Pharmacokinetics of lithium in healthy volunteers after exposure to high altitude

Arancibia, A; Paulos, Claudio; Chávez, J; Ritschel, W. A.

doi:10.5414/cpp41200

Cited by 36 publications

(18 citation statements)

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“…Relative covariate importance for SMR with 95% bootstrap confidence intervals using the LMG method. that these changes might be clinically significant (Arancibia et al, 2003;Brahm and Puls, 2011). Yet, more research using experimental designs is needed to investigate the interaction between lithium and altitude in more detail.…”

Section: Discussionmentioning

confidence: 99%

“…These findings have been criticised for not controlling for possible confounding factors such as sociodemographic variables and the availability of mental health care, alleged to be a more plausible explanation for higher suicide rates in high-altitude regions (Betz et al, 2011(Betz et al, , 2012. Nevertheless, altitude is also known to have an effect on the pharmacokinetics and has been shown to significantly influence lithium pharmacokinetics in healthy humans (Arancibia et al, 2003). These changes were considered clinically relevant and there is indeed a report of potential altitude-induced hypomania in a bipolar adolescent person secondary to altitude-related changes in lithium pharmacokinetics (Brahm and Puls, 2011).…”

Section: Introductionmentioning

confidence: 99%

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Does altitude moderate the impact of lithium on suicide? A spatial analysis of Austria

et al. 2013

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Abstract. Suicide, the tenth leading cause of death worldwide, is a complex phenomenon. Models aiming to explain the interaction of ambient variables such as socioeconomic factors, lithium content of drinking water and altitude are poorly developed. While controlling for several risk factors, this research bridges two different, but complementary research lines by investigating statistically the relationship on suicide mortality between lithium levels in drinking water in response to altitude above sea level. Besides regression models with main effects, a multiplicative interaction model between lithium and altitude has been developed providing estimates at the district-level for Austria where spatial autocorrelation was accounted for through spatial filtering. The correlation results showed a negative association between lithium levels and altitude. The regression confirmed a negative association of lithium levels and suicide mortality. Altitude was found to be positively associated with suicide mortality. On the other hand, lithium effects on suicide mortality were found to be moderated by altitude. In lower altitude regions the effect turned out to be negatively related to suicide mortality, while lithium had a positive association in high-altitude regions. These results provide evidence for the fact that the relationship between lithium, altitude and suicide rates is more complex than hitherto assumed. Further research on the effects of ambient variables such as low levels of lithium on suicide is needed and particularly the lithium-altitude interaction is worth further investigation to understand possible underlying neurochemical processes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does altitude moderate the impact of lithium on suicide? A spatial analysis of Austria

et al. 2013

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“…The prevention and treatment of high-altitude illness [9][10][11] and pharmacokinetic differences in the processing of drugs such as sulfamethoxazole, lithium, acetazolamide, meperidine, and prednisolone at high altitudes have been studied [12][13][14][15] . These studies found significant changes in the disposition of drugs in healthy subjects after both acute and chronic exposure to high altitude.…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetics of Lidocaine Hydrochloride Metabolized by CYP3A4 in Chinese Han Volunteers Living at Low Altitude and in Native Han and Tibetan Chinese Volunteers Living at High Altitude

Zhang¹,

Zhu²,

Yao³

et al. 2016

Pharmacology

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To investigate the pharmacokinetics of lidocaine hydrochloride metabolized by cytochrome P450 3A4 (CYP3A4) in Chinese Han volunteers living at low altitude (LA) and in native Han and Tibetan Chinese volunteers living at high altitude, lidocaine hydrochloride 10 mg was given by intramuscular injection to 3 groups: Han volunteers living at LA, and native Han and Tibetan volunteers living at a high altitude. Blood samples were collected before the (baseline) study drug was given and at 0.25, 0.5, 1.0, 1.5, 2.0, 3.0, 4.0, 6.0, 8.0 h after study drug administration. Lidocaine hydrochloride in plasma was determined by RP-HPLC. Pharmacokinetics parameters of lidocaine hydrochloride showed that there were no significant difference between the native Han and Tibetan volunteers, but the t_1/2 was 29.8 and 29.8% higher in 2 groups, respectively, than in the LA group. To study related mechanism, the effects of exposure to chronic high-altitude hypoxia (CHH) on the activity and expression of CYP3A1 were examined in rats. Rats were divided into LA, chronic moderate altitude hypoxia, and CHH groups. CHH caused significant decreases in the activity and protein and mRNA expression of rat CYP3A1 in vivo. This study found significant changes in the disposition of lidocaine hydrochloride in native healthy Tibetan and Han Chinese subjects living at a high altitude in comparison to healthy Han Chinese subjects living at LA, it might be due to significant decreases in the activity and protein and mRNA expression of CYP3A4 under CHH condition.

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“…A study of lithium in healthy volunteers has demonstrated that altitude can change the pharmacokinetics of lithium (Arancibia et al, 2003). Volunteers were administered 300 mg of lithium carbonate at 600 m above the mean sea level (MSL) at acute exposure (15 hours) and after chronic exposure (10 months) at 4,360 m above MSL.…”

Section: Introductionmentioning

confidence: 99%

Relationship between altitude and lithium in groundwater in the United States of America: results of a 1992-2003 study

et al. 2014

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Therapeutic dosages of lithium are known to reduce suicide rates, which has led to investigations of confounding environmental risk factors for suicide such as lithium in groundwater. It has been speculated that this might play a role in the potential relationship between suicide and altitude. A recent study in Austria involving geospatial analysis of lithium in groundwater and suicide found lower levels of lithium at higher altitudes. Since there is no reason to suspect this correlation is universal given variation in geology, the current study set out to investigate the relationship between altitude and lithium in groundwater in the United States of America (USA). The study utilised data extracted from the National Water-Quality Assessment programme implemented by the United States Geological Survey that has collected 5,183 samples from 48 study areas in USA for the period of 1992 to 2003. Lithium was the trace-element of interest and 518 samples were used in the current analyses. Due to uneven lithium sampling within the country, only the states (n=15) with the highest number of lithium samples were included. Federal information processing standard codes were used to match data by county with the mean county altitude calculated using altitude data from the Shuttle Radar Topography Mission. The study was controlled for potential confounding factors known to affect levels of lithium in groundwater including aquifer, aquifer type, lithology, water level and the depths of wells. The levels of lithium in groundwater, increased with altitude (R2 = 0.226, P <0.001) during the study period. These findings differ from the Austrian study and suggest a need for further research accounting also for the impact of geographical variation.

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Pharmacokinetics of lithium in healthy volunteers after exposure to high altitude

Cited by 36 publications

References 0 publications

Does altitude moderate the impact of lithium on suicide? A spatial analysis of Austria

Does altitude moderate the impact of lithium on suicide? A spatial analysis of Austria

Pharmacokinetics of Lidocaine Hydrochloride Metabolized by CYP3A4 in Chinese Han Volunteers Living at Low Altitude and in Native Han and Tibetan Chinese Volunteers Living at High Altitude

Relationship between altitude and lithium in groundwater in the United States of America: results of a 1992-2003 study

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