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PHARMACOLOGICAL COMPATIBILITY*

Response to Lithium in Bipolar Disorder

Lithium is the antipsychotic drug of first choice in manic episodes and in the maintenance of recurrent affective disorders. The dose is adjusted by determining the plasma levels of this mineral. Currently and despite the existence of other mood stabilizers of new generations, lithium remains the first line treatment in bipolar disorder (BD); however, the individual response to treatment is very variable.

CONTRAINDICATIONS

Treatment with lithium is contraindicated in the following cases: hypersensitivity to lithium, pregnancy and lactation, severe renal insufficiency, severe cardiovascular disease, debilitation, dehydration or severe sodium depletion.

CAUTIONS

Extreme caution should be exercised when prescribing lithium in the following cases:

Severe kidney disease, Concomitance with diuretics, Excessive sweating, Diarrhea, Infections with high fever, Hypothyroidism, when prescribed to patients with low sodium diets, Elderly, Children.

In the long term, lithium can induce the appearance of microcysts, oncocytomas and carcinomas of the collecting duct in severe renal failure

SIDE EFFECTS

Hypothyroidism, goiter, polyuria and polydipsia, hypercalcemia.

Drowsiness, tiredness, muscle weakness, muscle hyperirritability, tremor, headache, confusion, nasal word, difficulty concentrating, “”cogwheel”” stiffness, hyperreflexia, hypertonia.

T wave abnormalities in the ECG (electrocardiogram), anorexia, nausea, vomiting, diarrhea, abdominal pain, abdominal distension, constipation and leukocytosis.

PHARMACOLOGICAL INTERACTIONS

Lithium plasma levels are increased by: NSAIDs, thiazides and ACE inhibitors

Lithium plamatic levels are decreased by: calcium antagonists, acetazolamide, urea, xanthines and alkalizing agents.

Lithium plasma levels can be increased or decreased by fluoxetine.

Risk of neurological adverse effects in concomitancy with carbamazepine, phenytoin, haloperidol (monitor in order to be able to withdraw the treatment if signs of neurological toxicity appear).

Additive or synergistic hypothyroid effect with iodides

BRAND NAMES

  • Plenur ®
  • Eskalith®
  • Lithobid®

GENE OR REGION STUDIED


  • HLA-DMA
  • BDNF
  • AL157359.4
  • CRY1
  • GFRA2

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