, Lancelot S. Cluster headache: state of the art of pharmacological treatments and therapeutic perspectives. Fundam Clin Pharmacol 2020; 35:595-619. [DOI: 10.1111/fcp.12636] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/13/2020] [Accepted: 12/03/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Pierre Courault
- Lyon Neuroscience Research Center (CRNL) Université de LyonCNRSINSERM Lyon France
- Hospices Civils de Lyon (HCL) Lyon France
| | | | - Luc Zimmer
- Lyon Neuroscience Research Center (CRNL) Université de LyonCNRSINSERM Lyon France
- Hospices Civils de Lyon (HCL) Lyon France
- CERMEP‐Imaging Platform Groupement Hospitalier Est Bron France
- National Institute for Nuclear Science and Technology (INSTN) CEA Saclay France
| | - Sophie Lancelot
- Lyon Neuroscience Research Center (CRNL) Université de LyonCNRSINSERM Lyon France
- Hospices Civils de Lyon (HCL) Lyon France
- CERMEP‐Imaging Platform Groupement Hospitalier Est Bron France
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12
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Uwai Y, Kondo R, Suzuki T, Kawasaki T, Nabekura T. Potent Inhibition of Biphasic Tubular Reabsorption of Lithium by Acetazolamide and Foscarnet in Rats. Physiol Res 2020; 69:645-651. [PMID: 32584131 DOI: 10.33549/physiolres.934285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Lithium is mainly excreted into urine, and a large fraction of lithium filtered through glomeruli is reabsorbed in the proximal tubule. However, the mechanisms responsible for lithium reabsorption remain unclear. We previously reported that the reabsorption of lithium was biphasic in rats, and that foscarnet inhibited lithium reabsorption with a high affinity type. We herein evaluated the effects of acetazolamide and foscarnet on the renal excretion of lithium in rats treated with lithium chloride at 2 doses. In rats intravenously injected with a bolus of 25 mg/kg lithium chloride, acetazolamide facilitated the urinary excretion of lithium, and increased the fractional excretion of lithium from 0.446 to 0.953, near the theoretically maximum value. At a dose of 2.5 mg/kg lithium chloride, the fractional excretion of lithium was 0.241 in control rats, 0.420 in rats administered acetazolamide, and 0.976 in rats administered acetazolamide and foscarnet. These results showed the potent inhibition of lithium reabsorption by acetazolamide and foscarnet in rats. And, it was exhibited that the effects of acetazolamide on lithium reabsorption differed with the dosages of lithium administered.
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Affiliation(s)
- Y Uwai
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Kusumoto, Chikusa, Nagoya, Japan.
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13
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Qaswal AB. Lithium Stabilizes the Mood of Bipolar Patients by Depolarizing the Neuronal Membrane Via Quantum Tunneling through the Sodium Channels. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:214-218. [PMID: 32329302 PMCID: PMC7242109 DOI: 10.9758/cpn.2020.18.2.214] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/13/2019] [Accepted: 08/19/2019] [Indexed: 01/02/2023]
Abstract
Objective Lithium is used as first line in treating bipolar patients to stabilize their mood. However, the exact mechanism of lithium is not yet established. One of the proposed mechanisms is that lithium depolarizes the hyperpolarized neuronal membrane of bipolar patients bringing it back to the normal potential. On the other hand, the only way that lithium causes significant therapeutic depolarization is to have a membrane conductance that must be at least an order of magnitude higher than that for sodium but this is not achieved since both; lithium and sodium have the same conductance because the membrane channels are selective for them approximately by the same degree. So, this study aimed to explain how lithium could achieve higher conductance than sodium. Methods The idea of quantum tunneling through closed channels was used in a way to calculate the tunneling probability and the quantum conductance for lithium ions. Results It was found that lithium could achieve higher conductance than sodium because it has a smaller mass than sodium making lithium to have higher probability of tunneling and consequently higher conductance through channels and membrane. Conclusion Lithium tunneling model provides a reasonable explanation for the therapeutic depolarization effect of lithium. This model is experimentally testable to prove the tunneling effect of ions through the closed channels and to show the variations of quantum conductance between ions according to their mass.
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Pharmacist-Psychiatrist Interventions Triggered by Clinical Decision Support System Improve Monitoring of Patients Using Lithium in a General Hospital. J Clin Psychopharmacol 2020; 39:532-533. [PMID: 31415287 DOI: 10.1097/jcp.0000000000001084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Medić B, Stojanović M, Stimec BV, Divac N, Vujović KS, Stojanović R, Čolović M, Krstić D, Prostran M. Lithium - Pharmacological and Toxicological Aspects: The Current State of the Art. Curr Med Chem 2020; 27:337-351. [DOI: 10.2174/0929867325666180904124733] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/16/2018] [Accepted: 07/19/2018] [Indexed: 12/21/2022]
Abstract
:
Lithium is the smallest monovalent cation with many different biological effects.
Although lithium is present in the pharmacotherapy of psychiatric illnesses for decades, its
precise mechanism of action is still not clarified. Today lithium represents first-line therapy
for bipolar disorders (because it possesses both antimanic and antidepressant properties) and
the adjunctive treatment for major depression (due to its antisuicidal effects). Beside, lithium
showed some protective effects in neurological diseases including acute neural injury, chronic
degenerative conditions, Alzheimer's disease as well as in treating leucopenia, hepatitis and
some renal diseases. Recent evidence suggested that lithium also possesses some anticancer
properties due to its inhibition of Glycogen Synthase Kinase 3 beta (GSK3β) which is included
in the regulation of a lot of important cellular processes such as: glycogen metabolism,
inflammation, immunomodulation, apoptosis, tissue injury, regeneration etc.
:
Although recent evidence suggested a potential utility of lithium in different conditions, its
broader use in clinical practice still trails. The reason for this is a narrow therapeutic index of
lithium, numerous toxic effects in various organ systems and some clinically relevant interactions
with other drugs. Additionally, it is necessary to perform more preclinical as well as
clinical studies in order to a precise therapeutic range of lithium, as well as its detailed
mechanism of action. The aim of this review is to summarize the current knowledge concerning
the pharmacological and toxicological effects of lithium.
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Affiliation(s)
- Branislava Medić
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marko Stojanović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bojan V. Stimec
- Anatomy Sector, Department of Cell Physiology and Metabolism, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nevena Divac
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Katarina Savić Vujović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Radan Stojanović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mirjana Čolović
- Department of Physical Chemistry, “Vinca“ Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| | - Danijela Krstić
- Institute of Medical Chemistry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milica Prostran
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Kim MS, Bang J, Jeon WK. The Involvement of Canonical Wnt Signaling in Memory Impairment Induced by Chronic Cerebral Hypoperfusion in Mice. Transl Stroke Res 2020; 11:734-746. [DOI: 10.1007/s12975-019-00748-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 01/25/2023]
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Jobbagy S, Vitturi DA, Salvatore SR, Pires MF, Rowart P, Emlet DR, Ross M, Hahn S, St Croix C, Wendell SG, Subramanya AR, Straub AC, Tan RJ, Schopfer FJ. Nrf2 activation protects against lithium-induced nephrogenic diabetes insipidus. JCI Insight 2020; 5:128578. [PMID: 31941842 DOI: 10.1172/jci.insight.128578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 11/20/2019] [Indexed: 12/14/2022] Open
Abstract
Lithium (Li) is the mainstay pharmacotherapeutic mood stabilizer in bipolar disorder. Its efficacious use is complicated by acute and chronic renal side effects, including nephrogenic diabetes insipidus (NDI) and progression to chronic kidney disease (CKD). The nuclear factor erythroid-derived 2-related factor 2 (Nrf2) pathway senses and coordinates cellular responses to oxidative and electrophilic stress. Here, we identify that graded genetic activation of Nrf2 protects against Li-induced NDI (Li-NDI) and volume wasting via an aquaporin 2-independent mechanism. Renal Nrf2 activity is differentially expressed on functional segments of the nephron, and its activation along the distal tubule and collecting duct directly modulates ion transporter expression, mimicking paradoxical effects of diuretics in mitigating Li-NDI. In addition, Nrf2 reduces cyclooxygenase expression and vasoactive prostaglandin biosynthesis. Pharmacologic activation of Nrf2 confers protective effects, confirming this pathway as a potentially novel druggable target for the prevention of acute and chronic renal sequelae of Li therapy.
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Affiliation(s)
| | - Dario A Vitturi
- Department of Pharmacology and Chemical Biology.,Pittsburgh Heart, Lung and Blood Vascular Medicine Institute
| | | | | | | | - David R Emlet
- Center for Critical Care Nephrology, Department of Critical Care Medicine
| | | | - Scott Hahn
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute
| | | | - Stacy G Wendell
- Department of Pharmacology and Chemical Biology.,Health Sciences Metabolomics and Lipidomics Core, and
| | - Arohan R Subramanya
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Adam C Straub
- Department of Pharmacology and Chemical Biology.,Pittsburgh Heart, Lung and Blood Vascular Medicine Institute
| | - Roderick J Tan
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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18
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Pacholko AG, Wotton CA, Bekar LK. Poor Diet, Stress, and Inactivity Converge to Form a "Perfect Storm" That Drives Alzheimer's Disease Pathogenesis. NEURODEGENER DIS 2019; 19:60-77. [PMID: 31600762 DOI: 10.1159/000503451] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/17/2019] [Indexed: 11/19/2022] Open
Abstract
North American incidence of Alzheimer's disease (AD) is expected to more than double over the coming generation. Although genetic factors surrounding the production and clearance of amyloid-β and phosphorylated tau proteins are known to be responsible for a subset of early-onset AD cases, they do not explain the pathogenesis of the far more prevalent sporadic late-onset variant of the disease. It is thus likely that lifestyle and environmental factors contribute to neurodegenerative processes implicated in the pathogenesis of AD. Herein, we review evidence that (1) excess sucrose consumption induces AD-associated liver pathologies and brain insulin resistance, (2) chronic stress overdrives activity of locus coeruleus neurons, leading to loss of function (a common event in neurodegeneration), (3) high-sugar diets and stress promote the loss of neuroprotective sex hormones in men and women, and (4) Western dietary trends set the stage for a lithium-deficient state. We propose that these factors may intersect as part of a "perfect storm" to contribute to the widespread prevalence of neurodegeneration and AD. In addition, we put forth the argument that exercise and supplementation with trace lithium can counteract many of the deleterious consequences associated with excessive caloric intake and perpetual stress. We conclude that lifestyle and environmental factors likely contribute to AD pathogenesis and that simple lifestyle and dietary changes can help counteract their effects.
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Affiliation(s)
- Anthony G Pacholko
- Department of Anatomy, Physiology, and Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Caitlin A Wotton
- Department of Anatomy, Physiology, and Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lane K Bekar
- Department of Anatomy, Physiology, and Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada,
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Marazziti D, Mucci F, Avella MT, Dell’Oste V, Baroni S, Dell’Osso L. Treatment of the obsessive-compulsive and bipolar disorders comorbidity: pharmacodynamic and pharmacokinetic evaluation. Expert Opin Drug Metab Toxicol 2019; 15:619-631. [DOI: 10.1080/17425255.2019.1640211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Donatella Marazziti
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Federico Mucci
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Maria Teresa Avella
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Valerio Dell’Oste
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Stefano Baroni
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Liliana Dell’Osso
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
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20
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Seidel U, Baumhof E, Hägele FA, Bosy-Westphal A, Birringer M, Rimbach G. Lithium-Rich Mineral Water is a Highly Bioavailable Lithium Source for Human Consumption. Mol Nutr Food Res 2019; 63:e1900039. [PMID: 31051049 DOI: 10.1002/mnfr.201900039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/27/2019] [Indexed: 01/24/2023]
Abstract
SCOPE Lithium is an important trace element in human nutrition and medicine. Mineral and medicinal waters may represent a significant source of dietary lithium intake. METHODS AND RESULTS The lithium concentration of 360 German mineral and 21 medicinal waters is determined. Based on a systematic screening, three different mineral waters exhibiting low (1.7 µg L-1 ), medium (171 µg L-1 ), and high lithium (1724 µg L-1 ) concentrations are chosen for an acute bioavailability study in male healthy volunteers. In Germany, a north-east to south-west gradient of analyzed lithium concentrations is observed in the 381 tested waters. The lithium concentration in the water is significantly correlated with its sodium (r = 0. 810), potassium (r = 0.716), and magnesium (r = 0.361), but not with its calcium concentration. In a randomized cross-over trial, volunteers (n = 3×10 each) drink 1.5 L of the respective mineral waters, and lithium concentrations in serum and urine are monitored over 24 h. Consumption of the mineral waters with a medium and high lithium content results in a dose-dependent response in serum lithium concentrations and total urinary lithium excretion. CONCLUSION Lithium-rich mineral and medicinal waters may be an important and highly bioavailable lithium source for human consumption.
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Affiliation(s)
- Ulrike Seidel
- Kiel University, Institute of Human Nutrition and Food Science, Devision of Food Science, 24118, Kiel, Germany
| | - Elena Baumhof
- Kiel University, Institute of Human Nutrition and Food Science, Devision of Food Science, 24118, Kiel, Germany
| | - Franziska A Hägele
- Kiel University, Institute of Human Nutrition and Food Science, Devision of Food Science, 24118, Kiel, Germany
| | - Anja Bosy-Westphal
- Kiel University, Institute of Human Nutrition and Food Science, Devision of Food Science, 24118, Kiel, Germany
| | - Marc Birringer
- Fulda University of Applied Science, Devision of Nutritional, Food and Consumer Science, 36037, Fulda, Germany
| | - Gerald Rimbach
- Kiel University, Institute of Human Nutrition and Food Science, Devision of Food Science, 24118, Kiel, Germany
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21
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Kumar SB, Kamal R, Khan A, Chadha VD. Dose optimization of lithium to increase the uptake and retention of I-131 in rat thyroid. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2019; 58:257-262. [PMID: 30810817 DOI: 10.1007/s00411-019-00783-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 02/19/2019] [Indexed: 06/09/2023]
Abstract
The present study was undertaken to optimize the dose of lithium, with an aim to increase the retention of I-131 in the thyroid follicles while maintaining the euthyroid state. 24 female Wistar rats weighing 110 ± 20 g were segregated into four groups. Animals in group I were fed standard laboratory feed and water throughout the period of experimentation. Animals in group II, III and IV were additionally fed with lithium in the form of lithium carbonate orally, at a dose of 10 mg/kg body weight, 20 mg/kg body weight, 30 mg/kg body weight respectively. The dose of lithium was started 1 week prior to radioiodine administration and continued thereafter for another 8 days. After 7 days of lithium treatment, 0.48 MBq of carrier-free I-131 was injected intraperitoneally into each rat, of the four groups. I-131 thyroidal uptake and biokinetics, as well as serum TSH, T3, T4 levels were estimated in all the treatment groups. A significant increase in the thyroid and whole body counts was observed after 4 and 24 h of I-131 aministration in lithium treated rats, compared to control animals. An increase in thyroidal effective t1/2 and serum TSH levels, along with decrease in the levels of serum T3 and T4 was observed with a dose of 20 mg/kg or higher. In Conclusion, a Lithium dose of 10 mg/kg body weight in rats could increase the uptake of I-131 in the thyroid, without disturbing the control circulating levels of thyroid hormones.
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Affiliation(s)
- Sanny B Kumar
- Centre for Nuclear Medicine (UIEAST), Panjab University, Chandigarh, 160014, India
| | - Rozy Kamal
- Centre for Nuclear Medicine (UIEAST), Panjab University, Chandigarh, 160014, India
| | - Anna Khan
- Centre for Nuclear Medicine (UIEAST), Panjab University, Chandigarh, 160014, India
| | - Vijayta D Chadha
- Centre for Nuclear Medicine (UIEAST), Panjab University, Chandigarh, 160014, India.
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22
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Ganter NM, Tong K, McDonald C, Doherty AM. The clinical characteristics and correlates of lithium toxicity in a tertiary referral centre. Ir J Med Sci 2019; 188:1103-1109. [PMID: 30632028 DOI: 10.1007/s11845-018-01963-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Lithium is a medication indicated for the treatment of bipolar disorder and treatment-resistant depression, with a narrow therapeutic index. Overdose, either acute or chronic can result in neurological symptoms, requiring dialysis and admission to intensive care in some cases. Lithium toxicity is avoidable with careful monitoring. However, we have noted several recent cases of lithium toxicity in our local service and thus sought to investigate this issue in a more systematic manner. AIM We aimed to quantify the incidence of lithium toxicity in our local population over a single year and identify the patients most at risk. We also aimed to generate clinical recommendations on the prevention of lithium toxicity to improve patient safety. METHOD We identified the incidence of lithium toxicity in our local population, by searching the hospital pathology database for patients with serum lithium levels greater than 1.0 mmol/L. We examined the available clinical notes for these patients. RESULTS We identified 74 serum lithium readings above 1.0 mmol/L measured in 44 individual patients. The highest recorded level was 3.2 mmol/L. Of these, 11 patients were aged 65 years or older. Hospital admission was required in 14 cases. There were missing data of note: 29.5% had no renal function/eGFR measurement at time of toxicity and 52.3% without a baseline eGFR. CONCLUSION Lithium toxicity is common in our population. Given the narrow therapeutic index, this demonstrates the need for careful monitoring and prescribing, especially patients aged 65 and over.
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Affiliation(s)
- Niamh M Ganter
- School of Medicine, National University of Ireland, Galway, Ireland.
| | - Kezanne Tong
- Department of Psychiatry, University Hospital Galway, Galway, Ireland
| | - Colm McDonald
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Psychiatry, University Hospital Galway, Galway, Ireland
| | - Anne M Doherty
- Department of Psychiatry, University Hospital Galway, Galway, Ireland
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23
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Zhang Y, Riquier-Brison A, Liu T, Huang Y, Carlson NG, Peti-Peterdi J, Kishore BK. Genetic Deletion of P2Y 2 Receptor Offers Long-Term (5 Months) Protection Against Lithium-Induced Polyuria, Natriuresis, Kaliuresis, and Collecting Duct Remodeling and Cell Proliferation. Front Physiol 2018; 9:1765. [PMID: 30618788 PMCID: PMC6304354 DOI: 10.3389/fphys.2018.01765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/22/2018] [Indexed: 11/15/2022] Open
Abstract
Chronic lithium administration for the treatment of bipolar disorder leads to nephrogenic diabetes insipidus (NDI), characterized by polyuria, natriuresis, kaliuresis, and collecting duct remodeling and cell proliferation among other features. Previously, using a 2-week lithium-induced NDI model, we reported that P2Y2 receptor (R) knockout mice are significantly resistant to polyuria, natriuresis, kaliuresis, and decrease in AQP2 protein abundance in the kidney relative to wild type mice. Here we show this protection is long-lasting, and is also associated with significant amelioration of lithium-induced collecting duct remodeling and cell proliferation. Age-matched wild type and knockout mice were fed regular (n = 5/genotype) or lithium-added (40 mmol/kg chow; n = 10/genotype) diet for 5 months and euthanized. Water intake, urine output and osmolality were monitored once in every month. Salt blocks were provided to mice on lithium-diet to prevent sodium loss. At the end of 5 months mice were euthanized and serum and kidney samples were analyzed. There was a steady increase in lithium-induced polyuria, natriuresis and kaliuresis in wild type mice over the 5-month period. Increases in these urinary parameters were very low in lithium-fed knockout mice, resulting in significantly widening differences between the wild type and knockout mice. Terminal AQP2 and NKCC2 protein abundances in the kidney were significantly higher in lithium-fed knockout vs. wild type mice. There were no significant differences in terminal serum lithium or sodium levels between the wild type and knockout mice. Confocal immunofluorescence microscopy revealed that lithium-induced marked remodeling of collecting duct with significantly increased proportion of [H+]-ATPase-positive intercalated cells and decreased proportion of AQP2-positive principal cells in the wild type, but not in knockout mice. Lithium-induced collecting duct cell proliferation (indicated by Ki67 labeling), was significantly lower in knockout vs. wild type mice. This is the first piece of evidence that purinergic signaling is potentially involved in lithium-induced collecting duct remodeling and cell proliferation. Our results demonstrate that genetic deletion of P2Y2-R protects against the key structural and functional alterations in Li-induced NDI, and underscore the potential utility of targeting this receptor for the treatment of NDI in bipolar patients on chronic lithium therapy.
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Affiliation(s)
- Yue Zhang
- Nephrology Research, Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
- Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, United States
- Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China
| | - Anne Riquier-Brison
- Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, CA, United States
- Department of Physiology and Neuroscience, University of Southern California, Los Angeles, CA, United States
| | - Tao Liu
- Nephrology Research, Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
- Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Yufeng Huang
- Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Noel G. Carlson
- Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
- Department of Neurobiology and Anatomy, University of Utah Health, Salt Lake City, UT, United States
- Center on Aging, University of Utah Health, Salt Lake City, UT, United States
| | - János Peti-Peterdi
- Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, CA, United States
- Department of Physiology and Neuroscience, University of Southern California, Los Angeles, CA, United States
| | - Bellamkonda K. Kishore
- Nephrology Research, Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
- Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, United States
- Center on Aging, University of Utah Health, Salt Lake City, UT, United States
- Department of Nutrition and Integrative Physiology, University of Utah Health, Salt Lake City, UT, United States
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Uwai Y, Suzuki T, Kondo R, Kawasaki T, Nabekura T. Effect of renal ischemia on urinary excretion of lithium in rats. Biopharm Drug Dispos 2018; 39:448-451. [PMID: 30393876 DOI: 10.1002/bdd.2163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/12/2018] [Accepted: 10/20/2018] [Indexed: 11/11/2022]
Abstract
Lithium, administered to patients with bipolar disorders, is mainly excreted in the urine, and tubular reabsorption is involved. This study characterized the renal excretion of lithium in rats subjected to renal ischemia for 60 min or 90 min. After intravenous injection of lithium chloride at 25 mg/kg, the pharmacokinetic parameters of lithium were determined. In sham-operated rats, the renal clearance of lithium was calculated to be 1.49 ml/min/kg, and its ratio to creatinine clearance (fractional excretion) was 43.4%. Renal ischemia inhibited the renal excretion of lithium, and did not affect its fractional excretion. The urinary pH of rats with renal ischemia for 90 min was significantly higher than those of the other groups, and the linear regression with the fractional excretion of lithium in rats with renal ischemia showed a moderate correlation (r = 0.650, p = 0.00193). This study demonstrated the effect of renal ischemia on the renal excretion of lithium in rats. It was suggested that not only glomerular filtration but also the reabsorption of lithium was impaired by renal ischemia.
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Affiliation(s)
- Yuichi Uwai
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
| | - Takato Suzuki
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
| | - Ryota Kondo
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
| | - Tatsuya Kawasaki
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
| | - Tomohiro Nabekura
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
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25
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Felthous AR, Stanford MS, Saß H. Zur Pharmakotherapie impulsiver Aggression bei antisozialen und psychopathischen Störungen. FORENSISCHE PSYCHIATRIE PSYCHOLOGIE KRIMINOLOGIE 2018. [DOI: 10.1007/s11757-018-0491-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Joint pain due to osteoarthritis (OA) is often severe and disabling and affects a large proportion of the aging population impairing daily living and quality of life. Numerous pharmacological treatment approaches are available. Including major OA guidelines this review presents the current evidence of pharmacological therapies in OA-related pain and covers topical, oral and intraarticular treatment approaches. In patients with mild OA topical nonsteroidal antiinflammatory drugs (NSAIDs) can be recommended. Topical capsaicin can be used when other treatments are ineffective or contraindicated. In patients with moderate to severe OA oral NSAIDs are suggested at the lowest effective dose for the shortest possible duration to control symptoms. Importantly, drug-related side effects and gastrointestinal, cardiovascular and renal comorbidities need to be taken into account. In patients with multiple-joint OA and high risk of NSAID-induced adverse events duloxetine can be considered. The evidence of metamizole, symptomatic slow-acting drugs in osteoarthritis and other nutritional supplements in the treatment of OA pain is uncertain and the use of opioids is not routinely recommended. In patients suffering from severe OA-related pain intraarticular injections with glucocorticoids can be suggested to achieve short-term pain relief. Evidence for interventional approaches using hyaluronic acid or platelet-rich plasma is uncertain. Yet, the efficacy of pharmacological therapies in OA-related pain is often inconsistent and severe adverse events might occur. Thus, critical use of the different treatment options considering patient-related comorbidities and nonpharmacological therapies is of major importance.
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Affiliation(s)
- T A Nees
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 220a, 69118, Heidelberg, Deutschland.
| | - M Schiltenwolf
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 220a, 69118, Heidelberg, Deutschland
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27
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Nunes RP. Lithium interactions with non-steroidal anti-inflammatory drugs and diuretics – A review. ARCH CLIN PSYCHIAT 2018. [DOI: 10.1590/0101-60830000000153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Mehta N, Vannozzi R. Lithium-induced electrocardiographic changes: A complete review. Clin Cardiol 2017; 40:1363-1367. [PMID: 29247520 DOI: 10.1002/clc.22822] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/12/2017] [Accepted: 09/20/2017] [Indexed: 02/01/2023] Open
Abstract
Lithium has been used for the treatment of bipolar disorder for more than 6 decades. Reports of cardiac side effects resulting in both benign electrocardiographic (ECG) changes and near fatal arrhythmias have been reported in the literature. A systematic literature search was conducted on 2 electronic databases-PubMed and Medline-for the time period between January 1970 and March 2016 using the key word "lithium," along with "electrocardiography" or "ECG." All articles and their references were then screened by title for relevance by 2 authors and a librarian. A total of 406 articles were found on literature search, of which 56 met the screening criteria. T wave inversion was the most frequently reported ECG finding. Other findings include sinus node dysfunction, sinoatrial blocks, PR prolongation, QT prolongation/dispersion, and ventricular tachyarrhythmias. Some cases have shown lithium-treated patients experiencing serious cardiac outcomes, such as ST elevation myocardial infarction, heart blocks, and the Brugada pattern. Electrical changes from lithium were found to be dependent on both duration of treatment and the serum lithium level. Although there are no standardized ECG guidelines, frequent monitoring of patients on lithium therapy can ensure the medication's safe use.
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Affiliation(s)
- Nikhil Mehta
- Department of Internal Medicine, Rochester Regional Health, Rochester, New York
| | - Robert Vannozzi
- Department of Cardiology, Rochester Regional Health, Rochester, New York
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Uwai Y, Kawasaki T, Nabekura T. Nonlinear disposition of lithium in rats and saturation of its tubular reabsorption by the sodium-phosphate cotransporter as a cause. Biopharm Drug Dispos 2017; 39:83-87. [PMID: 29214648 DOI: 10.1002/bdd.2116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/16/2017] [Accepted: 11/26/2017] [Indexed: 12/26/2022]
Abstract
We previously reported the contribution of sodium-phosphate cotransporter to the tubular reabsorption of lithium in rats. In the present study, the dose dependency of the renal handling of lithium was examined in rats. When lithium chloride at 1.25 mg/kg, 2.5 mg/kg and 25 mg/kg was intravenously injected as a bolus, the areas under the plasma concentration-time curve of lithium until 60 minutes were calculated to be 6.23 mEq·min/l, 8.77 mEq·min/l and 64.6 mEq·min/l, respectively. The renal clearance of lithium and its fractional excretion increased with increments in the dose administered. The renal clearance of lithium strongly correlated with the urinary excretion rate of phosphate in the 1.25 mg/kg group (r = 0.840) and 2.5 mg/kg group (r = 0.773), whereas this correlation was weak in the 25 mg/kg group (r = 0.306). The infusion of foscarnet, a typical inhibitor of sodium-phosphate cotransporter, decreased the fractional reabsorption of lithium in rats administered lithium chloride at 2.5 mg/kg, but did not affect it in rats administered 25 mg/kg. These results demonstrate the nonlinearity of the renal excretion of lithium in rats, with the saturation of lithium reabsorption by the sodium-phosphate cotransporter potentially being involved.
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Affiliation(s)
- Yuichi Uwai
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
| | - Tatsuya Kawasaki
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
| | - Tomohiro Nabekura
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
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Zhang Y, Peti-Peterdi J, Brandes AU, Riquier-Brison A, Carlson NG, Müller CE, Ecelbarger CM, Kishore BK. Prasugrel suppresses development of lithium-induced nephrogenic diabetes insipidus in mice. Purinergic Signal 2017; 13:239-248. [PMID: 28233082 PMCID: PMC5432483 DOI: 10.1007/s11302-017-9555-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/23/2017] [Indexed: 12/17/2022] Open
Abstract
Previously, we localized ADP-activated P2Y12 receptor (R) in rodent kidney and showed that its blockade by clopidogrel bisulfate (CLPD) attenuates lithium (Li)-induced nephrogenic diabetes insipidus (NDI). Here, we evaluated the effect of prasugrel (PRSG) administration on Li-induced NDI in mice. Both CLPD and PRSG belong to the thienopyridine class of ADP receptor antagonists. Groups of age-matched adult male B6D2 mice (N = 5/group) were fed either regular rodent chow (CNT), or with added LiCl (40 mmol/kg chow) or PRSG in drinking water (10 mg/kg bw/day) or a combination of LiCl and PRSG for 14 days and then euthanized. Water intake and urine output were determined and blood and kidney tissues were collected and analyzed. PRSG administration completely suppressed Li-induced polydipsia and polyuria and significantly prevented Li-induced decreases in AQP2 protein abundance in renal cortex and medulla. However, PRSG either alone or in combination with Li did not have a significant effect on the protein abundances of NKCC2 or NCC in the cortex and/or medulla. Immunofluorescence microscopy revealed that PRSG administration prevented Li-induced alterations in cellular disposition of AQP2 protein in medullary collecting ducts. Serum Li, Na, and osmolality were not affected by the administration of PRSG. Similar to CLPD, PRSG administration had no effect on Li-induced increase in urinary Na excretion. However, unlike CLPD, PRSG did not augment Li-induced increase in urinary arginine vasopressin (AVP) excretion. Taken together, these data suggest that the pharmacological inhibition of P2Y12-R by the thienopyridine group of drugs may potentially offer therapeutic benefits in Li-induced NDI.
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Affiliation(s)
- Yue Zhang
- Department of Internal Medicine and Center on Aging, University of Utah Health Sciences Center, Veterans Affairs Salt Lake City, Health Care System, 500 Foothill Drive (151M), Salt Lake City, UT, 84148, USA
| | - János Peti-Peterdi
- Zilkha Neurogenetic Institute and Department of Physiology and Biophysics, University of Southern California, 1501 San Pablo Street, ZNI 313, Los Angeles, CA, 90033, USA
| | - Anna U Brandes
- Department of Internal Medicine and Center on Aging, University of Utah Health Sciences Center, Veterans Affairs Salt Lake City, Health Care System, 500 Foothill Drive (151M), Salt Lake City, UT, 84148, USA
| | - Anne Riquier-Brison
- Zilkha Neurogenetic Institute and Department of Physiology and Biophysics, University of Southern California, 1501 San Pablo Street, ZNI 313, Los Angeles, CA, 90033, USA
| | - Noel G Carlson
- PharmaCenter Bonn, Pharmaceutical Institute, Pharmaceutical Chemistry I, University of Bonn, An der Immenburg 4, D-53121, Bonn, Germany
| | - Christa E Müller
- Depatment of Neurobiology and Anatomy and Center on Aging, University of Utah Health Sciences Center, Geriatric Research, Education, and Clinical Center (GRECC) Veterans Affairs Salt Lake City Health Care System, 500 Foothill Drive (151B), Salt Lake City, UT, 84148, USA
| | - Carolyn M Ecelbarger
- Department of Medicine, Center for the Study of Sex Differences in Health, Aging, and Disease, Georgetown University, 4000 Reservoir Road NW Bldg D, Rm 392, Washington, DC, 20057, USA
| | - Bellamkonda K Kishore
- Department of Internal Medicine and Center on Aging, University of Utah Health Sciences Center, Veterans Affairs Salt Lake City, Health Care System, 500 Foothill Drive (151M), Salt Lake City, UT, 84148, USA.
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Uwai Y, Matsumoto M, Kawasaki T, Nabekura T. Enantioselective Effect of Flurbiprofen on Lithium Disposition in Rats. Pharmacology 2017; 99:236-239. [PMID: 28147361 DOI: 10.1159/000455917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/09/2017] [Indexed: 11/19/2022]
Abstract
AIMS Lithium is administered for treating bipolar disorders and is mainly excreted into urine. Nonsteroidal anti-inflammatory drugs inhibit this process. In this study, we examined the enantioselective effect of flurbiprofen on the disposition of lithium in rats. METHODS Pharmacokinetic experiments with lithium were performed. RESULTS Until 60 min after the intravenous administration of lithium chloride at 30 mg/kg as a bolus, 17.8% of lithium injected was recovered into the urine. Its renal clearance was calculated to be 1.62 mL/min/kg. Neither creatinine clearance (Ccr) nor pharmacokinetics of lithium was affected by the simultaneous injection of (R)-flurbiprofen at 20 mg/kg. (S)-flurbiprofen impaired the renal function and interfered with the urinary excretion of lithium. The ratio of renal clearance of lithium to Ccr was decreased by the (S)-enantiomer. CONCLUSION This study clarified that the (S)-flurbiprofen but not (R)-flurbiprofen inhibited the renal excretion of lithium in rats.
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Affiliation(s)
- Yuichi Uwai
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
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Shahzad B, Mughal MN, Tanveer M, Gupta D, Abbas G. Is lithium biologically an important or toxic element to living organisms? An overview. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2017; 24:103-115. [PMID: 27785724 DOI: 10.1007/s11356-016-7898-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 10/11/2016] [Indexed: 05/18/2023]
Abstract
Industrialized world is exposing living organisms to different chemicals and metals such as lithium (Li). Due to their use in common household items to industrial applications, it is imperative to examine their bioavailability. Lithium belongs to the group IA and also has wider uses such as in batteries, air conditioners to atomic reactors. Lithium occurs naturally in soil and water, mostly at low concentrations, and enters the food chain. It is not one of the essential minerals though various studies indicate that low levels of Li have beneficial effects on living organisms, whereas high levels expose them to toxicity and related detrimental effects. This review suggests that Li could be biologically important to living organism depending upon its concentration/exposure. Little is known about its biological importance and molecular understanding of its accumulation and mode of action, which might have future implications for Li's long-term effects on living organisms.
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Affiliation(s)
- Babar Shahzad
- Department of Agronomy, University of Agriculture Faisalabad, Faisalabad, Pakistan
| | - Mudassar Niaz Mughal
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, China.
| | - Mohsin Tanveer
- School of Land and Food, University of Tasmania, Hobart, Australia
| | - Dorin Gupta
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia
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de Andrés F, Lionetto L, Curto M, Capi M, Cipolla F, Negro A, Martelletti P. Acute, transitional and long-term cluster headache treatment: pharmacokinetic issues. Expert Opin Drug Metab Toxicol 2016; 12:1011-20. [DOI: 10.1080/17425255.2016.1201067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Fernando de Andrés
- CICAB Clinical Research Centre, Extremadura University Hospital and Medical School, Badajoz, Spain
| | - Luana Lionetto
- Advanced Molecular Diagnostics Unit, IDI-IRCCS, Rome, Italy
| | - Martina Curto
- Department of Molecular Medicine, Sant’Andrea Medical Center, Sapienza University of Rome, Rome, Italy
- Regional Referral Headache Center, Sant’Andrea Hospital, Rome, Italy
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Matilde Capi
- NESMOS Department, Sapienza University of Rome, Rome, Italy
| | | | - Andrea Negro
- Department of Molecular Medicine, Sant’Andrea Medical Center, Sapienza University of Rome, Rome, Italy
- Regional Referral Headache Center, Sant’Andrea Hospital, Rome, Italy
| | - Paolo Martelletti
- Department of Molecular Medicine, Sant’Andrea Medical Center, Sapienza University of Rome, Rome, Italy
- Regional Referral Headache Center, Sant’Andrea Hospital, Rome, Italy
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Chen Y, Zheng L, Liu W, Li H, Yu S, Chen Q, Pan B, Yu H, Yu R. Electrocardiographic changes caused by lithium intoxication in an elderly patient. SPRINGERPLUS 2016; 5:10. [PMID: 26759749 PMCID: PMC4700026 DOI: 10.1186/s40064-015-1602-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/09/2015] [Indexed: 11/29/2022]
Abstract
Lithium intoxication can cause serious cardiac toxicity and is associated with electrocardiogram (ECG) changes. This paper described a case of a 76-year-old man who was lithium intoxicated and showed a variety of ECG abnormalities including sinus bradycardia, rapid atrial fibrillation, second-degree atrioventricular block and T wave changes. We monitored his ECGs during the after 3 days consecutively. After hemodialysis, his ECG abnormalities partially eased along with his serum lithium concentration decreased.
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Affiliation(s)
- Yiping Chen
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang China
| | - Leilei Zheng
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang China
| | - Weibo Liu
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang China
| | - Huichun Li
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang China
| | - Shaohua Yu
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang China
| | - Qiaozhen Chen
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang China
| | - Bin Pan
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang China
| | - Hualiang Yu
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang China
| | - Risheng Yu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang China
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Moore N, Pollack C, Butkerait P. Adverse drug reactions and drug-drug interactions with over-the-counter NSAIDs. Ther Clin Risk Manag 2015. [PMID: 26203254 PMCID: PMC4508078 DOI: 10.2147/tcrm.s79135] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen have a long history of safe and effective use as both prescription and over-the-counter (OTC) analgesics/antipyretics. The mechanism of action of all NSAIDs is through reversible inhibition of cyclooxygenase enzymes. Adverse drug reactions (ADRs) including gastrointestinal bleeding as well as cardiovascular and renal effects have been reported with NSAID use. In many cases, ADRs may occur because of drug-drug interactions (DDIs) between the NSAID and a concomitant medication. For example, DDIs have been reported when NSAIDs are coadministered with aspirin, alcohol, some antihypertensives, antidepressants, and other commonly used medications. Because of the pharmacologic nature of these interactions, there is a continuum of risk in that the potential for an ADR is dependent on total drug exposure. Therefore, consideration of dose and duration of NSAID use, as well as the type or class of comedication administered, is important when assessing potential risk for ADRs. Safety findings from clinical studies evaluating prescription-strength NSAIDs may not be directly applicable to OTC dosing. Health care providers can be instrumental in educating patients that using OTC NSAIDs at the lowest effective dose for the shortest required duration is vital to balancing efficacy and safety. This review discusses some of the most clinically relevant DDIs reported with NSAIDs based on major sites of ADRs and classes of medication, with a focus on OTC ibuprofen, for which the most data are available.
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Affiliation(s)
- Nicholas Moore
- Department of Pharmacology, Université de Bordeaux, Bordeaux, France
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Kishore BK, Carlson NG, Ecelbarger CM, Kohan DE, Müller CE, Nelson RD, Peti-Peterdi J, Zhang Y. Targeting renal purinergic signalling for the treatment of lithium-induced nephrogenic diabetes insipidus. Acta Physiol (Oxf) 2015; 214:176-88. [PMID: 25877068 PMCID: PMC4430398 DOI: 10.1111/apha.12507] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/08/2015] [Indexed: 12/26/2022]
Abstract
Lithium still retains its critical position in the treatment of bipolar disorder by virtue of its ability to prevent suicidal tendencies. However, chronic use of lithium is often limited by the development of nephrogenic diabetes insipidus (NDI), a debilitating condition. Lithium-induced NDI is due to resistance of the kidney to arginine vasopressin (AVP), leading to polyuria, natriuresis and kaliuresis. Purinergic signalling mediated by extracellular nucleotides (ATP/UTP), acting via P2Y receptors, opposes the action of AVP on renal collecting duct (CD) by decreasing the cellular cAMP and thus AQP2 protein levels. Taking a cue from this phenomenon, we discovered the potential involvement of ATP/UTP-activated P2Y2 receptor in lithium-induced NDI in rats and showed that P2Y2 receptor knockout mice are significantly resistant to Li-induced polyuria, natriuresis and kaliuresis. Extension of these studies revealed that ADP-activated P2Y12 receptor is expressed in the kidney, and its irreversible blockade by the administration of clopidogrel bisulphate (Plavix(®)) ameliorates Li-induced NDI in rodents. Parallel in vitro studies showed that P2Y12 receptor blockade by the reversible antagonist PSB-0739 sensitizes CD to the action of AVP. Thus, our studies unravelled the potential beneficial effects of targeting P2Y2 or P2Y12 receptors to counter AVP resistance in lithium-induced NDI. If established in further studies, our findings may pave the way for the development of better and safer methods for the treatment of NDI by bringing a paradigm shift in the approach from the current therapies that predominantly counter the anti-AVP effects to those that enhance the sensitivity of the kidney to AVP action.
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Affiliation(s)
- B. K. Kishore
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
- Nephrology Research, Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Center on Aging, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - N. G. Carlson
- Center on Aging, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
- Department of Neurobiology and Anatomy, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
- Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - C. M. Ecelbarger
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
- Center for the Study of Sex Differences in Health, Aging, and Disease, Georgetown University, Washington, District of Columbia, USA
| | - D. E. Kohan
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
- Nephrology Research, Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - C. E. Müller
- PharmaCenter Bonn, Pharmaceutical Institute, Pharmaceutical Chemistry I, University of Bonn, Bonn, Germany
| | - R. D. Nelson
- Department of Paediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - J. Peti-Peterdi
- Department of Physiology and Biophysics, and Zilkha Neurogenetic Institute, University of Southern California, Los Angeles, California, USA
| | - Y. Zhang
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
- Nephrology Research, Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA
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Chiu YY, Ereshefsky L, Preskorn SH, Poola N, Loebel A. Lurasidone drug-drug interaction studies: a comprehensive review. ACTA ACUST UNITED AC 2015; 29:191-202. [PMID: 24825095 DOI: 10.1515/dmdi-2014-0005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/24/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND To evaluate potential drug-drug interactions with the atypical antipsychotic lurasidone. METHODS Seven phase I studies were conducted to investigate the effects of repeated dosing of ketoconazole, diltiazem, rifampin, or lithium on the pharmacokinetics (PK) of single oral doses of lurasidone, or the effects of repeated dosing of lurasidone on the PK of digoxin, midazolam, or the oral contraceptive norgestimate/ethinyl estradiol. Two 6-week, phase III studies included evaluation of the potential for interaction between lurasidone and lithium or valproate. Maximum serum or plasma concentration (Cmax) and area under the concentration-time curve (AUC) were calculated. RESULTS Concomitant ketoconazole administration resulted in a 6.8-fold increase in lurasidone Cmax and a 9.3-fold increase in lurasidone AUC; concomitant diltiazem administration resulted in 2.1- and 2.2-fold increases, respectively. Rifampin decreased lurasidone Cmax and AUC (one-seventh and one-fifth of lurasidone alone, respectively). Steady-state dosing with lurasidone increased Cmax and AUC0-24 (AUC from time 0 to 24 h postdose) of digoxin by 9% and 13%, respectively, and of midazolam by 21% and 44%, respectively. There were no significant interactions between lurasidone and lithium, valproate, ethinyl estradiol, or norelgestromin (the major active metabolite of norgestimate). CONCLUSIONS Lurasidone PK is altered by strong cytochrome P450 (CYP) 3A4 inhibitors or inducers, and coadministration is contraindicated; whereas moderate CYP3A4 inhibitors have less effect, and lurasidone dosage restrictions are recommended. No dose adjustment for lurasidone is needed when administered with lithium or valproate. Dose adjustment is not required for lithium, valproate, digoxin (a P-glycoprotein substrate), or midazolam or oral contraceptives (CYP3A4 substrates) when coadministered with lurasidone.
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Zhang Y, Peti-Peterdi J, Müller CE, Carlson NG, Baqi Y, Strasburg DL, Heiney KM, Villanueva K, Kohan DE, Kishore BK. P2Y12 Receptor Localizes in the Renal Collecting Duct and Its Blockade Augments Arginine Vasopressin Action and Alleviates Nephrogenic Diabetes Insipidus. J Am Soc Nephrol 2015; 26:2978-87. [PMID: 25855780 DOI: 10.1681/asn.2014010118] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 01/27/2015] [Indexed: 11/03/2022] Open
Abstract
P2Y12 receptor (P2Y12-R) signaling is mediated through Gi, ultimately reducing cellular cAMP levels. Because cAMP is a central modulator of arginine vasopressin (AVP)-induced water transport in the renal collecting duct (CD), we hypothesized that if expressed in the CD, P2Y12-R may play a role in renal handling of water in health and in nephrogenic diabetes insipidus. We found P2Y12-R mRNA expression in rat kidney, and immunolocalized its protein and aquaporin-2 (AQP2) in CD principal cells. Administration of clopidogrel bisulfate, an irreversible inhibitor of P2Y12-R, significantly increased urine concentration and AQP2 protein in the kidneys of Sprague-Dawley rats. Notably, clopidogrel did not alter urine concentration in Brattleboro rats that lack AVP. Clopidogrel administration also significantly ameliorated lithium-induced polyuria, improved urine concentrating ability and AQP2 protein abundance, and reversed the lithium-induced increase in free-water excretion, without decreasing blood or kidney tissue lithium levels. Clopidogrel administration also augmented the lithium-induced increase in urinary AVP excretion and suppressed the lithium-induced increase in urinary nitrates/nitrites (nitric oxide production) and 8-isoprostane (oxidative stress). Furthermore, selective blockade of P2Y12-R by the reversible antagonist PSB-0739 in primary cultures of rat inner medullary CD cells potentiated the expression of AQP2 and AQP3 mRNA, and cAMP production induced by dDAVP (desmopressin). In conclusion, pharmacologic blockade of renal P2Y12-R increases urinary concentrating ability by augmenting the effect of AVP on the kidney and ameliorates lithium-induced NDI by potentiating the action of AVP on the CD. This strategy may offer a novel and effective therapy for lithium-induced NDI.
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Affiliation(s)
- Yue Zhang
- Nephrology Research and Department of Internal Medicine
| | - Janos Peti-Peterdi
- Zilkha Neurogenetic Institute and Department of Physiology and Biophysics, University of Southern California, Los Angeles, California
| | - Christa E Müller
- PharmaCenter Bonn, Pharmaceutical Institute, Pharmaceutical Chemistry I, University of Bonn, Bonn, Germany; and
| | - Noel G Carlson
- Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; Department of Neurobiology and Anatomy, and Center on Aging, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Younis Baqi
- PharmaCenter Bonn, Pharmaceutical Institute, Pharmaceutical Chemistry I, University of Bonn, Bonn, Germany; and Department of Chemistry, Faculty of Science, Sultan Qaboos University, Muscat, Oman
| | | | | | - Karie Villanueva
- Zilkha Neurogenetic Institute and Department of Physiology and Biophysics, University of Southern California, Los Angeles, California
| | | | - Bellamkonda K Kishore
- Nephrology Research and Department of Internal Medicine, Center on Aging, University of Utah Health Sciences Center, Salt Lake City, Utah;
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Uwai Y, Kawasaki T, Nabekura T. Minor contribution of biliary excretion in lithium elimination in rats. Drug Metab Pers Ther 2015; 30:65-67. [PMID: 25803094 DOI: 10.1515/dmdi-2014-0033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/09/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Lithium, which is often used for the treatment of bipolar disorders, is mainly recovered into urine after being orally administered. Due to the fact that it is completely absorbed via the gastrointestinal tract, it remains unknown whether biliary excretion is involved in the lithium disposition. In this study, we examined biliary excretion of lithium in rats and compared these with renal excretion. MATERIALS AND METHODS After the injection of lithium chloride to femoral vein, plasma levels and excretion into urine and bile of lithium were evaluated. RESULTS After its intravenous administration as a bolus, the plasma concentration of lithium decreased time-dependently. Until 60 min, 6.47% and 0.694% of injected lithium were excreted into urine and bile, respectively. The biliary clearance of lithium was calculated to be 0.0779 mL/min/kg, and this was 11.3% of the renal clearance. CONCLUSIONS These findings suggest the low ability of the liver to eliminate lithium from plasma in comparison with the kidney in rats.
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Decker BS, Goldfarb DS, Dargan PI, Friesen M, Gosselin S, Hoffman RS, Lavergne V, Nolin TD, Ghannoum M. Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup. Clin J Am Soc Nephrol 2015; 10:875-87. [PMID: 25583292 DOI: 10.2215/cjn.10021014] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The Extracorporeal Treatments in Poisoning Workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments in poisoning. Here, the EXTRIP workgroup presents its recommendations for lithium poisoning. After a systematic literature search, clinical and toxicokinetic data were extracted and summarized following a predetermined format. The entire workgroup voted through a two-round modified Delphi method to reach a consensus on voting statements. A RAND/UCLA Appropriateness Method was used to quantify disagreement, and anonymous votes were compiled and discussed in person. A second vote was conducted to determine the final workgroup recommendations. In total, 166 articles met inclusion criteria, which were mostly case reports, yielding a very low quality of evidence for all recommendations. A total of 418 patients were reviewed, 228 of which allowed extraction of patient-level data. The workgroup concluded that lithium is dialyzable (Level of evidence=A) and made the following recommendations: Extracorporeal treatment is recommended in severe lithium poisoning (1D). Extracorporeal treatment is recommended if kidney function is impaired and the [Li(+)] is >4.0 mEq/L, or in the presence of a decreased level of consciousness, seizures, or life-threatening dysrhythmias irrespective of the [Li(+)] (1D). Extracorporeal treatment is suggested if the [Li(+)] is >5.0 mEq/L, significant confusion is present, or the expected time to reduce the [Li(+)] to <1.0 mEq/L is >36 hours (2D). Extracorporeal treatment should be continued until clinical improvement is apparent or [Li(+)] is <1.0 mEq/L (1D). Extracorporeal treatments should be continued for a minimum of 6 hours if the [Li(+)] is not readily measurable (1D). Hemodialysis is the preferred extracorporeal treatment (1D), but continuous RRT is an acceptable alternative (1D). The workgroup supported the use of extracorporeal treatment in severe lithium poisoning. Clinical decisions on when to use extracorporeal treatment should take into account the [Li(+)], kidney function, pattern of lithium toxicity, patient's clinical status, and availability of extracorporeal treatments.
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Affiliation(s)
- Brian S Decker
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - David S Goldfarb
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Paul I Dargan
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Marjorie Friesen
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Sophie Gosselin
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Robert S Hoffman
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Valéry Lavergne
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Thomas D Nolin
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Marc Ghannoum
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
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41
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Abstract
Lithium carbonate is a widely administered antimanic drug used for the treatment of bipolar disorder, schizoaffective disorder, and depression. Despite the established clinical efficacy of lithium, its usage must be approached with caution due to its narrow therapeutic index. Lithium poisoning results in multisystem toxicity, and characteristic clinical manifestations are directly correlated to serum lithium concentration. We describe a rather rare but fatal side effect of lithium: acute respiratory distress syndrome (ARDS) in a 46-year-old female on lithium for the treatment of bipolar disease. She was referred for generalized weakness, found in hemodynamic compromise, and had laboratory data significant for a lithium level of 3.3 mmole/L, needing emergent hemodialysis. Subsequently, she developed hypoxic respiratory failure requiring intubation. Her chest x-rays showed new bilateral pulmonary edema, the computed tomography scan showed extensive alveolar consolidation and V/Q scan of low probability for pulmonary embolism. She underwent 3 dialysis sessions and supportive care and was able to be extubated in 5 days. To our knowledge, 4 cases of ARDS after the onset of lithium toxicity have been documented. All patients presented with altered mental status at serum lithium levels ranging from 3.8 to 4.9 mmole/L and cardiogenic etiologies in addition to other likely causes of ARDS were ruled out in each case. The patients were treated with saline hydration (50%) or hemodialysis (50%), indicating that hemodialysis may be a permissive factor in lithium-associated ARDS development rather than a required component. Taken together, we believe that lithium is a likely culprit in the initiation of ARDS and propose the addition of ARDS to the family of clinical manifestations of severe lithium toxicity.
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Oruch R, Elderbi MA, Khattab HA, Pryme IF, Lund A. Lithium: A review of pharmacology, clinical uses, and toxicity. Eur J Pharmacol 2014; 740:464-73. [DOI: 10.1016/j.ejphar.2014.06.042] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/20/2014] [Accepted: 06/20/2014] [Indexed: 01/10/2023]
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Jackson E, Endow-Eyer RA. A review of the evidence supporting the use of lithium augmentation therapy for the reduction of suicidal behavior in patients with unipolar depression: Revisiting an overlooked benefit of an older medication. Ment Health Clin 2014. [DOI: 10.9740/mhc.n207175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Major depressive disorder is a serious, recurrent condition with significant impact on a person's quality of life and functioning, which carries a significant risk of premature death due to suicide. There is evidence that supports the effectiveness of lithium as an augmentation strategy for treatment-resistant depression, as well as for reducing suicidality in this population. This review introduces several theories regarding the proposed mechanism behind lithium's anti-suicidal effects and summarizes a selection of the pertinent literature supporting lithium's beneficial effects on suicidality.
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Affiliation(s)
- Elizabeth Jackson
- 1 PGY-1 Pharmacy Resident, Veterans Affairs San Diego Healthcare System
| | - Rene A. Endow-Eyer
- 2 Psychiatric Clinical Pharmacist Specialist, Veterans Affairs San Diego Healthcare System
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Uwai Y, Arima R, Takatsu C, Furuta R, Kawasaki T, Nabekura T. Sodium-phosphate cotransporter mediates reabsorption of lithium in rat kidney. Pharmacol Res 2014; 87:94-8. [PMID: 24997387 DOI: 10.1016/j.phrs.2014.06.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 06/24/2014] [Accepted: 06/24/2014] [Indexed: 01/28/2023]
Abstract
Lithium, used for the treatment of bipolar disorders, is reabsorbed via sodium-transport system in the proximal tubule. This step causes intra-/inter-individual difference of lithium disposition, and it has not been unclear which transporter contributes. In this study, we examined effect of foscarnet and parathyroid hormone (PTH), inactivators for sodium-phosphate cotransporter, and phlorizin, a typical inhibitor for sodium-glucose cotransporter, on the disposition of lithium in rats. Their intravenous administration stimulated urinary excretion of phosphate or glucose. After the intravenous injection of lithium chloride as a bolus, plasma concentration of lithium decreased time-dependently. The renal clearance of lithium was calculated to be 0.740 ml/min/kg in control rats, and this was 26.7% of creatinine clearance. Foscarnet and PTH significantly increased the renal clearance of lithium and its ratio to creatinine clearance, suggesting that they prevented the reabsorption of lithium. No effect of phlorizin on the renal handling of lithium was recognized. In control rats, the renal clearance of lithium showed a strong correlation with the renal excretion rate of phosphate, compared with creatinine clearance. These findings suggest that sodium-phosphate cotransporter reabsorbs lithium in the rat kidney. Furthermore, its contribution was estimated to be more than 65.9% in the lithium reabsorption. And, this study raised the possibility that therapeutic outcome of lithium is related with the functional expression of sodium-phosphate cotransporter in the kidney.
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Affiliation(s)
- Yuichi Uwai
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan.
| | - Ryosuke Arima
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
| | - Chihiro Takatsu
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
| | - Ryo Furuta
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
| | - Tatsuya Kawasaki
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
| | - Tomohiro Nabekura
- Department of Pharmaceutics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
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López-Álvarez A, Román-Fernández A, Fernández-Vieitez M, Fossati-Puertas S. Medicación crónica durante el preoperatorio: ¿suspender o no suspender? Semergen 2014; 40:89-96. [DOI: 10.1016/j.semerg.2013.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 06/16/2013] [Accepted: 06/18/2013] [Indexed: 11/29/2022]
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46
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Nichols TA, Drayton SJ, Borckardt J, Taber DJ. Lithium dosing equations: are they accurate? Ann Pharmacother 2014; 48:596-600. [PMID: 24577145 DOI: 10.1177/1060028014524375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Several equations are used to predict lithium doses necessary to attain therapeutic serum concentrations. A number of studies have evaluated these equations; however, few equations were compared simultaneously. OBJECTIVE To assess the accuracy and precision of published dosing equations in predicting daily lithium doses and to evaluate if pertinent laboratory tests were performed prior to initiation. METHODS A retrospective analysis was performed of patients who received lithium at the Medical University of South Carolina Institute of Psychiatry between July 2010 and July 2012. Using dosing equations, expected lithium doses were calculated based on corresponding serum concentrations identified in patient charts. Expected doses were then compared with actual lithium doses. The primary end point was to assess the accuracy and precision of dosing equations using mean differences in daily lithium doses and standard deviations. Secondary end points included presence of pertinent laboratory tests and use of concomitant interacting drugs . RESULTS Of 155 patients identified, 59 were eligible for analysis. Equations developed by Abou-Auda et al and Pepin et al did not predict doses that were significantly different from actual doses. Conversely, equations by Jermain et al, Terao et al, and Zetinet al did predict statistically different doses. CONCLUSIONS Abou-Auda et al developed a predictive lithium dosing equation that was more accurate than equations developed by Jermain et al, Terao et al, and Zetin et al and more precise than the Pepin et al equation. Further study evaluating the influence of equations on clinical outcomes is warranted.
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Kishore BK, Ecelbarger CM. Lithium: a versatile tool for understanding renal physiology. Am J Physiol Renal Physiol 2013; 304:F1139-49. [PMID: 23408166 DOI: 10.1152/ajprenal.00718.2012] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
By virtue of its unique interactions with kidney cells, lithium became an important research tool in renal physiology and pathophysiology. Investigators have uncovered the intricate relationships of lithium with the vasopressin and aldosterone systems, and the membrane channels or transporters regulated by them. While doing so, their work has also led to 1) questioning the role of adenylyl cyclase activity and prostaglandins in lithium-induced suppression of aquaporin-2 gene transcription; 2) unraveling the role of purinergic signaling in lithium-induced polyuria; and 3) highlighting the importance of the epithelial sodium channel (ENaC) in lithium-induced nephrogenic diabetes insipidus (NDI). Lithium-induced remodeling of the collecting duct has the potential to shed new light on collecting duct remodeling in disease conditions, such as diabetes insipidus. The finding that lithium inhibits glycogen synthase kinase-3β (GSK3β) has opened an avenue for studies on the role of GSK3β in urinary concentration, and GSK isoforms in renal development. Finally, proteomic and metabolomic profiling of the kidney and urine in rats treated with lithium is providing insights into how the kidney adapts its metabolism in conditions such as acquired NDI and the multifactorial nature of lithium-induced NDI. This review provides state-of-the-art knowledge of lithium as a versatile tool for understanding the molecular physiology of the kidney, and a comprehensive view of how this tool is challenging some of our long-standing concepts in renal physiology, often with paradigm shifts, and presenting paradoxical situations in renal pathophysiology. In addition, this review points to future directions in research where lithium can lead the renal community.
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Affiliation(s)
- Bellamkonda K Kishore
- Nephrology Research (151M) VA SLC Health Care System, 500 Foothill Dr, Salt Lake City, UT 84148, USA.
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48
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Abstract
Diuretics, in one form or another, have been around for centuries and this review sets out to chart their development and clinical use. Starting with the physiology of the kidney, it progresses to explain how diuretics actually work, via symports on the inside of the renal tubules. The different classes of diuretics are characterized, along with their mode of action. The clinical use of diuretics in conditions like congestive cardiac failure and hypertension, as well as some rarer, but clinically important, conditions is then examined. An account is given of the adverse effects of diuretics and how they come about. Common adverse effects like hypokalaemia and hyponatraemia are examined in some detail, and other electrolyte disturbances like hypomagnesaemia also gain a mention. Diuretic use in chronic kidney disease is examined and new guidelines that have been introduced are presented. A section on diuretic abuse is included as this is becoming an all too common clinical scenario, and the sometimes tragic consequences of this abuse are emphasized. Diuretics also find a role in the diagnosis of forms of renal tubular acidosis and this role is explored. Finally, a selection of some of the newer approaches to diuretic therapy are presented, often the consequence of the increasing development of molecular biology, and some of the novel compounds – which may be in drug formularies of the future – are revealed.
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Affiliation(s)
- David Wile
- Department of Clinical Biochemistry, University Hospital, Aintree, Longmoor Lane, Liverpool L9 7AL, UK
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49
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van Melick EJM, Wilting I, Souverein PC, Egberts TCG. Differences in Lithium Use Patterns in the Netherlands: Comparing Middle-Aged and Older Patients in a Database Study. ACTA ACUST UNITED AC 2012; 10:193-200. [DOI: 10.1016/j.amjopharm.2012.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/01/2012] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
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50
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Abstract
INTRODUCTION Despite more that 60 years of clinical experience, the effective use of lithium for the treatment of mood disorder, in particular bipolarity, is in danger of becoming obsolete. In part, this is because of exaggerated fears surrounding lithium toxicity, acute and long-term tolerability and the encumbrance of life-long plasma monitoring. Recent research has once again positioned lithium centre stage and amplified the importance of understanding its science and how this translates to clinical practice. OBJECTIVE The aim of this paper is to provide a sound knowledge base as regards the science and practice of lithium therapy. METHOD A comprehensive literature search using electronic databases was conducted along with a detailed review of articles known to the authors pertaining to the use of lithium. Studies were limited to English publications and those dealing with the management of psychiatric disorders in humans. The literature was synthesized and organized according to relevance to clinical practice and understanding. RESULTS Lithium has simple pharmacokinetics that require regular dosing and monitoring. Its mechanisms of action are complex and its effects are multi-faceted, extending beyond mood stability to neuroprotective and anti-suicidal properties. Its use in bipolar disorder is under-appreciated, particularly as it has the best evidence for prophylaxis, qualifying it perhaps as the only true mood stabilizer currently available. In practice, its risks and tolerability are exaggerated and can be readily minimized with knowledge of its clinical profile and judicious application. CONCLUSION Lithium is a safe and effective agent that should, whenever indicated, be used first-line for the treatment of bipolar disorder. A better understanding of its science alongside strategic management of its plasma levels will ensure both wider utility and improved outcomes.
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Affiliation(s)
- Gin S Malhi
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, Australia.
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