Review of Lithium's Safety

[liveonearth]

notes from Medscape article and study abstract:

Lithium's Safety Examined
Findings Reaffirm Drug's Role as First-Line Therapy for Bipolar Disorder
January 19, 2012

THE META-ANALYSIS
systematic review and meta-analysis
385 randomized, controlled trials and observational studies
funded by the National Institute for Health

DOWNSIDES OF LITHIUM TX
linked to thyroid and parathyroid abnormalities, weight gain
increased risk for reduced urinary concentrating ability
lithium blocks thyroid secretion (Miller)

BIRTH DEFECTS?
teratogenicity not established or supported by this study
no significant increased risk for
congenital abnormalities, hair loss, or skin disorders
still recommended that lithium be avoided during pregnancy, effects uncertain

FOR BIPOLAR
most effective long-term therapy for bipolar disorder
protects vs depression and mania
reduces risk of suicide and short-term mortality
unpatented, cheap drug, not commercially promoted

RENAL FUNCTION
scant evidence that li+-->clinically sig reduction in renal fx in most pts
risk of end-stage renal failure among users of the drug is low
lithium reduces GFR by an average of −6.22 mL/min
and urinary concentrating ability by 15% of normal maximum
absolute risk of renal failure was small

CAUSES HYPOTHYROIDISM
increase in the prevalence of clinical hypothyroidism
incr TSH by an average of 4.00 iU/mL

INCREASES SERUM CALCIUM
also linked to increased blood calcium
increased parathyroid hormone
(check calcium levels before and during tx)

CAUSES WEIGHT GAIN
less with lithium than with olanzapine

SOURCES
http://www.medscape.com/viewarticle/757241?src=mpnews&spon=12
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961516-X/abstract