Oppfølging av pasienter som bruker litium
Effekten er godt dokumentert, men midlet kan gi alvorlige bivirkninger og interaksjoner med andre legemidler. Litium har et smalt terapeutisk område og intoksikasjoner kan forekomme ved vanlige/lave doser. (Tidsskr Nor Legeforen 2008; 128:1410-2 (12.6.2008))
DrugLabel lithium carbonate (Lithium Carbonate) tablet, extended release [Boehringer Ingelheim Roxane Laboratories] (fda.gov)
Lithium toxicity profile: a systematic review and meta-analysis
Lancet. 2012 Feb 25;379(9817):721-8. Epub 2012 Jan 20
(...) BACKGROUND: Lithium is a widely used and effective treatment for mood disorders. There has been concern about its safety but no adequate synthesis of the evidence for adverse effects. We aimed to undertake a clinically informative, systematic toxicity profile of lithium. (...)
INTERPRETATION: Lithium is associated with increased risk of reduced urinary concentrating ability, hypothyroidism, hyperparathyroidism, and weight gain. There is little evidence for a clinically significant reduction in renal function in most patients, and the risk of end-stage renal failure is low. The risk of congenital malformations is uncertain; the balance of risks should be considered before lithium is withdrawn during pregnancy. Because of the consistent finding of a high prevalence of hyperparathyroidism, calcium concentrations should be checked before and during treatment. (...)
The Immunostimulating and Antimicrobial Properties of Lithium and Antidepressants
inewp.com 4.2.2012
(...) Selective serotonin reuptake inhibitors (SSRIs)can destroy such fungi in vitro as Candida and Aspergillus species.[84] Sertraline can remit recurrent vulvovaginal candidiasis in vivo.[85] Munoz-Bellido and colleagues have shown that such antidepressants as sertraline, fluoxetine and paroxetine have antimicrobial activity especially against Gram-positive microorganisms. These anti-depressants also show synergistic activity when combined with some antibiotics against several bacteria.[86] In a separate study Munoz-Bellido andcolleagues tested the in vitro activity of various antibiotics and psychotropic drugs against 32 strains of Corynebacterium urealyticum. Sertraline was the most effective psychiatric drug and it enhanced the activity of ciprofloxacin and tetracycline against all strains.[87] (...)
(...) Depression, antidepressants and immunity
The depressive effect of bereavement and other stresses on immune function is well documented.[88] Impaired lymphocyte function, reduced natural killer cell activity, reduced lymphocyte responses to mitogens and decreased natural killer cellpopulations have been demonstrated in depressives.[89,90] Antidepressants augment natural killer cell activity in vivo and in vitro.[91] The MAOI tranylcypromine enhances cell-mediated immunity.[92] (...)
Conclusions
While lithium is effective against some bacteria and viruses evidence for effectiveness against parasites and fungi is lacking. Antidepressants, on the other hand, are effective against various bacteria, viruses, parasites and fungi. As lithium and anti-depressants have immunopotentiating as well as antimicrobial properties they stand to be effective against a gamut of microorganisms. The response of infection to lithium and antidepressants mirrors depression with subjects responding to TCAs, to SSRIs, to MAOIs or to lithium. An infection should not be labeled refractory to antidepressants untilmany, if not all have been tried. Many comparison studies with antidepressants are biased by the generalization that ‘antidepressants’ lack a specific property when the study involved only one. Anti-depressants are highly specific and humans remarkably variable.
Excessive synthesis of PGs depresses brain and immune function. When depressives with an infection respond to lithium or an antidepressant the response is invariably simultaneous, suggesting that the central actions of the drugs are important.
The immunostimulating actions of lithium and anti-depressants are systemic and suggest central orchestration. While antivirals are not necessarily immunostimulants, the actions of lithium and anti-depressants suggest that immunostimulants are antivirals. The SARS epidemic was a clarion call for immunostimulants. The immunostimulating properties of lithium and antidepressants couldtransform the prevention and treatment of many such infections.
Tachyphylaxis may complicate the treatment of depression[99 – 101] and paradoxical reactions induce or intensify symptoms. These phenomena may interfere with the treatment of infection with lithium and antidepressants. Antidepressants are, paradoxically, capable of activating dormant viruses.[102] Remission of depression in subjectstreated for tuberculosis ushered in the pharmaco-logical treatment of depression.
The wheel will turn full circle when lithium and antidepressants areintegrated into the pharmacology and therapeutics of infection. (...)
Lithium toxicity profile: a systematic review and meta-analysis
Lancet. 2012 Jan 19. [Epub ahead of print]
(...)
BACKGROUND:
Lithium is a widely used and effective treatment for mood disorders. There has been concern about its safety but no adequate synthesis of the evidence for adverse effects. We aimed to undertake a clinically informative, systematic toxicity profile of lithium. (...)
INTERPRETATION: Lithium is associated with increased risk of reduced urinary concentrating ability, hypothyroidism, hyperparathyroidism, and weight gain. There is little evidence for a clinically significant reduction in renal function in most patients, and the risk of end-stage renal failure is low. The risk of congenital malformations is uncertain; the balance of risks should be considered before lithium is withdrawn during pregnancy. Because of the consistent finding of a high prevalence of hyperparathyroidism, calcium concentrations should be checked before and during treatment. (...)
Lithium Carbonate 150 mg, 300 mg, and 600 mg capsules
fda.gov (October 2011)
Detailed View: Safety Labeling Changes Approved By FDA Center for Drug Evaluation and Research (CDER) – October 2011
Summary View
WARNINGS
Unmasking of Brugada Syndrome
...the unmasking of Brugada Syndrome [added]
PRECAUTIONS
Information for the Patients
...the unmasking of Brugada Syndrome [added]
ADVERSE REACTIONS
Cardiovascular
...the unmasking of Brugada Syndrome [added] (...)
(Anm: Brugada Syndrome (Tidsskr Nor Legeforen 2008; 128:2828-31 (18.12.2008).)
Lithium-Associated Hyperthyroidism Treated With Lithium Withdrawal: A Case Report
Am J Psychiatry 2011;168:438-439 (April)
TO THE EDITOR: Lithium, a first-line treatment for bipolar disorder, is a well-known cause of hypothyroidism; however, case reports have documented the emergence of thyrotoxicosis during lithium treatment, with evidence showing the incidence rate to be greater than expected in the general population (1–3). The recommended conservative management is antithyroid medication and continuation of lithium (4). It is advised that lithium not be withdrawn because of several reports of exacerbation of thyrotoxicosis (1, 2, 5). We report the case of a patient with lithium-associated hyperthyroidism treated with drug withdrawal, a treatment method documented in only one previous case (6). (...)
Theories that lithium causes hyperthyroidism include induction of autoimmunity and direct toxic effect causing thyroid hormone release (4). Notably, the three reports of exacerbation of thyrotoxicosis after withdrawal of lithium were in patients with Graves' disease. Conversely, our patient, who presented with thyroiditis, improved after withdrawal of lithium, which is consistent with the theory of lithium's direct toxic effect on thyrocytes. One could conclude that management of lithium-associated hyperthyroidism would differ based on the etiology of the thyroid overactivity. Our case suggests that patients who present with thyroiditis can be effectively treated with withdrawal of lithium. (...)
Experts: Lithium doesn't slow Lou Gehrig's disease
seattletimes.nwsource.com 6.4.2010
Lithium doesn't help patients with ALS, or Lou Gehrig's disease, contrary to previous study results, new research says.
LONDON — Lithium doesn't help patients with ALS, or Lou Gehrig's disease, contrary to previous study results, new research says.
Results from a small study published two years ago suggested the drug, often used for depression, could slow the fatal neurological disorder. Many ALS sufferers and their families rushed to try it, spearheading a patient-led effort to test lithium without doctors.
In the first trial to scientifically assess whether lithium works for Lou Gehrig's disease, doctors found it had no effect - and stopped the study early because it seemed futile. The results were published online Tuesday in the medical journal, Lancet Neurology. (...)
A young woman's myterious case of fatigue and confusion
clinicaladvisor.com 21.1.2010
Amber, a 23-year-old day-care worker, was brought by ambulance to the ER with symptoms of severe fatigue. Two days earlier, she had presented at the same ER with fatigue, malaise, and acute vomiting and diarrhea. At that time, she was diagnosed with a viral infection. (...)
Lithium is almost (90%-100%) completely absorbed from the GI tract and cleared primarily through the kidneys. It is not metabolized, and its clearance is directly dependent upon the glomerular filtration rate. As a result, dosing must be adjusted based on renal function. Serum lithium levels will peak two to four hours after ingestion; the half-life of the drug ranges from 12 to 27 hours. Several drug classes have the potential to increase lithium levels, including nonsteroidal anti-inflammatory drugs, ACE inhibitors, and calcium channel blockers. These should be used with caution in conjunction with lithium therapy.
In early stages, lithium toxicity often goes unnoticed because of its vague presentation of mild intoxication (nausea, vomiting, diarrhea, and general malaise). The initial physical examination of a patient with mild lithium overdose may be normal. As the toxicity progresses, later symptoms, such as confusion, tremors, seizure, or even coma, make the diagnosis more evident. (...)
In Amber's case, the lithium toxicity was initially misdiagnosed as a simple viral infection. It was not until the second visit and an increase in toxicity that the correct diagnosis was made. Although a potentially fatal outcome was averted, dialysis might have been avoided had earlier diagnosis occurred. (...)
Lithium and chronic kidney disease
BMJ 2009;339:b2452 (3 July)
Lithium use is associated with renal disorder and renal failure; this article offers guidance on monitoring, drug interactions, and when to consider stopping the drug (...)
This article discusses the effects of lithium on the kidney and looks at existing evidence to guide treatment when incidental chronic kidney disease is detected in those in whom lithium is being considered or when long term lithium users develop chronic kidney disease. (...)
How should renal function be monitored in lithium therapy?
Although our recommendations extrapolate evidence from high quality diagnostic studies used to develop the NICE guideline on chronic kidney disease, it remains uncertain how lithium users differ from those at risk of the disease because of hypertension, diabetes, or use of non-steroidal anti-inflammatory drugs. (...)
Lithium, antipsychotics, and risk of psoriasis.
J Clin Psychopharmacol. 2009 Apr;29(2):134-40.
(...) CONCLUSIONS: Long-term use of lithium was associated with a small increase in risk of incident psoriasis. (...)
Oppfølging av pasienter som bruker litium
MEDISIN OG VITENSKAP Legemidler i praksis
Tidsskr Nor Legeforen 2008; 128:1410-2 (12.6.2008)
I mer enn 50 år har litium vært blant de viktigste legemidler i behandlingen av psykiske lidelser. Hovedindikasjonen er behandling og forebygging av bipolar lidelse (manisk-depressiv sykdom). Litium brukes også i behandlingen av affektive symptomer ved schizofreni og andre psykiske lidelser. Effekten er godt dokumentert, men midlet kan gi alvorlige bivirkninger og interaksjoner med andre legemidler. Litium har et smalt terapeutisk område og intoksikasjoner kan forekomme ved vanlige/lave doser. (...)
Lithium-Like Drugs May Impair Neuronal Function
healthfinder.gov 21.12.2006
High doses in Alzheimer's patients may even kill nerve cells, researchers find
-- Too high a dose of lithium and other drugs that inhibit an enzyme called GSK-3 beta can impair, rather than improve, neurological function in patients with Alzheimer's disease and should be used with caution, a new study says.
Lithium is currently undergoing clinical trials as a treatment for Alzheimer's disease. It has been shown to be safe in treating people with manic depressive illness.
"People might think that if you make the inhibitor stronger and stronger, that would be better. Our in-vitro experiments show that you will have to be careful with how you use GSK-3 beta inhibitors, because if you use too much, it will interfere with and possibly kill neurons," study co-author Dr. William D. Snider, professor of neurology, cell and molecular physiology at the University of North Carolina at Chapel Hill's School of Medicine, said in a prepared statement. (...)
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