Psychopharmacology - Lithium

4 important questions on Psychopharmacology - Lithium

Side Effects following Lithium initiation

LITHIUM
Lethargy
Insipidus - Symptoms such as polyuria, polydypsia
Tremors - Can be challanged with oral beta blockers if no contraindication
Hypothyroidsm - consider thyroxine
Impaired cognitive function
Upset GI
Muscle cramps

TDM monitoring of Lithium

- Lower than 0.6 is considered good, but still not in therapeutic range yet
- Best therapeutic value falls between 0.6-1.0
- Toxicity value is expected to range more than 1.0
- Monitoring once stable may between 3-6 monthly
- For each dose adjustment, after 5 days is advisable to monitor TDM Lithium

Drug interactions with Lithium

- ACE-I : Potentially causing increase in serum concentration of oral lithium in the sYstem
- Thiazide : Reduce renal clearance of Lithium
- NSAID : May also precipitate Lithium concentration
- May need to consider more frequent TDM monitoring an renal functions
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Evidence base Lithium use

· Augmentation with lithium remains as one of the evidence-supported adjunctive agents in treating pts with TRD that have not responded adequately to ADs.
· Its ‘anti-suicidal’ property makes it especially favorable as patients with TRD often manifest suicidal ideation.

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