In particular, angiotensin-converting enzyme inhibitors, nonsteroidal anti-inflammatory drugs and thiazide diuretics can enhance lithium serum levels by increasing renal reabsorption in the proximal tubule.
2007).įull size image Risk factors for lithium intoxicationĭrugs that alter renal function must be considered risk factors for lithium intoxication. For this reason, lithium toxicity depends on the exposure pattern which needs to be considered regarding treatment strategy (Waring et al. In the cases of acute lithium toxicity, lithium concentrations tend to fall rapidly due to distribution in several tissues, meanwhile chronic toxicity faces lithium-saturated tissues. The rationale for clinical differences is compartment saturation. Acute lithium intoxication is most often associated with gastrointestinal symptoms, cardiotoxic effects and late developing neurological signs whereas chronic forms manifest primarily as neurological symptoms, including confusion, myoclonus and seizures (Timmer and Sands 1999 Ward et al. Regarding the subtypes of lithium intoxication, there are acute, acute-on-chronic and chronic forms, which differ in their symptomatology due to lithium pharmacokinetics. Lithium pharmacokinetics can be divided into absorption, distribution and elimination phases (Jaeger et al.
Lithium is an alkali metal, like potassium and sodium, which facilitates its rapid distribution (Young 2009). Since lithium is one of the lightest elements of the periodic table, it is easily distributed throughout total body water (Young 2009 Perrone 2015). The effective dose range of lithium is 0.6–1.0 mmol/l, while in prolonged administration it may be toxic at 1.2 mmol/l or greater (Young 2009). In addition, lithium has been shown efficacious in augmenting response in antidepressant non-responders and in severe treatment-resistant unipolar major depression (Haussmann and Bauer 2013).ĭue to a relatively narrow therapeutic index, lithium intoxication has been a common clinical problem (Timmer and Sands 1999 Hampton 2014). 2014) and frequently also used in the treatment of recurrent major depressive disorders since the 1950s (Bschor 2014). Since 1970, lithium has been approved and widely used as the gold standard for the treatment of acute episodes and maintenance treatment of bipolar disorder (Nolen 2015 Severus et al.
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