Lithium Toxicity in Older Adults: a Systematic Review of Case Reports

Sun, Meng; Herrmann, Nathan; Shulman, Kenneth I.

doi:10.1007/s40261-017-0598-9

Cited by 26 publications

(24 citation statements)

References 54 publications

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“…This current practice by local laboratories puts older adults at risk of lithium toxicity and adds urgency to this clinical issue. Providing separate more appropriate therapeutic ranges of serum lithium levels for older adults should help to minimize the risk of toxicity in this vulnerable population …”

Section: Discussionmentioning

confidence: 99%

“…Providing separate more appropriate therapeutic ranges of serum lithium levels for older adults should help to minimize the risk of toxicity in this vulnerable population. 20 With regard to lithium administration, the experts did not reach consensus on the value of twice compared to once daily dosing. The uncertainty in the literature on this point was reflected by the fact that some experts gave the same reason (less stress on the kidneys) for both options.…”

Section: Discussionmentioning

confidence: 99%

“…As the cohort of bipolar patients successfully maintained on lithium reaches their 70’s and 80’s, the age associated decrease in renal clearance may lead to higher lithium levels. This in turn leads to increased risk of side effects and outright toxicity if typical adult doses are not lowered . Several commonly used drugs in older adults, such as diuretics, ACE Inhibitors and non‐steroidal anti‐inflammatory drugs, can interact with lithium and cause higher serum levels, thereby increasing the risk of toxicity .…”

Section: Introductionmentioning

confidence: 99%

“…One concern has been its possible role in increasing the risk of chronic renal failure although there is also considerable recent epidemiological evidence that the risk is not as concerning as originally considered . Other concerns include hypothyroidism, hypercalcemia, neurotoxicity, and parkinsonism . As the cohort of bipolar patients successfully maintained on lithium reaches their 70’s and 80’s, the age associated decrease in renal clearance may lead to higher lithium levels.…”

Section: Introductionmentioning

confidence: 99%

“…This in turn leads to increased risk of side effects and outright toxicity if typical adult doses are not lowered. 20,22 Several commonly used drugs in older adults, such as diuretics, ACE Inhibitors and non-steroidal anti-inflammatory drugs, can interact with lithium and cause higher serum levels, thereby increasing the risk of toxicity. 23 Furthermore, symptoms of toxicity (eg, tremor, gastrointestinal upset, and neurological disturbance) can be misinterpreted as other conditions commonly seen in later life, such as parkinsonism or dementia.…”

mentioning

confidence: 99%

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Delphi survey of maintenance lithium treatment in older adults with bipolar disorder: An ISBD task force report

et al. 2018

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Objectives Despite the growing numbers and proportion of older adults with bipolar disorder (OABD), there are very limited guidelines for the use of lithium with its double‐edged potential for effectiveness and toxicity in this population. The primary aims of this Delphi survey were: (a) To determine the place of lithium among the preferred choices for maintenance treatment of OABD. (b) To provide detailed clinical guidelines for the safe and effective use of lithium in OABD. Methods In the face of limited evidence, the Delphi survey method was used to achieve consensus by a group of 25 experts in OABD from nine countries. An oversight committee monitored and analyzed the results of each survey and formulated more focused questions with each subsequent iteration. Results A 100% response rate was achieved for all three iterations of the survey. Lithium was the preferred choice for maintenance monotherapy in OABD. Serum levels of 0.4‐0.8 mmol/L were recommended for ages 60‐79 and serum levels of 0.4‐0.7 mmol/L were recommended for ages 80 and over. Specific recommendations achieved consensus for second line monotherapy as well as for other drugs to be used in combination with lithium if necessary. Guidelines for routine monitoring of lithium in OABD were provided for laboratory investigations and clinical assessments. Conclusions Lithium remains the preferred choice for maintenance monotherapy in OABD. Laboratories should report the therapeutic range for serum levels of lithium separately for older adults.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%