Comparative Study of Electrocardiographic Changes in Patients of Acute Mania Receiving Verapamil or Lithium Carbonate

Singh, Mukhtiar; Kaur, Sharanjit; Sehgal, Vijay Kumar

doi:10.7860/jcdr/2014/9920.5268

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…40 In addition, the current study reported ventricular dysrhythmia in the lithiumtreated group in accordance with Chen et al 15 Various ECG changes have been reported in lithium overdose such as junctional bradycardia, complete heart block, and first-degree atrioventricular block. [41][42][43] The current work showed also that lithium caused a depressed ST segment, decreased amplitude of R wave, and narrow PR interval. Numerous mechanisms might explain the lithium-related ECG changes.…”

Section: Discussionsupporting

confidence: 57%

The molecular mechanisms of lithium-induced cardiotoxicity in male rats and its amelioration by N-acetyl cysteine

2020

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Lithium is one of the most powerful and commonly used medications for the treatment of various psychiatric diseases, especially bipolar disorder. However, it has a narrow therapeutic index with toxic effects on various organs. There are several case reports of lithium-induced arrhythmia and ischemia. The current work aimed to study the toxic effects of lithium on the heart of adult albino rats and its molecular mechanisms and the ameliorating effect of N-acetyl cysteine (NAC). Sixty adult male Wistar albino rats were classified into four groups; control, NAC-treated received NAC 500 mg/kg/week dissolved in 1 ml 0.9% sodium chloride intraperitoneal, lithium-treated received 52.5 mg/kg/day of lithium carbonate dissolved in 1 ml 0.9% sodium chloride orally by gavage, and lithium-and-NAC-treated (group IV) received lithium and NAC in the previous doses. After 12 weeks, the rats of group III showed a significant accumulation of ascites and a decrease in the mean arterial blood pressure and electrocardiographic (ECG) findings of ischemia and arrhythmia. In addition, there was an elevation in cardiac biomarkers creatine kinase MB (CK-MB), cardiac troponin I (cTnI), and several histological lesions with a significant increase in the area % of Van Gieson, endothelial nitric oxide synthase (eNOS), and 8-hydroxy-2′-deoxyguanosine (8-OHdG) immunoreaction. There was significant upregulation of microRNA-1, microRNA-21 (miRNA-21), and microRNA-29 (miRNA-29). MiRNA-21 was strongly positively correlated to the area % of 8-OHdG, while miRNA-29 was strongly positively correlated to the area % of Van Gieson staining. NAC significantly improved the cardiotoxic effects of lithium. Being a nontoxic and safe antioxidant, NAC can be used to ameliorate lithium-induced cardiac injury.

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Section: Discussionsupporting

confidence: 57%

The molecular mechanisms of lithium-induced cardiotoxicity in male rats and its amelioration by N-acetyl cysteine

2020

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“…Of 79 eligible RCTs, 5 single-blind RCTs did not report available data for performing a meta-analysis regarding objective outcomes [ 26 – 30 ]. Two double-blind RCTs did not report any available data for performing a meta-analysis [ 31 , 32 ]. Finally, 72 double-blinded RCTs ( n = 16442, males = 50.93%, mean age = 39.55 years, mean study duration = 3.96 ± 2.39 weeks) were included with the following treatment arms (number of studies ( N )/individuals ( n )): aripiprazole (9/1205), asenapine (3/620), brexpiprazole (2/321), carbamazepine (6/305), cariprazine (3/612), chlorpromazine (1/10), endoxifen (2/55), eslicarbazepine (2/148), haloperidol (10/1023), lamotrigine (3/173), licarbazepine (1/324), lithium (20/965), olanzapine (14/1565), oxcarbazepine (1/30), paliperidone (2/542), quetiapine (5/630), risperidone (7/676), tamoxifen (2/43), topiramate (4/659), valnoctamide (1/71), valproate (14/981), verapamil (1/17), ziprasidone (3/458), and a placebo (48/5009).…”

Section: Resultsmentioning

confidence: 99%

Pharmacological treatment for bipolar mania: a systematic review and network meta-analysis of double-blind randomized controlled trials

et al. 2021

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A systematic review and random-effects model network meta-analysis was conducted to compare the efficacy, acceptability, tolerability, and safety of pharmacological interventions for adults with acute bipolar mania. We searched PubMed, the Cochrane Library, and Embase databases for eligible studies published before March 14, 2021. Randomized controlled trials (RCTs) of oral medication monotherapy lasting ≥10 days in adults with mania were included, and studies that allowed the use of antipsychotics as a rescue medication during a trial were excluded. The primary outcomes were response to treatment (efficacy) and all-cause discontinuation (acceptability). The secondary outcomes were the improvement of mania symptoms and discontinuation due to inefficacy. Of the 79 eligible RCTs, 72 double-blind RCTs of 23 drugs and a placebo were included in the meta-analysis (mean study duration = 3.96 ± 2.39 weeks, n = 16442, mean age = 39.55 years, with 50.93% males). Compared with the placebo, aripiprazole, asenapine, carbamazepine, cariprazine, haloperidol, lithium, olanzapine, paliperidone, quetiapine, risperidone, tamoxifen, valproate, and ziprasidone outperformed response to treatment (N = 56, n = 14503); aripiprazole, olanzapine, quetiapine, and risperidone had lower all-cause discontinuation; however, topiramate had higher all-cause discontinuation (N = 70, n = 16324). Compared with the placebo, aripiprazole, asenapine, carbamazepine, cariprazine, haloperidol, lithium, olanzapine, paliperidone, quetiapine, risperidone, tamoxifen, valproate, and ziprasidone outperformed the improvement of mania symptoms (N = 61, n = 15466), and aripiprazole, asenapine, carbamazepine, cariprazine, haloperidol, lithium, olanzapine, paliperidone, quetiapine, risperidone, valproate, and ziprasidone had lower discontinuation due to inefficacy (N = 50, n = 14284). In conclusions, these antipsychotics, carbamazepine, lithium, tamoxifen, and valproate were effective for acute mania. However, only aripiprazole, olanzapine, quetiapine, and risperidone had better acceptability than the placebo.

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Electrocardiographic changes caused by lithium intoxication in an elderly patient

Zheng

Liu

et al. 2016

SpringerPlus

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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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Comparative Study of Electrocardiographic Changes in Patients of Acute Mania Receiving Verapamil or Lithium Carbonate

Cited by 3 publications

References 16 publications

The molecular mechanisms of lithium-induced cardiotoxicity in male rats and its amelioration by N-acetyl cysteine

The molecular mechanisms of lithium-induced cardiotoxicity in male rats and its amelioration by N-acetyl cysteine

Pharmacological treatment for bipolar mania: a systematic review and network meta-analysis of double-blind randomized controlled trials

Electrocardiographic changes caused by lithium intoxication in an elderly patient

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