Lithium in Bipolar Disorder: Optimizing Therapy Using Prolonged-Release Formulations

Abstract

Lithium has been a gold standard in the treatment of bipolar disorder (BD) for several decades. Despite a general reduction in the use of lithium over the past several years, it is effective in the management of both manic and depressive episodes in BD and continues to be recommended as a first-line mood stabilizer. This review provides an overview of the pharmacology of lithium and highlights its clinical profile in the management of BD, focusing on the potential advantages of prolonged-release (PR) versus immediate-release (IR) formulations of lithium. A literature search using PubMed was performed to identify articles describing IR and PR lithium in BD using specific search terms like ‘lithium’, ‘prolonged-release’, ‘sustained-release’, ‘extended-release’, ‘bipolar disorder’, ‘adherence’ and ‘compliance’. Relevant pharmacodynamic and pharmacokinetic data were also included. Several clinical trials suggested that lithium is effective in the treatment of acute mania and prophylaxis of BD and reduces the risk of suicide in patients with BD; it may also be used in combination with other drugs in the treatment of bipolar depression. Treatment with lithium must be monitored to avoid lithium-associated toxicity. The prolonged PR formulation of lithium has several advantages including consistent serum lithium concentrations, fewer adverse events and improved adherence to therapy. Although direct comparative studies between PR and IR formulations of lithium are primarily limited to pharmacokinetic studies, PR formulation of lithium provides potential advantages over IR formulation and can be effectively used in the management of BD with lesser adverse events.

Genetic polymorphisms associated with circadian rhythm dysregulation provide new perspectives on bipolar disorder

“…Most BD patients are diagnosed with BD type I (BDI) (manic and/or mixed episodes) or BD type II (BDII) (depressed and/or hypomanic episodes) . The symptoms of BD are serious and include unusual changes in mood, energy metabolism, activity levels and the ability to perform activities of daily living . BD places substantial burdens on society due to a greater loss of productivity in BD patients when compared to patients with other mood disorders .…”

“…Pharmacological treatment options to control symptoms and prevent relapse include lithium (Li), anticonvulsants, atypical antipsychotics, and antidepressants. Combination therapy is often used in clinical practice, especially for patients with an inadequate response to monotherapy …”

“…Lithium (Li) has been the gold standard in the treatment of BD for several decades. Despite a general reduction in the use of Li over the past few years, it is effective in treating manic and depressive episodes in BD and continues to be recommended as a first‐line mood stabilizer . Yet, use of mood stabilizers, such as Li and valproate, has been effective for only a proportion of patients and may have variable effects among individuals .…”

Application of induced pluripotent stem cells to understand neurobiological basis of bipolar disorder and schizophrenia

“…However, due to a lack of precise animal models, whether these changes are primary for the disease is questionable, which has baffled the development of new drugs or therapies precisely targeting BD pathology. Current drugs for the treatment of BD include mood stabilizers (e.g., lithium, anticonvulsants valproate, carbamazepine), atypical antipsychotics, antiepileptic drugs, and antidepressants; however, antidepressants may cause unexpected mania or hypomania . One of the most generalized drugs for BD is lithium (Li), a mood stabilizer that causes remarkable improvement in about one‐third of the patients .…”

Studying the Possible Mutagenic Properties of New Medicine on the Basis of Complex Lithium Citrate, Aluminum Oxide and Polymethilsiloxane

“…Однако длительная литиевая терапия может вызывать многочисленные токсические побочные эффекты [8]. Препараты лития с пролонгированным высвобождением имеют преимущество в том, что они обеспечивают более постоянные концентрации в сыворотке крови, приводящие к меньшему ко-личеству побочных эффектов и удобству режима дозирования, с улучшением приверженности к терапии [6].…”