Drugs and Conditions which Affect Serum Lithium Levels Question Which one of the following may affect blood levels of lithium? A. NSAIDS B. ACE inhibitors C. Thiazide diuretics D. Dehydration

Step 1: First obtain a complete history (to confirm that lithium is indicated and suitable, there is no contraindication, identify whether the patient is taking any medications that interact with lithium, likely to adhere to treatment and the protocol) Step 2: Physical examination especially blood pressure, pulse, weight, BMI, and thyroid examination Step 3: Laboratory investigations especially TFTs, eGFR, ECG if needed, and in women of childbearing age, a pregnancy test. Serum calcium is also desirable. Step 4: Education of the patient about the effects, side effects, the need for strict adherence, the risk of toxicity, signs of toxicity, and conditions that increase the risk of toxicity (in a way that generates a realistic and balanced view of the risks and advantages). Provide written materials Step 5: Start lithium OD200mg or 400mg. Aim for a plasma level of 0.4 to 0.8 mmol/L initially. Step 6: Check plasma level after a week, then every two weeks until the plasma level is sta...

The Safest NSAID for a patient on lithium What is the most suitable non-steroidal anti-inflammatory drug (NSAID) you can prescribe to a patient who is on Lithium therapy? >> Aspirin or Sulindac. 

  Lithium FAQ 01 What are the indications for lithium? We use lithium in the prophylaxis and treatment of mania, prophylaxis of bipolar disorder, as an augmentation strategy for patients with treatment -resistant depression. What are the common signs of lithium toxicity? Thirst, polyuria, memory problems, tremor, weight gain, tiredness, diarrhea. Cognitive dysfunction is the most common symptom that leads to non-compliance. Side effects are dose-related. What is the concentration at which toxic effects reliably occur? Toxic effects reliably occur at 1.5mmol/l but toxic effects can occur at MUCH LOWER LEVELS in many patients, especially in older patients, systemically ill patients, and in use of alcohol or other CNS active meds What are the two systems lithium causes the most damage to? Thyroid and kidneys What are the differences between the brands of lithium? There are differences in bioavailability, and recommendations are to keep to the patient on the same brand. If it is ne...