Proper management of lithium therapy

Lithium is the standard drug used to treat bipolar disorder. Most of its adverse effects are dose-dependent, and there is only a small margin between therapeutic and toxic blood concentrations. A review of 567 reports by the UK National Patient Safety Agency (NPSA) showed that the adverse effects of lithium were mainly due to dosing errors, irregular blood lithium assay, poor monitoring of renal or thyroid function, and inadequate patient information. An audit of 436 British medical teams recovered follow-up data on 2976 patients treated with lithium. Patient monitoring, studied during the previous year, was usually inadequate. In practice, regular lithium assay, regular renal and thyroid monitoring, and provision of verbal and written information to patients and their families are essential in preventing adverse effects.