Lithium--Early Development, Toxicity, and Renal Function

Johnson, Gordon

doi:10.1016/s0893-133x(98)00019-0

Cited by 45 publications

(37 citation statements)

References 22 publications

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“…Long‐term administration (ie, 10‐20+ years) is further associated with decreased glomerular filtration rate and chronic kidney disease 818. While long‐term lithium administration is probably an important risk factor for developing chronic kidney disease, factors that may increase susceptibility include higher plasma lithium levels, multiple daily lithium doses (vs once daily), concurrent medications (eg NSAIDs, ARBs, ACEIs and diuretics), somatic illnesses (eg, hypertension, diabetes mellitus and coronary artery disease) and older age 819, 820. Instances of lithium toxicity will also greatly increase risk of renal dysfunction 821.…”

Section: Safety and Monitoringmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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Section: Safety and Monitoringmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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“…On the other hand, patients who switched from one regimen to another did not show significant changes in tubular function, except when the switch occurred before five years of treatment 25 . Other risk factors for the progression of renal injury include current lithium therapy, concomitant use of nephrotoxic drugs, advanced age, episodes of lithium intoxication, and presence of comorbidities such as hypertension, diabetes mellitus, hyperparathyroidism, and hyperuricemia 8,[26][27][28] . …”

Section: Risk Factors For Lithium-induced Nephropathymentioning

confidence: 99%

Nefrotoxicidade por lítio

Oliveira¹,

Júnior²,

Abreu³

et al. 2010

Rev. Assoc. Med. Bras.

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Lithium has been widely used in the treatment of bipolar disorder. Its renal toxicity includes impaired urinary concentrating ability and natriuresis, renal tubular acidosis, tubulointerstitial nephritis progressing to chronic kidney disease and hypercalcemia. The most common adverse effect is nephrogenic diabetes insipidus, which affects 20-40% of patients within weeks of lithium initiation. Chronic nephropathy correlates with duration of lithium therapy. Early detection of renal dysfunction should be achieved by rigorous monitoring of patients and close collaboration between psychiatrists and nephrologists. Recent experimental and clinical studies begin to clarify the mechanisms by which lithium induces changes in renal function. The aim of this study was to review the pathogenesis, clinical presentation, histopathological aspects and treatment of lithium-induced nephrotoxicity.

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“…La implicación clínica de este hallazgo consistiría en que a mayor tiempo de tratamiento mayor es la posibilidad de que ocurra una intoxicación por litio (31). Sin embargo, estudios más recientes, han revelado que el daño progresivo que ocurre a nivel de la función glomerular y tubular, podría estar relacionada más bien con otros factores como una intoxicación por litio ocurrida en algún momento del tratamiento, el mantenimiento de altos niveles de litio en plasma, interacciones medicamentosas, otras enfermedades somáticas y la edad, más que con el tiempo de tratamiento con litio, por lo que habría que controlar todas estas variables (32,33). Estas dos opiniones nos muestran que la causa del daño renal durante el tratamiento con litio, es un punto que continúa generando controversia y no está nada claro en este momento.…”

Section: Farmacologíaunclassified

Intoxicación con litio

Ortega

Medina-Ortiz

García-Armenter

2006

An. Med. Interna (Madrid)

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INTRODUCCIÓNEl litio, es uno de los fármacos clásicos, que ha demostrado desde hace varias décadas, ser efectivo en el control de la excitación que se produce en los pacientes con episodios maníacos (1,2) y, en la prevención de nuevas crisis en los pacientes con trastorno bipolar (TB) (3,4). Sin embargo, la intoxicación con litio es una complicación frecuente cuando se administra a largo plazo en pacientes con trastornos del estado del ánimo. Aún con pequeñas elevaciones de litio séri-co, estos pacientes tienen una alta probabilidad de manifestar síntomas y signos de intoxicación grave comparados con pacientes que sufren una intoxicación aguda con niveles similares de litio en sangre, ya que, en una intoxicación aguda, los niveles de litio informados no se correlacionan directamente con los niveles en los tejidos, los cuales son mayores en pacientes que han recibido litio a largo plazo. Debido a esto, la toxicidad crónica se puede llegar a dar con bajas dosis de litio, en pacientes que llevan un tratamiento de varios años de evolución (5).Desde 1949, cuando Cade (6,7), introdujo las sales de litio para el manejo de la manía, son varios los casos de intoxicación por litio que se han informado (5,8,9). A mediados del siglo XIX, el litio era utilizado como la panacea para muchas afecciones comunes, por la comunidad médica, pero su alta toxicidad llevó a que el tratamiento con litio fuera prohibido en los Estados Unidos hasta 1970, cuando fue aprobado por la FDA (10) y, en 1974 se aprobó como terapia de mantenimien- [0212-7199 (2006) RESUMENLa intoxicación aguda por litio no es frecuente, entre el 75% al 90% de los pacientes con terapia de mantenimiento de litio pueden haber mantenido niveles tóxicos durante su tratamiento. La dosis por debajo de 2,5 mmol/L no suelen asociarse a la aparición de síntomas. Los sistemas más afectados son el neurológico, gastrointestinal y cardiovascular. Los sínto-mas aparecen desde las dos y las cuatro horas postingesta. En las horas posteriores a la ingestión de litio, los niveles de litio no reflejan la severidad del cuadro clínico, no obstante la monitorización hormonal es importante para dirigir la agresividad terapéutica y marcar el pronóstico del cuadro. La utilización de forzar diuresis con solución salina isotópica, son mencionadas por diversos autores. Entre otras opciones también descritas está la diálisis.En resumen, la intoxicación por litio puede ser un cuadro potencialmente frecuente y grave, por ello es necesario escribir unas normas de manejo terapéutico de esta entidad.

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Lithium--Early Development, Toxicity, and Renal Function

Cited by 45 publications

References 22 publications

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Nefrotoxicidade por lítio

Intoxicación con litio

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