Profile of lithium carbonate use in patients with bipolar disorder in Colombia
Abstract
Introduction: Lithium is the drug of choice for the treatment of bipolar affective disorder.
Objective: To define lithium therapeutic profile and adverse reactions to its use in patients with bipolar affective disorder in Colombia.
Materials and methods: We conducted an observational retrospective cohort study between January 1 and December 31, 2013, which included patients with a diagnosis of bipolar disorder treated with lithium carbonate in 25 Colombian cities; we evaluated socio-demographic variables, lithium dose, co-medication, drug interactions and adverse reactions. A multivariate analysis was done using SPSS 22.0.
Results: The 331 patients had an average age of 44.5 ± 13.9 years; 59.2% were women. The mean dose of lithium was 898 ± 294 mg/day; 22% received doses lower than recommended, and patients had received lithium for 38.0 ± 39.5 months (range: 12-159 months). Lithium levels in blood had been measured only in 13.5% of patients; 71.3% of them had received adjuvant therapy for bipolar disorder with other drugs, especially clozapine (16.6%) and valproic acid (16.6%). The main comorbidities were hypothyroidism (18.1%) and hypertension (12.7%); 390 potentially toxic drug interactions were found, and adverse reactions were reported in 1.2% of patients. A statistically significant association was found between a lower risk of combination therapy and receiving treatment in the cities of Bogotá (OR=0.4, p=0.025), Cartagena (OR=0.3, p=0.015) and Ibagué (OR=0.3, p=0.025).
Conclusion: Lithium was generally used at recommended doses and intervals, but a significant percentage of patients received lower doses than those recommended, and it was not possible to compare with lithium levels in blood. Adverse reactions and blood lithium levels reporting should be improved in patients with bipolar disorder in Colombia.
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References
Ferrari AJ, Saha S, McGrath JJ, Norman R, Baxter AJ, Vos T, et al. Health states for schizophrenia and bipolar disorder within the Global Burden of Disease 2010 Study. Popul Health Metr. 2012;10:16. http://dx.doi.org/10.1186/1478-7954-10-16
Malhi GS, Tanious M, Das P, Berk M. The science and practice of lithium therapy. Aust N Z J Psychiatry. 2012;46:192-211. http://dx.doi.org/10.1177/0004867412437346
Posada-Villa JA, Aguilar-Gaxiol, SA, Magaña CG, Gómez LC. Prevalencia de trastornos mentales y uso de servicios: resultados preliminares del Estudio Nacional de Salud Mental, Colombia. Rev Colomb Psiquiatr. 2003;33:241-62.
Fagiolini A, Forgione R, Maccari M, Cuomo A, Morana B, Dell’Osso MC, et al. Prevalence, chronicity, burden and borders of bipolar disorder. J Affect Disord. 2013;148:161-9. http://dx.doi.org/10.1016/j.jad.2013.02.001
Geddes JR, Burgess S, Hawton K, Jamison K, Goodwin GM. Long-term lithium therapy for bipolar disorder: Systematic review and meta-analysis of randomized controlled
trials. Am J Psychiatry. 2004;161:217-22. http://dx.doi.org/10.1176/appi.ajp.161.2.217
Shetty SJ, Desai PB, Patil NM, Nayak RB. Relationship between serum lithium, salivary lithium, and urinary lithium in patients on lithium therapy. Biol Trace Elem Res. 2012;147:59-62. http://dx.doi.org/10.1007/s12011-011-9295-3
Lacy CF, Armstrong LL, Goldman MP, Lance LL. Drug Information Handbook. 20th ed. Hudson, Ohio: Lexi-Comp, Inc.; 2011. p. 1143-7.
Habermeyer B, Hess M, Kozomara-Hocke P, Mager R, Kawohl W. Lithium intoxications at normal serum levels. Psychiatr Prax. 2008;35:198-200. http://dx.doi.org/10.1055/
s-2007-986226
Mondragón-Valeria J, Oviedo-Lugo GF. Neurotoxicidad por litio. Rev Colomb Psiquiatr. 2008;37:418-27.
Young W. Review of lithium effects on brain and blood. Cell Transplant. 2009;18:951-75. http://dx.doi.org/10.3727/096368909X471251
Bocchetta A, Ardau R, Carta P, Ligas F, Sardu C, Pani A, et al. Duration of lithium treatment is a risk factor for reduced glomerular function: A cross-sectional study. BMC Med. 2013;11:33. http://dx.doi.org/10.1186/1741-7015-11-33
Swartz HA, Fagiolini A. Cardiovascular disease and bipolar disorder: Risk and clinical implications. J Clin Psychiatry. 2012;73:1563-5. http://dx.doi.org/10.4088/JCP.12ac08227
Grandjean EM, Aubry JM. Lithium: Updated human knowledge using an evidence-based approach: Part III: Clinical safety. CNS Drugs. 2009;23:397-418. http://dx.doi.
org/10.2165/00023210-200923050-00004
Shen HC, Li JY, Lo YK. Lithium intoxication-induced acute parkinsonism complicated with hyperparathyroidism and nephrogenic diabetes insipidus: Report of a case. Acta Neurol Taiwan. 2007;16:231-3.
Rej S, Herrmann N, Shulman K. The effects of lithium on renal function in older adults--a systematic review. J Geriatr Psychiatry Neurol. 2012;25:51-61. http://dx.doi.org/10.1177/0891988712436690
Rätz-Bravo AE, Egger SS, Crespo S, Probst WL, Krähenbühl S. Lithium intoxication as a result of an interaction with rofecoxib. Ann Pharmacother. 2004;38:1189-
http://dx.doi.org/10.1345/aph.1E034
Miodownik C, Alkatnany A, Frolova K, Lerner V. Delirium associated with lithium-quetiapine combination. Clin Neuropharmacol. 2008;31:176-9. http://dx.doi.org/10.1097/WNF.0b013e31814a619d
Blanche P, Raynaud E, Kerob D, Galezowski N. Lithium intoxication in an elderly patient after combined treatment with losartan. Eur J Clin Pharmacol. 1997;52:501.
Ma CC, Shiah IS, Chang SW, Kao YC, Lee WK. Telmisartaninduced lithium intoxication in a patient with schizoaffective disorder. Psychiatry Clin Neurosci. 2012;66:165-6. http://dx.doi.org/10.1111/j.1440-1819.2011.02305.x
Spinewine A, Schoevaerdts D, Mwenge GB, Swine C, Dive A. Drug-induced lithium intoxication: A case report. J Am Geriatr Soc. 2005;53:360-1. http://dx.doi.org/10.1111/j.1532-5415.2005.53126_10.x
Pini S, de Queiroz V, Pagnin D, Pezawas L, Angst J, Cassano GB, et al. Prevalence and burden of bipolar disorders in European countries. Eur Neuropsychopharmacol. 2005;15:425-34. http://dx.doi.org/10.1016/j.euroneuro.2005.04.011
Diflorio A, Jones I. Is sex important? Gender differences in bipolar disorder. Int Rev Psychiatry. 2010;22:437-52. http://dx.doi.org/10.3109/09540261.2010.514601
Hendrick V, Altshuler LL, Gitlin MJ, Delrahim S, Hammen C. Gender and bipolar illness. J Clin Psychiatry.2000;61:393-6.
Kohn R, Levav I, Caldas-de Almeida JM, Vicente B, Andrade L, Caraveo-Anduaga JJ, et al. Los trastornos mentales en América Latina y el Caribe: asunto prioritario para la salud pública. Rev Panam Salud Pública. 2005;18:229-40. http://dx.doi.org/10.1590/S1020-49892005000900002
Kessing LV, Hansen HV, Christensen EM, Dam H, Gluud C, Wetterslev J. Early Intervention Affective Disorders (EIA) Trial Group. Do young adults with bipolar disorder benefit from early intervention? J Affect Disord. 2014;152-154:403-8. http://dx.doi.org/10.1016/j.jad.2013.10.001
Czepielewski L, Daruy Filho L, Brietzke E, Grassi-Oliveira R. Bipolar disorder and metabolic syndrome: A systematic review. Rev Bras Psiquiatr. 2013;35:88-93.
http://dx.doi.org/10.1016/j.rbp.2012.00.000
Latalova K, Prasko J, Grambal A, Havlikova P, Jelenova D, Mainerova B, et al. Bipolar disorder and anxiety disorders. Neuro Endocrinol Lett. 2013;34:738-44.
Chakrabarti S. Thyroid functions and bipolar affective disorder. J Thyroid Res. 2011;2011:306367. http://dx.doi.org/10.4061/2011/306367
Machado-Alba JE, Plaza CD, Solarte-Gómez MJ. Patrones de prescripción de antidepresivos en pacientes afiliados al Sistema General de Seguridad Social en Salud de
Colombia. Rev Panam Salud Pública. 2011;30:461-8. http://dx.doi.org/10.1590/S1020-49892011001100009
Geddes JR, Miklowitz DJ. Treatment of bipolar disorder. Lancet. 2013;381:1672-82. http://dx.doi.org/10.1016/S0140-6736(13)60857-0
Pfennig A, Bschor T, Falkai P, Bauer M. The diagnosis and treatment of bipolar disorder: Recommendations from the current S3 guideline. Dtsch Arztebl Int. 2013;110:92-100. http://dx.doi.org/10.3238/arztebl.2013.0092
Sajatovic M, Chen P. Geriatric bipolar disorder. Psychiatr Clin North Am. 2011;34:319-33. http://dx.doi.org/10.1016/j.psc.2011.02.007
D’Souza R, Rajji TK, Mulsant BH, Pollock BG. Use of lithium in the treatment of bipolar disorder in late-life. Curr Psychiatry Rep. 2011;13:488-92. http://dx.doi.org/10.1007/s11920-011-0228-9
Bocchetta A, Loviselli A. Lithium treatment and thyroid abnormalities. Clin Pract Epidemiol Ment Health. 2006;12:2-23. http://dx.doi.org/10.1186/1745-0179-2-23
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