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Published on: January 28, 2012
Lithium toxicity profile: a systematic review and meta-analysis.
Rebecca F McKnight1, Marc Adida, Katie Budge
1Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
Lancet (London, England)
|January 24, 2012
Summary
Lithium treatment for mood disorders can affect urinary concentration, thyroid function, and weight. While renal function decline is minimal and end-stage renal failure risk is low, regular calcium monitoring is advised.
Area of Science:
- Pharmacology
- Nephrology
- Endocrinology
- Psychiatry
Background:
- Lithium is a key treatment for mood disorders.
- Concerns exist regarding lithium's safety profile.
- A systematic review is needed to synthesize adverse effect evidence.
Purpose of the Study:
- To provide a clinically informative, systematic toxicity profile of lithium.
- To synthesize evidence on lithium's adverse effects.
- To assess lithium's impact on renal, thyroid, and parathyroid function, weight, and teratogenicity.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials and observational studies.
- Searched electronic databases, journals, reference lists, textbooks, and conference abstracts.
- Included studies on mood disorder patients treated with lithium, assessing renal, thyroid, parathyroid function, weight change, skin/hair disorders, and teratogenicity.
Main Results:
- Reduced urinary concentrating ability (p<0.0001).
- Increased risk of hypothyroidism (OR 5.78, p=0.001) and hyperparathyroidism (p<0.0001).
- Associated with weight gain (OR 1.89, p=0.002); low absolute risk of renal failure (0.5%).
Conclusions:
- Lithium is linked to reduced urinary concentrating ability, hypothyroidism, hyperparathyroidism, and weight gain.
- Clinically significant renal function decline is unlikely for most patients; renal failure risk is low.
- Calcium levels should be monitored; risks in pregnancy require careful consideration.
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