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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
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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.
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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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Ambrosiani L, Pisanu C, Deidda A, Chillotti C, Stochino ME, Bocchetta A. Thyroid and renal tumors in patients treated with long-term lithium: case series from a lithium clinic, review of the literature and international pharmacovigilance reports. Int J Bipolar Disord 2018; 6:17. [PMID: 30079440 PMCID: PMC6161981 DOI: 10.1186/s40345-018-0125-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/19/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cancer had never been considered as a relevant problem in patients treated with lithium until 2015, when a document published by the European Medicine Agency concluded that long-term use of lithium might induce renal tumors. A few months later, we observed the case of a woman treated with lithium for 18 years who was diagnosed with both thyroid and renal tumors. METHODS This study aimed to investigate the correlation between lithium treatment and thyroid or renal tumors. We analyzed clinical records in our lithium clinic database, causes of death of patients who had been visited at least once at the lithium clinic, reports of lithium adverse reactions in the European and WHO pharmacovigilance databases, and published cases of thyroid and renal tumors in long-term lithium-treated patients. RESULTS Of the 1871 lithium patients who had been visited at least once between 1980 and 2013, eight had been diagnosed with thyroid papillary carcinoma and two with clear-cell renal-cell carcinoma. No cases of thyroid cancer and only one case of renal tumor were the cause of death according to the 375 available death certificates. VigiAccess database contained a total of 29 and 14 cases of renal and thyroid tumors, respectively. EudraVigilance database contained 21 cases of renal and 8 of thyroid neoplasms. Literature search yielded 6 published cases of thyroid papillary carcinoma and 25 cases of various renal tumors. However, two population-based studies did not find any increased risks of cancer in patients exposed to lithium, whereas two nationwide studies did not find any excess of renal tumors. CONCLUSION So far it has not been possible epidemiologically to confirm an increased risk of thyroid or renal cancers associated with lithium. Such a conclusion is supported by the findings of low rates and mortalities of thyroid or renal cancers from the present lithium clinic data.
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Affiliation(s)
- Luca Ambrosiani
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, S.S. 554, km 4,500, Monserrato, Italy
| | - Claudia Pisanu
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, S.S. 554, km 4,500, Monserrato, Italy
| | - Arianna Deidda
- Sardinian Regional Centre of Pharmacovigilance, Azienda Ospedaliero-Universitaria, Cagliari, Italy
| | - Caterina Chillotti
- Unit of Clinical Pharmacology, “San Giovanni di Dio Hospital”, Azienda Ospedaliero-Universitaria, Cagliari, Italy
| | - Maria Erminia Stochino
- Sardinian Regional Centre of Pharmacovigilance, Azienda Ospedaliero-Universitaria, Cagliari, Italy
| | - Alberto Bocchetta
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, S.S. 554, km 4,500, Monserrato, Italy
- Unit of Clinical Pharmacology, “San Giovanni di Dio Hospital”, Azienda Ospedaliero-Universitaria, Cagliari, Italy
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