Treatment adherence and tolerability of immediate- and prolonged-release lithium formulations in a sample of bipolar patients: a prospective naturalistic study

Barbuti, Margherita; Colombini, Paola; Ricciardulli, S.; Amadori, Salvatore; Gemmellaro, Teresa; Dominicis, Francesco De; Rocca, Filippo Della; Petrücci, Aldo; Schiavi, Elisa; Perugi, Giulio

doi:10.1097/yic.0000000000000373

Cited by 11 publications

(5 citation statements)

References 25 publications

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“…Taken together, currently available evidence supports the hypothesis that lithium is an efficacious treatment of OABD; yet, safety and tolerability issues cannot be ignored 1,7,8 . Lithium‐related side‐effects can be both unpleasant (e.g., tremor) and clinically relevant in the long term (e.g., renal insufficiency or hypothyroidism), jeopardising the patient's adherence to treatment and discouraging clinicians to prescribe it 9 . According to register studies conducted in Denmark and Sweden, the pattern of prescription of mood‐stabilising drugs for the treatment of BD has changed over the past years, with a decline in the use of lithium and valproate, 10 alongside an increase in the use of lamotrigine and quetiapine 11 .…”

Section: Introductionmentioning

confidence: 96%

“…1,7,8 Lithium-related side-effects can be both unpleasant (e.g., tremor) and clinically relevant in the long term (e.g., renal insufficiency or hypothyroidism), jeopardising the patient's adherence to treatment and discouraging clinicians to prescribe it. 9 According to register studies conducted in Denmark and Sweden, the pattern of prescription of mood-stabilising drugs for the treatment of BD has changed over the past years, with a decline in the use of lithium and valproate, 10 alongside an increase in the use of lamotrigine and quetiapine. 11 Also, underutilisation of lithium has been reported in Scotland 12 and in North America, 13 which may have been driven by safety concerns and marketing investments by pharma favouring the prescription of newer drugs.…”

Section: Introductionmentioning

confidence: 99%

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Demographic and clinical characteristics of lithium‐treated older adults with bipolar disorder

Forlenza

Hájek

Almeida

et al. 2022

Acta Psychiatr Scand

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Objectives There is limited information on the characteristics of older adults with bipolar disorder (OABD) treated with lithium, along with safety concerns about its use by older adults. The aim of the present study is to describe the demographic and clinical characteristics of OABD receiving lithium therapy, using data from the Global Ageing & Geriatric Experiments in Bipolar Disorder (GAGE‐BD). Experimental Procedures Cross‐sectional analysis of the GAGE‐BD dataset to determine differences and similarities between lithium users and non‐users. We analysed data from 986 participants aged 50 years or older (mean age 63.5 years; 57.5% females) from 12 study sites. Two subgroups (‘Lithium’; ‘Non‐lithium’) were defined according to the current prescription of lithium. We compared several outcomes between these groups, controlling for age, gender, and study site. Results OABD treated with lithium had lower scores on depression rating scales and were less likely to be categorised as with moderate or severe depression. There was a lower proportion of lithium users than non‐users among those with evidence of rapid cycling and non‐bipolar psychiatric diagnoses. Assessment of global cognitive state and functionality indicated better performance among lithium users. The current use of antipsychotics was less frequent among lithium users, who also reported fewer cardiovascular comorbidities than non‐users. Conclusion We found several potentially relevant differences in the clinical profile of OABD treated with lithium compared with those treated with other mood stabilisers. However, the interpretation of the present results must take into account the methodological limitations inherent to the cross‐sectional approach and data harmonisation.

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Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Demographic and clinical characteristics of lithium‐treated older adults with bipolar disorder

Forlenza

Hájek

Almeida

et al. 2022

Acta Psychiatr Scand

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“…Another common stereotype is that using different lithium formulations does not modify lithium tolerability. On the contrary, the availability of prolonged-release lithium formulation represents an important strength of lithium treatment choice since it reduces some of the most common side effects of lithium, such as tremor and gastrointestinal symptoms, and also has a positive effect on adherence [96,97].…”

Section: Discussionmentioning

confidence: 99%

Facts and myths about the use of lithium for bipolar disorder in routine clinical practice: an expert consensus paper

Fiorillo,

Sampogna,

Albert

et al. 2023

Ann Gen Psychiatry

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Background Bipolar disorder is one of the most burdensome severe mental disorders, characterized by high levels of personal and social disability. Patients often need an integrated pharmacological and non-pharmacological approach. Lithium is one of the most effective treatments available not only in psychiatry, but in the whole medicine, and its clinical efficacy is superior to that of other mood stabilizers. However, a declining trend on lithium prescriptions has been observed worldwide in the last 20 years, supporting the notion that lithium is a ‘forgotten drug’ and highlighting that the majority of patients with bipolar disorder are missing out the best available pharmacological option. Based on such premises, a narrative review has been carried out on the most common “misconceptions” and “stereotypes” associated with lithium treatment; we also provide a list of “good reasons” for using lithium in ordinary clinical practice to overcome those false myths. Main text A narrative search of the available literature has been performed entering the following keywords: “bipolar disorder”, “lithium”, “myth”, “mythology”, “pharmacological treatment”, and “misunderstanding”. The most common false myths have been critically revised and the following statements have been proposed: (1) Lithium should represent the first choice for the treatment of patients with bipolar disorder; (2) lithium treatment is effective in different patients’ groups suffering from bipolar disorder; (3) Drug–drug interaction risk can be easily managed during lithium treatment; (4) The optimal management of lithium treatment includes periodical laboratory tests; (5) Slow-release lithium formulation has advantages compared to immediate release formulation; (6) Lithium treatment has antisuicidal properties; (7) Lithium can be carefully managed during pregnancy. Conclusions In recent years, a discrepancy between evidence-based recommendations and clinical practice in using lithium treatment for patients with bipolar disorder has been highlighted. It is time to disseminate clear and unbiased information on the clinical efficacy, effectiveness, tolerability and easiness to use of lithium treatment in patients with bipolar disorder. It is necessary to reinvigorate the clinical and academic discussion about the efficacy of lithium, to counteract the decreasing prescription trend of one of the most effective drugs available in the whole medicine.

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“…BDs are often associated with other psychiatric comorbidities, substance use disorder and a high risk of suicide. In addition, bipolar patients are difficult to manage for their tendency to discontinue pharmacological treatments, especially in the manic state and for their low compliance [12,13].…”

Section: Introductionmentioning

confidence: 99%

A 5-Year Study of Lithium and Valproic Acid Drug Monitoring in Patients with Bipolar Disorders in an Italian Clinical Center

et al. 2022

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Therapeutic drug monitoring (TDM) is an effective tool used to improve the pharmacological treatment in clinical practice, especially to detect subtherapeutic drug plasma concentration (Cp) in order to consider a change of dosage during treatment and reach its putative therapeutic range. In this study, we report the Cp values of lithium and valproic acid (VPA), alone and in combination, mostly in bipolar patients admitted to an Italian clinical center of the University of Pisa during the years 2016–2020, which include 12,294 samples of VPA, 7449 of lithium and 1118 of both in combination. Lithium and VPA are the most utilized drugs in treating bipolar disorders, and their TDM is strongly recommended by recent guidelines. In relation to lithium Cp monitoring, several studies have underlined that 0.5–0.8 mmol/L is the optimal range for chronic treatment, and below 0.4 mmol/L, it is unlikely to produce a clinical response. For VPA, the therapeutic range is 50–100 μg/mL and a linear correlation between Cp and clinical efficacy has been proposed, where below 50 μg/mL, the clinical efficacy of VPA has not been proven thus far. Toxic levels of both drugs were rarely found in our study, while a high percentage of patients, about one-third, had sub-therapeutic Cp during their treatments. In addition, in several cases of patients receiving multiple blood sampling, the initial subtherapeutic Cp changed only partially without reaching its therapeutic window. In relation to age, we found a higher percentage of lithium and VPA Cp values in range in the adolescents than in the adults and elderly groups. No differences were reported when analyzing the distribution of Cp values in males and females. In conclusion, this present study suggests that TDM is widely used by many specialists, but there is still a window of improvement for optimizing pharmacological treatments in clinical practice.

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Treatment adherence and tolerability of immediate- and prolonged-release lithium formulations in a sample of bipolar patients: a prospective naturalistic study

Cited by 11 publications

References 25 publications

Demographic and clinical characteristics of lithium‐treated older adults with bipolar disorder

Demographic and clinical characteristics of lithium‐treated older adults with bipolar disorder

Facts and myths about the use of lithium for bipolar disorder in routine clinical practice: an expert consensus paper

A 5-Year Study of Lithium and Valproic Acid Drug Monitoring in Patients with Bipolar Disorders in an Italian Clinical Center

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