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Psychotropic Drugs
Published in Diana Riley, Perinatal Mental Health, 2018
It has been reasoned that the infant has already been exposed to high plasma levels in utero, and the absorption from breast milk will produce lower and safer levels66. This view is supported by a study of a woman taking 400 mg of lithium carbonate daily at parturition137. At delivery, the infant’s serum level was similar to her own, but fell postpartum in spite of a doubling of the dose to the mother and the establishment of breastfeeding. Although the lithium concentration in milk almost doubled from the 14th to the 28th day postpartum, the baby’s serum level remained relatively constant during the same period. A recent investigation by the author showed that the serum level of a mother on 800 mg lithium citrate daily for 14 days was 0.7 meq/1, whilst that of the totally breast-fed and thriving five-month old baby was 0.03 meq/1.
Agitation and Psychosis
Published in Marc E. Agronin, Alzheimer's Disease and Other Dementias, 2014
Because of its side effects and narrow therapeutic window, lithium carbonate (or lithium citrate) is often not used in agitated elderly individuals with dementia. Checking blood levels routinely is imperative, especially after dose changes or the addition of medications known to affect lithium levels. Common side effects of lithium include sedation, tremor, and diarrhea. Renal and thyroid tests should be checked before the medication is begun to establish a baseline and then every four to six months thereafter because of the risk of damage to both organs. Many medications, especially nonsteroidal anti-inflammatory drugs, can affect lithium levels, usually by increasing them.
Comparison of immediate and sustained release formulations of lithium salts
Published in International Review of Psychiatry, 2022
Maurizio Pompili, Carlo Magistri, Cristiano Mellini, Giuseppe Sarli, Ross J. Baldessarini
A prospective cohort study compared 28 psychiatric patients given IR lithium carbonate once daily vs. 95 given SR lithium citrate twice daily over an average of 14.5 years (Table 1) (Schou et al., 1982). Mean serum lithium concentrations were slightly higher with IR than SR salts (0.93 vs. 0.88 mEq/L), despite somewhat higher doses with the SR preparation. Creatinine clearance (GFR) was somewhat lower with IR than SR lithium preparations (90.3 vs. 99.5 mL/min; Table 2), indicating less adverse impact on renal function with SR lithium. This difference was sustained after adjustment for age, sex, and duration of long-term lithium treatment. However, at least some of the GFR clearance-lowering effect appeared to reflect treatment with lithium once (IR) vs. twice daily (SR), although the impact of dosing interval was not tested explicitly.
Outcomes of acute exploratory pediatric lithium ingestions
Published in Clinical Toxicology, 2020
Faisal Syed Minhaj, Bruce D. Anderson, Joshua D. King, James B. Leonard
The primary objective of the study was to characterize acute unintentional exposures to lithium in children <6 years of age. As a secondary outcome, we sought to identify a weight-based threshold to empirically refer patients into a healthcare facility for symptoms consistent with moderate effect or worse. Only cases where either a specific dose of the lithium salt was identified or a quantity of a specific product was included. Liquid formulations of lithium were converted to milligrams of lithium carbonate (lithium citrate 8 mEq/5 mL = 300 mg of lithium carbonate). Despite minimal variability in the weight of young children and previous authors interpolation of weight in this population, no weights were interpolated [9,10]. Some additional exploratory analyses were performed. We analyzed the trend over time of the dose where patients were referred in to the hospital (e.g., call originated from home and patient was referred to a healthcare facility).
Survival genes expression analysis following ionizing radiation to LiCl treated KG1a cells
Published in International Journal of Radiation Biology, 2020
Yogesh Kumar Verma, Ajay Kumar Singh, Gangenahalli Ugraiah Gurudutta
Lithium chloride (LiCl) is a white-colored ionic compound, which affects the central nervous system (Gould and Manji 2005) and has toxic effects in high concentration (Kaufmann et al. 2011). Its salts, like lithium carbonate and lithium citrate tetrahydrate, are used prophylactically in bipolar and unipolar manic depressive illness for attenuation of both manic and depressive episodes. After oral intake, the peak concentration of lithium reaches within about 4–5 h. Its plasma half-life ranges from 8 to 45 h. Experimental studies have shown that LiCl stimulates the post-irradiation recovery of human hematopoietic marrow cells and provides considerable protection against radiation-induced damage in mouse spermatogonia (LiCl dose reduction factor is 1.84) (Bhattacharjee et al. 1997). It exerts its effect by decreasing cell death via up-regulation of Bcl-2. This is mediated through PP2A methylation and caspase-2 inhibition (Manji et al 2000; Chen et al. 2006). In a similar study, it has been shown that long term, but not acute, treatment of cultured cerebellar granule cells with LiCl results in a concentration-dependent decrease in mRNA and protein levels of proapoptotic p53 and Bax. Pretreatment of these cells with LiCl for 7 d elevates Bcl-2 expression and prevents glutamate-induced increase in p53 and Bax expression (Chen and Chuang 1999). The downregulation of p53 is mediated through phosphorylation of p38 MAPK, leading to G2/M arrest of cells (Tsui et al. 2012).