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Lactulose-associated lithium toxicity: a case series.

Andrew Bregman¹, Kathy Fritz, Glen L Xiong

¹From the *Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California at Davis; and †Sacramento County Mental Health Treatment Center, Sacramento, CA.

Journal of Clinical Psychopharmacology

|August 19, 2014

Summary

Lactulose use in patients on lithium may increase the risk of lithium toxicity. This interaction can lead to dehydration and impaired kidney function, necessitating careful monitoring of electrolyte balance.

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Area of Science:

Pharmacology
Nephrology
Psychiatry

Background:

Lactulose is a widely prescribed medication for constipation and hepatic encephalopathy.
Known adverse effects of lactulose include dehydration and electrolyte imbalances.
Lithium is a mood stabilizer commonly used for bipolar disorder.

Observation:

A case series involving three patients who developed lithium toxicity while undergoing lactulose treatment was observed.
These patients were prescribed lithium for acute mania and lactulose for constipation or hyperammonemia.
One patient required emergency department intervention due to the severity of lithium toxicity.

Findings:

The study identified a potential interaction between lactulose and lithium.
Lactulose-induced volume depletion is hypothesized to impair renal lithium excretion.
This can precipitate lithium toxicity even at therapeutic lithium doses.

Implications:

Clinicians should be aware of the potential for lactulose to increase lithium levels.
Monitoring of serum lithium concentrations and renal function is crucial in patients receiving both medications.
This interaction highlights the importance of comprehensive medication review to prevent adverse drug events.