Lithium: Refresh Your Basics
1. Does food alters the absorption and side effects of Lithium?
- Risk of diarrhea when Lithium is given empty stomach.
- Lithium gets almost completely absorbed when given after food, but absorption reduced with empty stomach.
- Clinical Tip: Lithium should therefore preferably be administered after meals.
2. What are the contraindications for Lithium use?
- Significant renal impairment.
- Sodium depletion.
- Significant cardiovascular disease (lithium can RARELY cause sinus node dysfunction- eg, sinus bradycardia and sinoatrial block; atrioventricular node dissociation with atrioventricular block and junctional rhythms; and ventricular premature beats).
- Psoriasis, which lithium exacerbates, is a RELATIVE contraindication.
- Clinical Tip: If the psychiatric indication is life-threatening, and if such a patient fails to respond to other measures, lithium treatment may be undertaken with extreme caution, including daily serum lithium determinations and adjustment to the usually low doses ordinarily tolerated by these individuals. In such instances, hospitalization is a necessity.
- Source: Lithium Package Insert
3. Is Lithium induced hypothyroidism a contraindication for future lithium therapy?
- Neither pretreatment hypothyroidism nor lithium-induced hypothyroidism is a contraindication to lithium therapy.
- Most experts recommend treatment with thyroid replacement treatment.
- HighTSH + no clinical signs of hypothyroidism = Monitor TSH Q3monthly without thyroxine replacement.
- High TSH + clinical signs of hypothyroidism = T4 preferred over T3 replacements.
- Initiate T4 at 0.025 mg and increase 0.025 mg Q3-6 weeks until TSH in normal range.
- Source: J Clin Psychiatry. 1999;60:249-255.
4. Which medications can affect Lithium levels?
Medications that Increases lithium level:-
- Thiazide diuretics
- Nonsteroidal antiinflammatory drugs (NSAIDS) except aspirin
- Angiotensin converting enzyme (ACE) inhibitors
- Antibiotics tetracyclines and metronidazole
Medications that Decreases lithium level:-
- Potassium-sparing diuretics
Source: Drugs for treatment of bipolar disorders. In: Handbook of Psychiatric Drug Therapy, 6th ed, Lippincott Williams & Wilkins, Philadelphia 2010. p.110.
5. What laboratory investigations are recommended prior to initiating and during Lithium treatment?
- Calcium concentrations should be checked before and during treatment (Because of the consistent finding of a high prevalence of hyperparathyroidism).
- Kidney function test (creatinine and urine specific gravity).
- Thyroid function test.
- Electrocardiogram for patient over age 50 yr.
Please do post your questions or comments below.
Dr. Harvinder Singh, M.D. (Admin)
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