Improving Tolerability of Lithium With a Once-Daily Dosing Schedule

Singh, Lokesh; Nizamie, S. Haque; Akhtar, Sayeed; Praharaj, Samir Kumar

doi:10.1097/mjt.0b013e3181d070c3

Cited by 23 publications

(20 citation statements)

References 9 publications

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“…Perhaps most importantly, only a single trial examined patients newly starting on lithium. 29 It is established that lithium causes renal impairment, such as reduced urinary concentrating ability, yet it is not known when, if ever, this becomes irreversible; therefore, studying SDD in patients previously exposed to MDD may fail to show any difference.…”

Section: Discussionmentioning

confidence: 99%

“…29 Among the 2 trials that compared renal biopsy results, both found significantly more pathologic damage to the kidneys in patients receiving lithium in MDD. 18,37 In addition to examining renal effects, it is important when proposing a dosage regimen change to also examine other adverse effects and clinical efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it is possible that irreversible renal damage and (or) above-average fluid intake (as a consequence of long-standing polyuria and polydipsia) may have negated any change in urine output and it may be too late to see a benefit in renal function by switching to SDD. A trial published in 2011 by Singh et al 29 addressed this concern by randomizing patients newly started on lithium therapy to either SDD or BID lithium in a single-blind investigation. Eighty-three patients newly admitted to hospital with a manic episode were followed for 42 days.…”

Section: Randomized Controlled Trialsmentioning

confidence: 99%

“…Some drawbacks of this study include that patients were all men, and a significant drop-out rate of 25.3% was seen, although this is not surprising given that patients were lithium-naive. Singh et al 29 concluded that SDD is a viable option to minimize adverse effects and improve patient compliance.…”

Section: Randomized Controlled Trialsmentioning

confidence: 99%

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

2013

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Objective: Despite several decades of research, there is still uncertainty regarding the optimal lithium dosage regimen associated with a decreased risk of renal effects, such as polyuria, in patients with bipolar affective disorder. We present an updated review of the literature to provide an informed dosing regimen recommendation for prescribers. Method:Major databases MEDLINE and Embase were searched using terms, such as lithium, drug administration schedule, dose-response relationship, once daily, twice daily, and sustained release. In addition, the bibliographies of related publications were manually searched.Results: A total of 20 trials were included. Some trials showed a reduction in urine volume with single daily dosing (SDD), while others showed no change. The only trial evaluating patients newly started on lithium found a reduction in urinary frequency with SDD after 21 days. Trials examining renal biopsy results found that multiple daily doses were associated with more pathologic damage to the kidneys. SDD regimens were generally well tolerated, and no reduction in efficacy was noted in any of the trials. Conclusions:The available evidence is contradictory as to whether SDD of lithium reduces polyuria; however, no trial has demonstrated any downfall of SDD in terms of prophylactic efficacy or adverse effects. Given the added benefits of SDD, such as improved compliance, we recommend patients newly started on lithium should be converted to a SDD of lithium at bedtime once an appropriate daily dose is determined. W W WUne revue mise à jour de la posologie optimale du lithium pour la protection rénale Objectif : Malgré plusieurs décennies de recherche, il y a encore de l'incertitude concernant la posologie optimale du lithium associée au risque réduit d'effets rénaux, comme la polyurie, chez les patients souffrant du trouble bipolaire affectif. Nous présentons une revue mise à jour de la littérature afin d'offrir aux prescripteurs une recommandation éclairée de régime posologique.Méthode : Cette recherche a été menée à partir des grandes bases de données MEDLINE et Embase à l'aide de termes comme : lithium, horaire d'administration des médicaments, relation dose-réponse, une fois par jour, deux fois par jour, et libération prolongée. En outre, les bibliographies de publications connexes ont fait l'objet d'une recherche manuelle.Résultats : Un total de 20 essais ont été inclus. Certains essais montraient une réduction du volume d'urine avec une dose unique quotidienne (DUQ), alors que d'autres n'indiquaient aucun changement. Le seul essai qui évaluait les patients qui commençaient le lithium a observé une réduction de la fréquence urinaire avec la DUQ après 21 jours. Les essais examinant les résultats de biopsie rénale ont constaté que les doses multiples quotidiennes étaient associées à plus de dommages pathologiques aux reins. Les posologies de DUQ étaient généralement bien tolérées, et aucune réduction d'efficacité n'a été notée dans tous les essais. Conclusions :Les données probantes disponibles sont...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Randomized Controlled Trialsmentioning

confidence: 99%

Section: Randomized Controlled Trialsmentioning

confidence: 99%

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

2013

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“…Long-term studies reported approximately a 15% incidence of irreversible decrease in the urinary concentrating ability of lithium users 51,52 . This effect can be more frequently found with lithium administered twice daily as compared with a single administration of an extended release formulation 53,54 . A study using other markers of kidney damage, such as β2-microglobulin (associated with proximal tubular injury) and glucosaminoglycan (component of the glomerular basement membrane) in 107 lithium users between 1 and 15 years with bipolar disorder were compared with 29 controls with other psychiatric disorders 55 .…”

Section: Renal Impairmentmentioning

confidence: 98%

Lithium safety and tolerability in mood disorders: a critical review

Aprahamian¹,

Sousa²,

Valiengo³

et al. 2014

Rev. psiquiatr. clín.

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Background: Lithium is a first-line treatment for bipolar disorder in all phases, also indicated as add-on drug for unipolar depression and suicide prevention. This study encompasses a broad critical review on the safety and tolerability of lithium for mood disorders. Methods: A computerized search for English written human studies was made in MEDLINE, using the keywords "lithium" and "mood disorders", starting from July 1993 through July 2013 (n = 416). This initial search aimed to select clinical trials, prospective data, and controlled design studies of lithium treatment for mood disorders reporting adverse effects (n = 36). The final selection yielded 91 studies. Results: The most common general side effects in patients on lithium treatment were thirst, frequent urination, dry mouth, weight gain, fatigue and cognitive complaints. Lithium users showed a high prevalence of hypothyroidism, hyperparathyroidism, and decrease in urinary concentration ability. Reduction of glomerular filtration rate in patients using lithium was also observed, but in a lesser extent. The evidence of teratogenicity associated with lithium use is not well established. Anti-inflammatory non-steroidal drugs, thiazide diuretics, angiotensin-converting enzyme inhibitors, and alprazolam may increase serum lithium and the consequent risk for intoxication. Discussion: Short-term lithium treatment is associated with mild side effects. Medium and long-term lithium treatment, however, might have effects on target organs which may be prevented by periodical monitoring. Overall, lithium is still a safe option for the treatment of mood disorders.

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