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Lithium Dosing and Serum Concentrations Across the Age Spectrum: From Early Adulthood to the Tenth Decade of Life

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Abstract

Objectives

Little is known about how lithium should be dosed to achieve therapeutic but safe serum concentrations in older adults. In this paper, we investigate how the lithium dose–concentration ratio changes across the lifespan.

Methods

This was a cross-sectional analysis of 63 current lithium users aged 20–95 years using data from McGLIDICS (the McGill Geriatric Lithium-Induced Diabetes Insipidus Clinical Study). Participants underwent blood and urine tests, including serum lithium concentrations. Multivariate analyses were conducted to evaluate potential correlates of the lithium dose–concentration ratio.

Results

We found that between the ages of 40–95 years, the total daily dose of lithium required to achieve a given serum concentration decreases threefold (500 vs. 1,500 mg for 1.0 mmol/L). Greater age, once-daily dosing, and lower renal function (estimated glomerular filtration rate) were independently associated with a lower lithium dose–concentration ratio.

Conclusions

The lithium dose required to achieve a given serum lithium concentration decreases threefold from middle to old age, with this trend continuing into the ninth and tenth decades of life. In order to avoid lithium toxicity in aging patients, continued serum concentration monitoring and judicious dose reduction may be required, particularly in those patients with reduced renal function.

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Acknowledgments

We wish to thank Ms. Nicole Bissonnette, Ms. Jean Enright, Dr. Pablo Cervantes, Ms. Sybille Saury, Dr. Rene Desautels, Ms. Rosi Abitbol, Mr. Brian Weixi Li, Ms. Lori Young, Dr. Gershon Frisch, Ms. Dilshad Ratansi, and colleagues at McGill University and University of Toronto. Without their incredible support and encouragement, the implementation of this study would not have been possible.

For this study, Soham Rej received Master’s training awards from the Canadian Institutes of Health Research (CIHR) and the Federation de Recherche en Sante Quebec (FRSQ).

Conflicts of interest

Serge Beaulieu receives research support [CIHR, FRSQ, NARSAD, RSMQ, Stanley Foundation, AstraZeneca, Biovail, Bristol Myers Squibb (BMS), Eli Lilly, Janssen-Ortho, Lundbeck, Merck-Frosst, Novartis, Otsuka, Pfizer, Servier]; speaker bureau fees [AstraZeneca, Biovail, BMS, Eli Lilly, GlaxoSmithKline (GSK), Janssen-Ortho, Lundbeck, Organon, Otsuka, Wyeth Pfizer, Sunovion]; and serves as a consultant/on advisory boards (AstraZeneca, BMS, Eli Lilly, Forest Laboratories, GSK, Janssen-Ortho, Lundbeck, Merck, Pfizer, Otsuka, Servier). Serge Beaulieu did not receive any specific funding for this paper. Soham Rej, Marilyn Segal, Nancy Low, Istvan Mucsi, Christina Holcroft, Kenneth Shulman, and Karl Looper have no conflicts to declare.

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Authors and Affiliations

  1. Department of Psychiatry, McGill University, Irving Ludmer Research and Training Building, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada

    Soham Rej, Serge Beaulieu, Marilyn Segal, Nancy C. P. Low & Karl J. Looper

  2. Division of Nephrology, Department of Medicine, Royal Victoria Hospital, McGill University, Montreal, QC, Canada

    Istvan Mucsi

  3. Biostatistician, Boston, MA, USA

    Christina Holcroft

  4. Division of Geriatric Psychiatry, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    Kenneth Shulman

Authors
  1. Soham Rej
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  2. Serge Beaulieu
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  3. Marilyn Segal
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  4. Nancy C. P. Low
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  5. Istvan Mucsi
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  6. Christina Holcroft
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  7. Kenneth Shulman
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  8. Karl J. Looper
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Correspondence to Soham Rej.

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Rej, S., Beaulieu, S., Segal, M. et al. Lithium Dosing and Serum Concentrations Across the Age Spectrum: From Early Adulthood to the Tenth Decade of Life. Drugs Aging 31, 911–916 (2014). https://doi.org/10.1007/s40266-014-0221-1

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