Lithium Toxicity Due to Drug-Drug Interactions: A Case Report
Abstract
Lithium has a relatively narrow therapeutic range. As a result of drug-drug interactions, the blood level of lithium is highly affected. This case describes lithium toxicity and its management resulting from drug interactions with lithium. A 37-year-old woman with bipolar illness, essential hypertension, hypothyroidism, unipolar depression, and schizoaffective disorder was admitted to the emergency department with hand numbness, tremor, agitation, and tachycardia. When the patient's lithium blood level was 1.7 mmol/L, lithium treatment was discontinued, and he was hospitalized in the intensive care unit with a prediagnosis of lithium toxicity. The clinical pharmacist used the Lexicomp drug interaction database to examine interactions. Candesartan, hydrochlorothiazide and dexketoprofen were determined to be the cause of toxicity. The clinical pharmacist advised amlodipine as an antihypertensive because it did not interact, reducing lithium levels to 1.4-1.2 and 0.8 mmol/L. Lithium toxicity due to drug-drug interactions was resolved by clinical pharmacist intervention.
Keywords
References
- Malhi GS, Gessler D, Outhred T. The use of lithium for the treatment of bipolar disorder: Recommendations from clinical practice guidelines. J Affect Disord. 2017;217:266-80.
- Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20(2):97-170.
- Skovbjerg BK, Helgestad OK, Oxlund CS, Christensen B, Henriksen JN. [Not Available]. Ugeskr Laeger. 2023;185(16).
- Finley PR. Drug interactions with lithium: an update. Clinical Pharmacokinetics. 2016;55(8):925-41.
- Ferensztajn-Rochowiak E, Rybakowski JK. Long-term lithium therapy: side effects and interactions. Pharmaceuticals. 2023;16(1):74.
- Scherf-Clavel M, Treiber S, Deckert J, Unterecker S, Hommers L. Drug-Drug Interactions Between Lithium and Cardiovascular as Well as Anti-Inflammatory Drugs. Pharmacopsychiatry. 2020;53(5):229-34.
- Spinewine A, Schoevaerdts D, Mwenge GB, Swine C, Dive A. Drug-induced lithium intoxication: a case report. J Am Geriatr Soc. 2005;53(2):360-1.
- De Winter S, Meersseman W, Verelst S, Willems L, Spriet I. Drug-related admissions due to interaction with an old drug, lithium. Acta Clinica Belgica. 2013;68(5):356-8.
- Handler J. Lithium and antihypertensive medication: a potentially dangerous interaction. J Clin Hypertens (Greenwich). 2009;11(12):738-42.