CNS Drugs

, Volume 23, Issue 4, pp 331–349

Lithium: Updated Human Knowledge Using an Evidence-Based Approach

Part II: Clinical Pharmacology and Therapeutic Monitoring
Review Article

Abstract

After a single dose, lithium, usually given as carbonate, reaches a peak plasma concentration at 1.0–2.0 hours for standard-release dosage forms, and 4–5 hours for sustained-release forms. Its bioavailability is 80–100%, its total clearance 10–40 mL/min and its elimination half-life is 18–36 hours. Use of the sustained-release formulation results in 30–50% reductions in peak plasma concentrations without major changes in the area under the plasma concentration curve.

Lithium distribution to the brain, evaluated using 7Li magnetic resonance spectroscopy, showed brain concentrations to be approximately half those in serum, occasionally increasing to 75–80%. Brain concentrations were weakly correlated with serum concentrations.

Lithium is almost exclusively excreted via the kidney as a free ion and lithium clearance is considered to decrease with aging. No gender- or race-related differences in kinetics have been demonstrated. Renal insufficiency is associated with a considerable reduction in renal clearance of lithium and is considered a contraindication to its use, especially if a sodium-poor diet is required. During the last months of pregnancy, lithium clearance increases by 30–50% as a result of an increase in glomerular filtration rate. Lithium also passes freely from maternal plasma into breast milk.

Numerous kinetic interactions have been described for lithium, usually involving a decrease in the drug’s clearance and therefore increasing its potential toxicity.

Clinical pharmacology studies performed in healthy volunteers have investigated a possible effect of lithium on cognitive functions. Most of these studies reported a slight, negative effect on vigilance, alertness, learning and short-term memory after long-term administration only.

Because of the narrow therapeutic range of lithium, therapeutic monitoring is the basis for optimal use and administration of this drug. Lithium dosages should be adjusted on the basis of the serum concentration drawn (optimally) 12 hours after the last dose. In patients receiving once-daily administration, the serum concentration at 24 hours should serve as the control value.

The efficacy of lithium is clearly dose-dependent and reliably correlates with serum concentrations. It is now generally accepted that concentrations should be maintained between 0.6 and 0.8 mmol/L, although some authors still favour 0.8–1.2 mmol/L. With sustained-release preparations, and because of the later peak of serum lithium concentration, it is advised to keep serum concentrations within the upper range (0.8–1 mmol/L), rather than 0.6–0.8 mmol/L for standard formulations. It is controversial whether a reduced concentration is required in elderly people.

The usual maintenance daily dose is 25–35 mmol (lithium carbonate 925–1300 mg) for patients aged <40 years; 20–25 mmol (740–925 mg) for those aged 40–60 years; and 15–20 mmol (550–740 mg) for patients aged >60 years. The initial recommended dose is usually 12–24 mmol (450–900 mg) per day, depending on age and bodyweight. The classical administration schedule is two or three times daily, although there is no strong evidence in favour of a three-times-daily schedule, and compliance with the midday dose is questionable. With a modern sustained-release preparation, the twice-daily schedule is well established, although one single evening dose is being recommended by a number of expert panels.

References

  1. 1.
    Aubry JM, Ferrero F, Schaad N. Pharmacotherapy of bipolar disorders. Chichester: J. Wiley, 2007CrossRefGoogle Scholar
  2. 2.
    Grandjean EM, Aubry J-M. Lithium: updated human knowledge, using an evidence-based approach. Part I: clinical efficacy in bipolar disorder. CNS Drugs 2009; 23(3): 225–40PubMedCrossRefGoogle Scholar
  3. 3.
    Young AH, Hammond JM. Lithium in mood disorders: increasing evidence base, declining use? Br J Psychiatry 2007 Dec; 191: 474–6PubMedCrossRefGoogle Scholar
  4. 4.
    US Food and Drug Administration, Center for Drug Evaluation and Research. Information for health professionals: suicidality and epileptic drugs [online]. Available from URL: http://www.fda.gov/cder/drug/InfoSheets/HCP/antiepilepticsHCP.htm [Accessed 2009 Jan 22]
  5. 5.
    Amdisen A. Serum level monitoring and clinical pharmacokinetics of lithium. Clin Pharmacokinet 1977 Mar–Apr; 2(2): 73–92PubMedCrossRefGoogle Scholar
  6. 6.
    Cooper TB, Simpson GM, Lee JH, et al. Evaluation of a slow-release lithium carbonate formulation. Am J Psychiatry 1978 Aug; 135(8): 917–22PubMedGoogle Scholar
  7. 7.
    Arancibia A, Corvalan F, Mella F, et al. Absorption and disposition kinetics of lithium carbonate following administration of conventional and controlled release formulations. Int J Clin Pharmacol Ther Toxicol 1986 May; 24(5): 240–5PubMedGoogle Scholar
  8. 8.
    Castrogiovanni P. A novel slow-release formulation of lithium carbonate (carbolithium once-a-day) vs. standard carbolithium: a comparative pharmacokinetic study. Clin Ther 2002 Mar–Apr; 153(2): 107–15Google Scholar
  9. 9.
    Frye MA, Kimbrell TA, Dunn RT, et al. Gabapentin does not alter single-dose lithium pharmacokinetics. J Clin Psychopharmacol 1998 Dec; 18(6): 461–4PubMedCrossRefGoogle Scholar
  10. 10.
    Lee CF, Yang YY, Hu OY. Single dose pharmacokinetic study of lithium in Taiwanese/Chinese bipolar patients. Aust N Z J Psychiatry 1998 Feb; 32(1): 133–6PubMedCrossRefGoogle Scholar
  11. 11.
    Luisier PA, Schulz P, Dick P. The pharmacokinetics of lithium in normal humans: expected and unexpected observations in view of basic kinetic principles. Pharmacopsychiatry 1987 Sep; 20(5): 232–4PubMedCrossRefGoogle Scholar
  12. 12.
    Thornhill DP. Pharmacokinetics of ordinary and sustained-release lithium carbonate in manic patients after acute dosage. Eur J Clin Pharmacol 1978 Dec 1; 14(4): 267–71PubMedCrossRefGoogle Scholar
  13. 13.
    Evans RL, Nelson MV, Melethil S, et al. Evaluation of the interaction of lithium and alprazolam. J Clin Psychopharmacol 1990 Oct; 10(5): 355–9PubMedCrossRefGoogle Scholar
  14. 14.
    Hunter R. Steady-state pharmacokinetics of lithium carbonate in healthy subjects. Br J Clin Pharmacol 1988 Mar; 25(3): 375–80PubMedCrossRefGoogle Scholar
  15. 15.
    Kristoff CA, Hayes PE, Barr WH, et al. Effect of ibuprofen on lithium plasma and red blood cell concentrations. Clin Pharm 1986 Jan; 5(1): 51–5PubMedGoogle Scholar
  16. 16.
    Apseloff G, Wilner KD, von Deutsch DA, et al. Tenidap sodium decreases renal clearance and increases steady-state concentrations of lithium in healthy volunteers. Br J Clin Pharmacol 1995; 39 Suppl. 1: 25–8SCrossRefGoogle Scholar
  17. 17.
    Granneman GR, Schneck DW, Cavanaugh JH, et al. Pharmacokinetic interactions and side effects resulting from concomitant administration of lithium and dival-proex sodium. J Clin Psychiatry 1996 May; 57(5): 204–6PubMedGoogle Scholar
  18. 18.
    Cold JA, ZumBrunnen TL, Simpson MA, et al. Increased lithium serum and red blood cell concentrations during ketorolac coadministration. J Clin Psychopharmacol 1998 Feb; 18(1): 33–7PubMedCrossRefGoogle Scholar
  19. 19.
    Levin GM, Grum C, Eisele G. Effect of over-the-counter dosages of naproxen sodium and acetaminophen on plasma lithium concentrations in normal volunteers. J Clin Psychopharmacol 1998 Jun; 18(3): 237–40PubMedCrossRefGoogle Scholar
  20. 20.
    Laroudie C, Salazar DE, Cosson JP, et al. Pharmacokinetic evaluation of co-administration of nefazodone and lithium in healthy subjects. Eur J Clin Pharmacol 1999 Feb; 54(12): 923–8PubMedCrossRefGoogle Scholar
  21. 21.
    Türck D, Heinzel G, Luik G. Steady-state pharmacokinetics of lithium in healthy volunteers receiving concomitant meloxicam. Br J Clin Pharmacol 2000 Sep; 50(3): 197–204PubMedCrossRefGoogle Scholar
  22. 22.
    Chen C, Veronese L, Yin Y. The effects of lamotrigine on the pharmacokinetics of lithium. Br J Clin Pharmacol 2000 Sep; 50(3): 193–5PubMedCrossRefGoogle Scholar
  23. 23.
    Sitsen JM, Voortman G, Timmer CJ. Pharmacokinetics of mirtazapine and lithium in healthy male subjects. J Psychopharmacol 2000 Jun; 14(2): 172–6PubMedCrossRefGoogle Scholar
  24. 24.
    Potkin SG, Thyrum PT, Bera R, et al. Open-label study of the effect of combination quetiapine/lithium therapy on lithium pharmacokinetics and tolerability. Clin Ther 2002 Nov; 24(11): 1809–23PubMedCrossRefGoogle Scholar
  25. 25.
    Canal M, Legangneux E, van Lier JJ, et al. Lack of effect of amisulpride on the pharmacokinetics and safety of lithium. Int J Neuropsychopharmacol 2003 Jun; 6(2): 103–9PubMedCrossRefGoogle Scholar
  26. 26.
    Ward ME, Musa MN, Bailey L. Clinical pharmacokinetics of lithium. J Clin Pharmacol 1994 Apr; 34(4): 280–5PubMedGoogle Scholar
  27. 27.
    Lehmann K. Pharmakokinetik von lithiumsalzen. In: Müller-Oerlinghausen B, Greil W, Berghöfer A, editors. Die Lithiumtherapie-Nutzen-Risiken — Alternativen. 2nd ed. Birlin: Springer, 1997: 148–60Google Scholar
  28. 28.
    Alda M. Pharmacokinetics of lithium. In: Bauer M, Grof P, Müller-Oerlinghausen B, editors. Lithium in neuro-psychiatry: the comprehensive guide. Oxon (UK): Informa, 2006: 321–8Google Scholar
  29. 29.
    Gai MN, Thielemann AM, Arancibia A. Effect of three different diets on the bioavailability of a sustained release lithium carbonate matrix tablet. Int J Clin Pharmacol Ther 2000; 38: 320–6PubMedGoogle Scholar
  30. 30.
    Gai MN, Ferj S, Garcia E, et al. Evaluation of the in vitro and in vivo performance of two sustained-release lithium carbonate matrix tablets: effect of different diets on the bioavailability. Drug Dev Ind Pharm 1999; 25: 131–40PubMedCrossRefGoogle Scholar
  31. 31.
    Komoroski RA. Biomedical applications of 7Li NMR. NMR Biomed 2005 Apr; 18(2): 67–73PubMedCrossRefGoogle Scholar
  32. 32.
    Soares JC, Boada F, Keshavan MS. Brain lithium measurements with (7)Li magnetic resonance spectroscopy (MRS): a literature review. Eur Neuropsychopharmacol 2000 May; 10(3): 151–8PubMedCrossRefGoogle Scholar
  33. 33.
    Moore CM, Demopulos CM, Henry ME, et al. Brain-to-serum lithium ratio and age: an in vivo magnetic resonance spectroscopy study. Am J Psychiatry 2002 Jul; 159(7): 1240–2PubMedCrossRefGoogle Scholar
  34. 34.
    Spirtes MA. Lithium levels in monkey and human brain after chronic, therapeutic, oral dosage. Pharmacol Biochem Behav 1976 Aug; 5(2): 143–7PubMedCrossRefGoogle Scholar
  35. 35.
    Birch NJ, Hullin RP. The distribution and binding of lithium following its long-term administration. Life Sci II 1972 Nov 22; 11(22): 1095–9PubMedCrossRefGoogle Scholar
  36. 36.
    Ebadi MS, Simmons VJ, Hendrickson MJ, et al. Pharmacokinetics of lithium and its regional distribution in rat brain. Eur J Pharmacol 1974 Aug; 27(3): 324–9PubMedCrossRefGoogle Scholar
  37. 37.
    Camus M, Hennere G, Baron G, et al. Comparison of lithium concentrations in red blood cells and plasma in samples collected for TDM, acute toxicity, or acute-on-chronic toxicity. Eur J Clin Pharmacol 2003; 59: 583–7PubMedCrossRefGoogle Scholar
  38. 38.
    Clarke WB, Clarke RM, Olson EK, et al. Binding of lithium and boron to human plasma proteins. Biol Trace Elem Res 1998; 65: 237–49PubMedCrossRefGoogle Scholar
  39. 39.
    Vestergaard P, Rejnmark L, Mosekilde L. Reduced relative risk of fractures among users of lithium. Calcif Tissue Int 2005 Jul; 77(1): 1–8PubMedCrossRefGoogle Scholar
  40. 40.
    Wilting I, de Vries F, Thio BM, et al. Lithium use and the risk of fractures. Bone 2007 May; 40(5): 1252–8PubMedCrossRefGoogle Scholar
  41. 41.
    Terhaag B, Scherber A, Schaps P, et al. The distribution of lithium into cerebrospinal fluid, brain tissue and bile in man. Int J Clin Pharmacol Biopharm 1978 Jul; 16(7): 333–5PubMedGoogle Scholar
  42. 42.
    Sproule BA, Hardy BG, Shulman KI. Differential pharmacokinetics of lithium in elderly patients. Drugs Aging 2000 Mar; 16(3): 165–77PubMedCrossRefGoogle Scholar
  43. 43.
    Vitiello B, Behar D, Malone R, et al. Pharmacokinetics of lithium carbonate in children. J Clin Psychopharmacol 1988 Oct; 8(5): 355–9PubMedCrossRefGoogle Scholar
  44. 44.
    Freeman MP, Gelenberg AJ. Bipolar disorder in women: reproductive events and treatment considerations. Acta Psychiatr Scand Suppl 2005 Aug; 112(2): 88–96CrossRefGoogle Scholar
  45. 45.
    Johnston AM, Eagles JM. Lithium-associated clinical hypothyroidism. Prevalence and risk factors. Br J Psychiatry 1999 Oct; 175: 336–9Google Scholar
  46. 46.
    Keck PE, McElroy SL. Bipolar disorder, obesity, and pharmacotherapy-associated weight gain. J Clin Psychiatry 2003 Dec; 64(12): 1426–35PubMedCrossRefGoogle Scholar
  47. 47.
    Kusalic M, Engelsmann F. Effect of lithium maintenance therapy on thyroid and parathyroid function. J Psychiatry Neurosci 1999 May; 24(3): 227–33PubMedGoogle Scholar
  48. 48.
    Using lithium safely. Drug Ther Bull 1999 Mar; 37(3): 22–4CrossRefGoogle Scholar
  49. 49.
    Reiss RA, Haas CE, Karki SD, et al. Lithium pharmacokinetics in the obese. Clin Pharmacol Ther 1994 Apr; 55(4): 392–8PubMedCrossRefGoogle Scholar
  50. 50.
    Schou M. Lithium treatment during pregnancy, delivery, and lactation: an update. J Clin Psychiatry 1990 Oct; 51(10): 410–3PubMedGoogle Scholar
  51. 51.
    Viguera AC, Cohen LS, Baldessarini RJ, et al. Managing bipolar disorder during pregnancy: weighing the risks and benefits. Can J Psychiatry 2002 Jun; 47(5): 426–36PubMedGoogle Scholar
  52. 52.
    Grandjean EM, Aubry J-M. Lithium: updated human knowledge using an evidence-based approach. Part III: clinical safety. CNS Drugs. In pressGoogle Scholar
  53. 53.
    Yoshida K, Smith B, Kumar R. Psychotropic drugs in mothers’ milk: a comprehensive review of assay methods, pharmacokinetics and of safety of breast-feeding. J Psychopharmacol 1999; 13(1): 64–80PubMedCrossRefGoogle Scholar
  54. 54.
    Moretti ME, Koren G, Verjee Z, et al. Monitoring lithium in breast milk: an individualized approach for breastfeeding mothers. Ther Drug Monit 2003 Jun; 25(3): 364–6PubMedCrossRefGoogle Scholar
  55. 55.
    Viguera AC, Newport DJ, Ritchie J, et al. Lithium in breast milk and nursing infants: clinical implications. Am J Psychiatry 2007 Feb; 164(2): 342–5PubMedCrossRefGoogle Scholar
  56. 56.
    Dunner DL. Drug interactions of lithium and other antimanic/mood-stabilizing medications. J Clin Psychiatry 2003; 64 Suppl. 5: 38–43Google Scholar
  57. 57.
    Finley PR, Warner MD, Peabody CA. Clinical relevance of drug interactions with lithium. Clin Pharmacokinet 1995 Sep; 29(3): 172–91PubMedCrossRefGoogle Scholar
  58. 58.
    Harvey NS, Merriman S. Review of clinically important drug interactions with lithium. Drug Saf 1994 Jun; 10(6): 455–63PubMedCrossRefGoogle Scholar
  59. 59.
    Juurlink DN, Mamdani MM, Kopp A, et al. Drug-induced lithium toxicity in the elderly: a population-based study. J Am Geriatr Soc 2004; 52: 794–8PubMedCrossRefGoogle Scholar
  60. 60.
    Battle DC, Vonriotte A, Gaviria M, et al. Amiloride in the treatment of lithium-induced diabetes insipidus. N Engl J Med 1985; 312(24): 1575–7CrossRefGoogle Scholar
  61. 61.
    Kosten TR, Forrest JN. Treatment of severe lithium-induced polyuria with amiloride. Am J Psychiatry 1986 Dec; 143(12): 1563–8PubMedGoogle Scholar
  62. 62.
    Bedford JJ, Weggery S, Ellis G, et al. Lithium-induced nephrogenic diabetes insipidus: renal effects of amiloride. Clin J Am Soc Nephrol 2008 Sep; 3(5): 1324–31PubMedCrossRefGoogle Scholar
  63. 63.
    Teitelbaum M. A significant increase in lithium levels after concomitant ACE inhibitor administration. Psychosomatics 1993 Sep–Oct; 34(5): 450–3PubMedCrossRefGoogle Scholar
  64. 64.
    Pinkofsky HB, Sabu R, Reeves RR. A nifedipine-induced inhibition of lithium clearance. Psychosomatics 1997 Jul–Aug; 38(4): 400–1PubMedCrossRefGoogle Scholar
  65. 65.
    Blanche P, Raynaud E, Kerob D, et al. Lithium intoxication in an elderly patient after combined treatment with losartan. Eur J Clin Pharmacol 1997; 52: 501PubMedCrossRefGoogle Scholar
  66. 66.
    Leung M, Remick RA. Potential drug interaction between lithium and valsartan. J Clin Psychopharmacol 2000; 20: 392–3PubMedCrossRefGoogle Scholar
  67. 67.
    Zwanzger P, Marcuse A, Boerner RJ, et al. Lithium intoxication after administration of AT1 blockers. J Clin Psychiatry 2001; 62: 208–9PubMedCrossRefGoogle Scholar
  68. 68.
    Su YP, Chang CJ, Hwang TJ. Lithium intoxication after valsartan treatment. Psychiatry Clin Neurosci 2007 Apr; 61(2): 204PubMedCrossRefGoogle Scholar
  69. 69.
    Cook BL, Smith RE, Perry PJ, et al. Theophylline-lithium interaction. J Clin Psychiatry 1985 Jul; 46(7): 278–9PubMedGoogle Scholar
  70. 70.
    Drug interactions with selective serotonin reuptake inhibitors, especially with other psychotropics. Prescrire Int 2001 Feb; 10(51): 25–31Google Scholar
  71. 71.
    Stip E, Dufresne J, Lussier I, et al. A double-blind, placebo-controlled study of the effects of lithium on cognition in healthy subjects: mild and selective effects on learning. J Affect Disord 2000 Nov; 60(3): 147–57PubMedCrossRefGoogle Scholar
  72. 72.
    Honig A, Arts BM, Ponds RW, et al. Lithium induced cognitive side-effects in bipolar disorder: a qualitative analysis and implications for daily practice. Int Clin Psychopharmacol 1999 May; 14(3): 167–71PubMedCrossRefGoogle Scholar
  73. 73.
    Pachet AK, Wisniewski AM. The effects of lithium on cognition: an updated review. Psychopharmacology (Berl) 2003 Nov; 170(3): 225–34CrossRefGoogle Scholar
  74. 74.
    Bell EC, Willson MC, Wilman AH, et al. Differential effects of chronic lithium and valproate on brain activation in healthy volunteers. Hum Psychopharmacol 2005 Aug; 20(6): 415–24PubMedCrossRefGoogle Scholar
  75. 75.
    Livingstone C, Rampes H. Lithium: a review of its metabolic adverse effects. J Psychopharmacol 2006 May; 20(3): 347–55PubMedCrossRefGoogle Scholar
  76. 76.
    Baptista T, Lacruz A, de Mendoza S, et al. Endocrine effects of lithium carbonate in healthy premenopausal women: relationship with body weight regulation. Prog Neuropsychopharmacol Biol Psychiatry 2000 Jan; 24(1): 1–16PubMedCrossRefGoogle Scholar
  77. 77.
    Baptista T, Alastre T, Contreras Q, et al. Effects of lithium carbonate on reproductive hormones in healthy men: relationship with body weight regulation. A pilot study. Prog Neuropsychopharmacol Biol Psychiatry 1997 Aug; 21(6): 937–50CrossRefGoogle Scholar
  78. 78.
    Ruzickova M, Turecki G, Alda M. Pharmacogenetics and mood stabilization in bipolar disorder. Am J Med Genet C Semin Med Genet 2003 Nov 15; 123(1): 18–25CrossRefGoogle Scholar
  79. 79.
    Grof P, Duffy A, Cavazzoni P, et al. Is response to prophylactic lithium a familial trait? J Clin Psychiatry 2002 Oct; 63(10): 942–7PubMedCrossRefGoogle Scholar
  80. 80.
    Serretti A, Artioli P. Predicting response to lithium in mood disorders: role of genetic polymorphisms. Am J Pharmacogenomics 2003; 3(1): 17–30PubMedCrossRefGoogle Scholar
  81. 81.
    Gitlin MJ. Lithium: serum levels, renal effects, and dosing strategies. Community Ment Health J 1992 Aug; 28(4): 355–62PubMedCrossRefGoogle Scholar
  82. 82.
    Berghöfer A, Grof P, Müller-Oerlinghausen B. Recommendations for the safe use of lithium. In: Bauer M, Grof P, Müller-Oerlinghausen B, editors. Lithium in neuropsychiatry: the comprehensive guide. Oxron (UK): Informa, 2006: 443–64Google Scholar
  83. 83.
    Mitchell PB. Therapeutic drug monitoring of psychotropic medications. Br J Clin Pharmacol 2000 Apr; 49(4): 303–12PubMedCrossRefGoogle Scholar
  84. 84.
    Schou M. Serum lithium monitoring of prophylactic treatment: critical review and updated recommendations. Clin Pharmacokinet 1988 Nov; 15(5): 283–6PubMedCrossRefGoogle Scholar
  85. 85.
    Goodwin GM. Evidence-based guidelines for treating bipolar disorder: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2003 Jun; 17(2): 149–73; discussion 7PubMedCrossRefGoogle Scholar
  86. 86.
    Webb AL, Solomon DA, Ryan CE. Lithium levels and toxicity among hospitalized patients. Psychiatr Serv 2001 Feb; 52(2): 229–31PubMedCrossRefGoogle Scholar
  87. 87.
    Hopkins HS, Gelenberg AJ. Serum lithium levels and the outcome of maintenance therapy of bipolar disorder. Bipolar Disord 2000 Sep; 2 (3 Pt 1): 174–9PubMedCrossRefGoogle Scholar
  88. 88.
    Chen ST, Altshuler LL, Melnyk KA, et al. Efficacy of lithium vs. valproate in the treatment of mania in the elderly: a retrospective study. J Clin Psychiatry 1999 Mar; 60(3): 181–6PubMedCrossRefGoogle Scholar
  89. 89.
    Severus WE, Grunze H, Kleindienst N, et al. Is the prophylactic antidepressant efficacy of lithium in bipolar I disorder dependent on study design and lithium level? J Clin Psychopharmacol 2005 Oct; 25(5): 457–62PubMedCrossRefGoogle Scholar
  90. 90.
    Gelenberg AJ, Kane JM, Keller MB, et al. Comparison of standard and low serum levels of lithium for maintenance treatment of bipolar disorder. N Engl J Med 1989 Nov 30; 321(22): 1489–93PubMedCrossRefGoogle Scholar
  91. 91.
    Severus WE, Kleindienst N, Seemuller F, et al. What is the optimal serum lithium level in the long-term treatment of bipolar disorder: a review? Bipolar Disord 2008 Mar; 10(2): 231–7PubMedCrossRefGoogle Scholar
  92. 92.
    Eastham JH, Jeste DV, Young RC. Assessment and treatment of bipolar disorder in the elderly. Drugs Aging 1998 Mar; 12(3): 205–24PubMedCrossRefGoogle Scholar
  93. 93.
    Cooper TB, Bergner PE, Simpson GM. The 24-hour serum lithium level as a prognosticator of dosage requirements. Am J Psychiatry 1973 May; 130(5): 601–3PubMedGoogle Scholar
  94. 94.
    Srisurapanont M, Pratoomsri W, Maneeton N. Evaluation of three simple methods for predicting therapeutic lithium doses. Psychiatry Res 2000 Apr 24; 94(1): 83–8PubMedCrossRefGoogle Scholar
  95. 95.
    Terao T, Okuno K, Okuno T, et al. A simpler and more accurate equation to predict daily lithium dose. J Clin Psychopharmacol 1999 Aug; 19(4): 336–40PubMedCrossRefGoogle Scholar
  96. 96.
    Zetin M, Garber D, De Antonio M, et al. Prediction of lithium dose: a mathematical alternative to the test-dose method. J Clin Psychiatry 1986 Apr; 47(4): 175–8PubMedGoogle Scholar
  97. 97.
    Keck Jr PE, McElroy SL, Bennett JA. Pharmacologic loading in the treatment of acute mania. Bipolar Disord 2000 Mar; 2(1): 42–6PubMedCrossRefGoogle Scholar
  98. 98.
    Plenge P, Mellerup ET. Lithium treatment: are the present schedules optimal? Acta Psychiatr Scand Suppl 1988; 345: 69–73Google Scholar
  99. 99.
    Ljubicic D, Letica-Crepulja M, Vitezic D, et al. Lithium treatments: single and multiple daily dosing. Can J Psychiatry 2008 May; 53(5): 323–31PubMedGoogle Scholar
  100. 100.
    Abraham G, Waldron JJ, Lawson JS. Are the renal effects of lithium modified by frequency of administration? Acta Psychiatr Scand Suppl 1995 Aug; 92(2): 115–8PubMedCrossRefGoogle Scholar
  101. 101.
    Kusalic M, Engelsmann F. Renal reactions to changes of lithium dosage. Neuropsychobiology 1996; 34(3): 113–6PubMedCrossRefGoogle Scholar
  102. 102.
    Plenge P, Amin M, Agarwal AK, et al. Prophylactic efficacy of lithium administered every second day: a WHO multicentre study. Bipolar Disord 1999 Dec; 1(2): 109–16PubMedCrossRefGoogle Scholar
  103. 103.
    Jensen HV, Plenge P, Mellerup ET, et al. Lithium prophylaxis of manic-depressive disorder: daily lithium dosing schedule versus every second day. Acta Psychiatr Scand Suppl 1995 Jul; 92(1): 69–74PubMedCrossRefGoogle Scholar
  104. 104.
    Andrade C. Is alternate-day lithium really ineffective? Acta Psychiatr Scand Suppl 1996 Oct; 94(4): 281–2PubMedCrossRefGoogle Scholar
  105. 105.
    Goodwin GM. Prophylaxis of bipolar disorder: how and who should we treat in the long term? Eur Neuropsychopharmacol 1999 Aug; 9Suppl. 4: S125–9PubMedCrossRefGoogle Scholar
  106. 106.
    Dunner DL. Lithium carbonate: maintenance studies and consequences of withdrawal. J Clin Psychiatry 1998; 59Suppl. 6: 48–55; discussion 6PubMedGoogle Scholar
  107. 107.
    Bowden CL. Key treatment studies of lithium in manic-depressive illness: efficacy and side effects. J Clin Psychiatry 1998; 59Suppl. 6: 13–9; discussion 20PubMedGoogle Scholar
  108. 108.
    Miller AL, Bowden CL, Plewes J. Lithium and impairment of renal concentrating ability. J Affect Disord 1985 Sep; 9(2): 115–9PubMedCrossRefGoogle Scholar
  109. 109.
    Kleindienst N, Greil W, Ruger B, et al. The prophylactic efficacy of lithium: transient or persistent? Eur Arch Psychiatry Clin Neurosci 1999; 249(3): 144–9PubMedCrossRefGoogle Scholar
  110. 110.
    Coryell W, Winokur G, Solomon D, et al. Lithium and recurrence in a long-term follow-up of bipolar affective disorder. Psychol Med 1997 Mar; 27(2): 281–9PubMedCrossRefGoogle Scholar
  111. 111.
    Coryell W, Solomon D, Leon AC, et al. Lithium discontinuation and subsequent effectiveness. Am J Psychiatry 1998 Jul; 155(7): 895–8PubMedGoogle Scholar
  112. 112.
    Guedj F, Saba G, Olie JP. Lithium: principes et règles d’utilisation. Rev Prat 1996 Jun 1; 46(11): 1401–7PubMedGoogle Scholar
  113. 113.
    Pinabel F, Hardy P. Lithium: principes et règles d’utilisation. Rev Prat 1999 Nov 15; 49(18): 2053–9PubMedGoogle Scholar
  114. 114.
    Gay C, Olié JP. Prise en charge des troubles bipolaires. Rev Prat 2005; 55: 513–22PubMedGoogle Scholar
  115. 115.
    Dunner DL. Optimizing lithium treatment. J Clin Psychiatry 2000; 61 Suppl. 9: 76–81Google Scholar
  116. 116.
    Thomsen K, Schou M. Avoidance of lithium intoxication: advice based on knowledge about the renal lithium clearance under various circumstances. Pharmacopsychiatry 1999 May; 32(3): 83–6PubMedCrossRefGoogle Scholar
  117. 117.
    Kowatch RA, Fristad M, Birmaher B, et al. Treatment guidelines for children and adolescents with bipolar disorder. The Child Psychiatric Workgroup on Bipolar Disorder. J Am Acad Child Adolesc Psychiatry 2005 Mar; 44(3): 213–35CrossRefGoogle Scholar
  118. 118.
    Findling RL, Frazier JA, Kafantaris V, et al. The Collaborative Lithium Trials (CoLT): specific aims, methods, and implementation. Child Adolesc Psychiatry Ment Health 2008 Aug 12; 2(1): 21PubMedCrossRefGoogle Scholar
  119. 119.
    Wilkinson D, Holmes C, Woolford J, et al. Prophylactic therapy with lithium in elderly patients with unipolar major depression. Int J Geriatr Psychiatry 2002; 17: 619–22PubMedCrossRefGoogle Scholar
  120. 120.
    Grunze H, Kasper S, Goodwin G, et al. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders, part III: maintenance treatment. World J Biol Psychiatry 2004 Jul; 5(3): 120–35PubMedCrossRefGoogle Scholar
  121. 121.
    National Institute for Health and Clinical Excellence (NICE). Bipolar disorder: the management of bipolar disorder in adults, children and adolescents, in primary and secondary care. London: National Institute for Health and Clinical Excellence, 2006Google Scholar
  122. 122.
    Yatham LN, Kennedy SH, O’Donovan C, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: update 2007. Bipolar Disord 2006 Dec; 8(6): 721–39PubMedCrossRefGoogle Scholar

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© Adis Data Information BV 2009

Authors and Affiliations

  1. 1.Phidalsa Institute for Clinical InvestigationGenevaSwitzerland
  2. 2.Bipolar Programme, Department of PsychiatryGenevaSwitzerland
  3. 3.Bipolar Programme, Department of PsychiatryGenevaSwitzerland

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