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Blog #13

28 Apr 2021, 11:21 Publicly Viewable
  1. Mechanism of action of lithium: Lithium influences the IP3 and DAG second messenger systems by decreasing the various enzymes which are very important for conversion and re-circulation of membrane phosphoinositides.
  2. The therapeutic index of lithium is 0,5-1.5mM which is very small and thus the dosing of lithium should be done very carefully and blood levels must be monitored very closely to prevent lithium toxicity.
  3. Lithium as monotherapy is used for prophylaxis of manic and hypomanic episodes and treatment of an acute manic episodes. Lithium is used in combination with antidepressant for the treatment of resistant or recurrent unipolar depression and aggressive or self-mutilating behavior.
  4. The renal clearance may be decreased (the toxicity be increased) by thiazide diuretics, new NSAIDs, ACE-inhibitors and fluoxetine. Renal clearance of lithium is increased by theophylline and caffeine. Lithium is neurotoxic in combination with carbamazepine, calcium-blockers, losartan, methyldopa, metronidazole and phenytoin.
  5. Tremors, sedation, ataxia, aphasia, muscle weakness, fatigue, polydipsia, polyuria, nocturia, nephrogenic diabetes insipidus, thyroid enlargement, leukocytosis, edema, weight gain, acne, alopecia and sexual dysfunction.
  6.  Lithium has been associated with an increased incidence of congenital cardiovascular abnormalities but the incidence is very low and when the risk-benefit has been considered it may be continued. Lithium is excreted into the breastmilk in high concentrations and thus breastfeeding is not recommended.
  7.  Lithium as monotherapy is used for prophylaxis of manic and hypomanic episodes and treatment of an acute manic episodes.
  8. The NSAID is causing decreased clearance of the lithium and that is why it causes an increase in the patient’s weight and other side effects of lithium are starting to arise. I would rather recommend that the patient uses Tylenol (acetaminophen) for the pain of her muscle injury for it does not have any interaction with the lithium.