Safe and effective use of lithium

Malhi, Gin S; Tanious, Michelle; Bargh, Danielle M; Das, Pritha; Berk, Michael

doi:10.18773/austprescr.2013.008

Cited by 18 publications

(9 citation statements)

References 9 publications

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“…6 Because of these limitations, lithium blood levels need to be monitored regularly in patients treated with lithium to ensure optimum efficacy and adequate tolerability. 7 This is currently done through trimonthly attendance to clinics, where a blood sample is taken and sent to the laboratory for analysis using the standard technique of flame emission photometry (FEP). Nevertheless, levels of treatment nonadherence are high and the quality of contemporary lithium monitoring falls short of NICE guidelines.…”

Section: Introductionmentioning

confidence: 99%

Methodology for rapid assessment of blood lithium levels in ultramicro volumes of blood plasma for applications in personal monitoring of patients with bipolar mood disorder

et al. 2018

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Bipolar disorder (BD) is a common mental health condition, characterized by extreme changes in mood, energy, and behavior. BD is often managed through mood-stabilizing medications, of which lithium formulations remain the most reliable and effective at reducing the risk of suicide. To achieve adequate and consistent efficacy, lithium concentrations need to be maintained within a narrow therapeutic range (0.4 to 1.2 mmol∕L). Because of its narrow therapeutic index, long-term lithium therapy is associated with serious side effects and risks of toxicity. It is believed that the availability of a personal blood lithium analyzer would benefit patients who are on lithium treatment. We detail the results of a spectrophotometric method performed on ultramicro volumes to determine blood plasma lithium concentrations as compared with reference measurements of flame photometry, and validated in samples of unknown lithium content. Applying multiple linear regression, lithium concentrations could be determined in a rapid manner using full-range spectra or triwavelength data. Both techniques highly correlated with reference standards and could predict lithium levels accurately (R 2 ¼ 0.794214 and RMSEP ¼ 0.209584, and R 2 ¼ 0.863921 and RMSEP ¼ 0.167524, respectively). Therefore, this method can be a useful for rapid assessment of blood lithium in nonlaboratory settings i.e., general practices, hospital clinics, and community health centers by healthcare professionals and/or by patients. Future work will now focus on completion of a miniaturized and integrated system that will deliver a portable and personal lithium-monitoring device.

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Section: Introductionmentioning

confidence: 99%

Methodology for rapid assessment of blood lithium levels in ultramicro volumes of blood plasma for applications in personal monitoring of patients with bipolar mood disorder

et al. 2018

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“…Improved record keeping, such as a lithium‐monitoring book 17 or electronic records, is important. We suggest that renal function (based on estimated GFR derived from serum creatinine levels, and proteinuria tests) and serum lithium levels should be monitored more frequently than 6 months, and certainly more than every 12 months, which some authors have suggested 18 . This is most important for patients who have received lithium for many years.…”

Section: Discussionmentioning

confidence: 98%

Renal replacement therapy associated with lithium nephrotoxicity in Australia

Roxanas

Grace

George

2014

Medical Journal of Australia

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“…Monitoring of patients is an essential component of treating BD to ensure medication safety, adherence to therapy and adequate control of the disease [11]. In this study, which assessed the safety monitoring of patients with BD, the lithium concentrations were measured in the past 6 months in less than half of patients and in one-year in 59%.…”

Section: Discussionmentioning

confidence: 99%

“…Those on lithium therapy require regular therapeutic drug monitoring as lithium has a narrow therapeutic index. Such monitoring minimizes lithium toxicity and can be used to assess adherence to medication [11]. Long-term treatment with lithium is associated with occurrence of renal side effects such as chronic kidney disease and renal failure.…”

Section: Introductionmentioning

confidence: 99%

Safety monitoring of treatment in bipolar disorder in a tertiary care setting in Sri Lanka and recommendations for improved monitoring in resource limited settings

et al. 2019

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Background Safety monitoring of medicines is essential during therapy for bipolar disorder (BD). We determined the extent of safety monitoring performed according to the International Society for Bipolar Disorders (ISBD) guidelines in patients with BD attending the main tertiary care psychiatry clinics in Sri Lanka to give realistic recommendations for safety monitoring in resource limited settings. Methods Patients diagnosed with BD on mood stabilizer medications for more than 1 year were recruited. Data were collected retrospectively from clinic and patient held records and compared with the standards of care recommended by ISBD guidelines for safety monitoring of medicines. Results Out of 256 patients diagnosed with BD, 164 (64.1%) were on lithium. Only 75 (45.7%) had serum lithium measurements done in the past 6 months and 96 (58.5%) had concentrations recorded at least once in the past year. Blood urea or creatinine was measured in the last 6 months only in 30 (18.3%). Serum electrolytes and thyroid-stimulating hormone (TSH) concentrations were measured in the last year only in 34 (20.7%) and 30 (18.3%) respectively. Calcium concentrations were not recorded in any patient. None of the patients on sodium valproate ( n = 119) or carbamazepine ( n = 6) had blood levels recorded to establish therapeutic concentrations. Atypical antipsychotics were prescribed for 151 (59%), but only 13 (8.6%) had lipid profiles and only 31 (20.5%) had blood glucose concentration measured annually. Comorbidities experienced by patients influenced monitoring more than the medicines used. Patients with diabetes, hypothyroidism and hypercholesterolemia were more likely to get monitored for fasting blood glucose and ( p < 0.001), TSH (p < 0.001) and lipid profiles (p < 0.001). Lithium therapy was associated with TSH monitoring ( p < 0.05). Therapy with atypical antipsychotics was not associated with fasting blood glucose or lipid profile monitoring ( p > 0.05). A limitation of the study is that although some tests were performed, the results may not have been recorded. Conclusions Safety monitoring in BD was suboptimal compared to the ISBD guidelines. ISBD standards are difficult to achieve in resource limited settings due to a multitude of reasons. Realistic monitoring benchmarks and recommendations are proposed for methods to improve monitoring in resource limited settings based on our experience.

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Safe and effective use of lithium

Cited by 18 publications

References 9 publications

Methodology for rapid assessment of blood lithium levels in ultramicro volumes of blood plasma for applications in personal monitoring of patients with bipolar mood disorder

Methodology for rapid assessment of blood lithium levels in ultramicro volumes of blood plasma for applications in personal monitoring of patients with bipolar mood disorder

Renal replacement therapy associated with lithium nephrotoxicity in Australia

Safety monitoring of treatment in bipolar disorder in a tertiary care setting in Sri Lanka and recommendations for improved monitoring in resource limited settings

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