Lithium Intoxication Associated With Intramuscular Ziprasidone in Schizoaffective Patients

Miodownik, Chanoch; Hausmann, Michael; Frolova, Katherina; Lerner, Vladimir

doi:10.1097/01.wnf.0000194037.75621.78

Cited by 10 publications

(4 citation statements)

References 24 publications

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“…Lithium does interact adversely with several drugs, including clozapine (123), levofloxacin (301), COX-2 inhibitors (231, 242, 285), ziprasidone (196), topiramate (1), and carbamazepine (189). Renal loop diuretics, angiotensin-converting enzymes, and nonsteroidal anti-inflammatory drugs all increase the risk of elevated serum lithium levels (145).…”

Section: Lithium and Manic Depressionmentioning

confidence: 99%

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Review of Lithium Effects on Brain and Blood

2009

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Clinicians have long used lithium to treat manic depression. They have also observed that lithium causes granulocytosis and lymphopenia while it enhances immunological activities of monocytes and lymphocytes. In fact, clinicians have long used lithium to treat granulocytopenia resulting from radiation and chemotherapy, to boost immunoglobulins after vaccination, and to enhance natural killer activity. Recent studies revealed a mechanism that ties together these disparate effects of lithium. Lithium acts through multiple pathways to inhibit glycogen synthetase kinase-3β (GSK3β). This enzyme phosphorylates and inhibits nuclear factors that turn on cell growth and protection programs, including the nuclear factor of activated T cells (NFAT) and WNT/β-catenin. In animals, lithium upregulates neurotrophins, including brain-derived neurotrophic factor (BDNF), nerve growth factor, neurotrophin-3 (NT3), as well as receptors to these growth factors in brain. Lithium also stimulates proliferation of stem cells, including bone marrow and neural stem cells in the subventricular zone, striatum, and forebrain. The stimulation of endogenous neural stem cells may explain why lithium increases brain cell density and volume in patients with bipolar disorders. Lithium also increases brain concentrations of the neuronal markers n-acetyl-aspartate and myoinositol. Lithium also remarkably protects neurons against glutamate, seizures, and apoptosis due to a wide variety of neurotoxins. The effective dose range for lithium is 0.6-1.0 mM in serum and >1.5 mM may be toxic. Serum lithium levels of 1.5-2.0 mM may have mild and reversible toxic effects on kidney, liver, heart, and glands. Serum levels of >2 mM may be associated with neurological symptoms, including cerebellar dysfunction. Prolonged lithium intoxication >2 mM can cause permanent brain damage. Lithium has low mutagenic and carcinogenic risk. Lithium is still the most effective therapy for depression. It "cures" a third of the patients with manic depression, improves the lives of about a third, and is ineffective in about a third. Recent studies suggest that some anticonvulsants (i.e., valproate, carbamapazine, and lamotrigene) may be useful in patients that do not respond to lithium. Lithium has been reported to be beneficial in animal models of brain injury, stroke, Alzheimer's, Huntington's, and Parkinson's diseases, amyotrophic lateral sclerosis (ALS), spinal cord injury, and other conditions. Clinical trials assessing the effects of lithium are under way. A recent clinical trial suggests that lithium stops the progression of ALS.

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Section: Lithium and Manic Depressionmentioning

confidence: 99%

“…Demented patients may have a including clozapine (123), levofloxacin (301), COX-2 inhibitors (231,242,285), ziprasidone (196), topiramate (1), lower renal secretion of lithium (149,183). Lithium levels thus must be carefully monitored in elderly patients and carbamazepine (189).…”

Section: Lithium-induced Granulocytosismentioning

confidence: 99%

Review of Lithium Effects on Brain and Blood

2009

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“…[33] Birlikte intramüsküler atipik antipsikotik kullanımı sonrası gelişen lityum zehirlenmesi olguları da bildirilmiştir. [34] Fenitoin ve karbamazepinle birlikte lityum kullanımı önemli etkileşimler doğurabilir. Böyle durumlarda gelişen nörotoksisitenin daha şiddetli olduğu belirtilmektedir.…”

Section: Zehirlenmenin Mekanizmasıunclassified

Lithium Intoxication

Kesebir¹,

Üstündağ²,

Kavzoğlu³

2011

Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychia

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Lityum yaklaşık 60 yıldır bipolar bozukluk başta olmak üzere duygudurum bozukluklarının tedavisinde yaygın olarak kullanılan bir ilaçtır Zehirlenmesinden, her zaman artmış alım ya da azalmış atılım sorumlu olmaktadır. Lityum zehirlenmesi geri dönüşümlü ve geri dönüşümsüz şeklinde iki grupta incelenmektedir. Geri dönüşümsüz hasarın zehirlenmede kalınan süre ile ilişkilendirilmiştir. Yanlışlıkla ya da özkıyım amacıyla fazla miktarda lityum kapsülünün alınması ile akut zehirlenmeler, bazen de kendi kendini tedavi amacıyla yüksek dozlarda lityum alınması ile kronik zeminde akut zehirlenmeler ve aynı dozda ilaç alımı sürerken kronik lityum zehirlenmeler ortaya çıkabilmektedir. Böyle bir durumda, risk etkenlerinin nedenlerinin iyi bilinmesi, düzenli izlem ve erken klinik belirtilerin tanınması önemlidir. Aynı zamanda tanıyı doğrulamak ya da dışlamak için kanda kantitatif ölçüm ve idrarda toksikolojik tarama yapılmalıdır. Lityum kullanımında izlem kurallarına uyulması ve zehirlenme halinde hızlı müdahele edilmesi, lityum zehirlenmesine bağlı ölüm ve sekel oranlarını azaltacaktır. Bu yazıda lityum zehirlenmesinin tanımı, sıklığı, etiyolojisi, klinik ve tedavi özellikleri kısaca gözden geçirilmiştir.

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“…One report documented two schizoaffective patients who experienced abrupt rises in plasma lithium levels and symptoms of lithium toxicity within two days of the initiation of intramuscular ziprasidone treatment (Miodownik et al 2005).…”

Section: Combination/augmentation Studiesmentioning

confidence: 99%

Ziprasidone in the treatment of mania in bipolar disorder

Nicolson

Nemeroff

2008

NDT

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Abstract:Ziprasidone is an atypical antipsychotic with a unique receptor-binding profi le. Currently, ziprasidone is approved by the US Food and Drug Administration for the acute treatment of psychosis in schizophrenia and mania in bipolar disorder. When compared to certain other atypical antipsychotics, ziprasidone appears to have a relatively benign side effect profi le, especially as regards metabolic effects eg, weight gain, serum lipid elevations and glucose dysregulation. Taken together, these data suggest that ziprasidone may be a fi rst line treatment for patients with bipolar mania. However, ziprasidone is a relatively new medication for which adverse events after long-term use and/or in vulnerable patient populations must be studied. Unstudied areas of particular importance include the effi cacy and safety of ziprasidone in the treatment of bipolar depression and relapse prevention of mania as, well as in the subpopulations of pregnant women, the elderly and pediatric patients. The emergence of mania in patients taking ziprasidone is another topic for further study.

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Lithium Intoxication Associated With Intramuscular Ziprasidone in Schizoaffective Patients

Cited by 10 publications

References 24 publications

Review of Lithium Effects on Brain and Blood

Review of Lithium Effects on Brain and Blood

Lithium Intoxication

Ziprasidone in the treatment of mania in bipolar disorder

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