Content area
Full Text
Published online: 2 March 2016
© Springer International Publishing Switzerland 2016
Abstract Lithium has been used for the management of psychiatric illnesses for over 50 years and it continues to be regarded as a first-line agent for the treatment and prevention of bipolar disorder. Lithium possesses a narrow therapeutic index and comparatively minor alterations in plasma concentrations can have significant clinical sequelae. Several drug classes have been implicated in the development of lithium toxicity over the years, including diuretics and non-steroidal anti-inflammatory compounds, but much of the anecdotal and experimental evidence supporting these interactions is dated, and many newer medications and medication classes have been introduced during the intervening years. This review is intended to provide an update on the accumulated evidence documenting potential interactions with lithium, with a focus on pharmacokinetic insights gained within the last two decades. The clinical relevance and ramifications of these interactions are discussed.
1 Introduction
Lithium salts have been administered for the treatment and prevention of mood disorders for over 60 years [1]. From the outset, it was evident that lithium was associated with a wide variety of potential toxicities but clinicians and researchers also realized that this medication demonstrated unprecedented therapeutic potential for ameliorating episodes of both mania and depression. Over time, other medications were identified that possessed mood-stabilizing properties and appeared to have a wider therapeutic index than lithium, leading to a sharp decline in the popularity of this older compound.
In recent years, the clinical utility of lithium has undergone a renaissance of sorts due, in part, to longitudinal data demonstrating that lithium had a more favorable effect on suicidality than other mood stabilizers [2, 3]. Newfound concerns about the safety and long-term efficacy of these compounds contributed to the ascension of lithium as well [4]. Today, lithium is regarded as a first-line agent for the prophylaxis of bipolar disorder, but the safe and efficacious use of this medication demands a comprehensive understanding of its pharmacokinetic disposition, adverse effect potential, and the relative risk (RR) of drug interactions [5, 6].
2 Pharmacology of Lithium
Lithium is a monovalent cation and the third element featured on the periodic table. It is quite abundant in nature, frequently found in groundwater, and the concentration of lithium circulating...