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Atorvastatin lowers serum calcium levels in lithium-users: results from a randomized controlled trial
Jocelyn Fotso Soh1,2, Katie Bodenstein1,3, Oriana Hoi Yun Yu4,5
1GeriPARTy Research Group, Jewish General Hospital, Montreal, Canada.
Insights
Atorvastatin may help lower calcium levels in patients with bipolar disorder using lithium. Further research is needed to confirm if atorvastatin can treat lithium-induced hypercalcemia.
Area of Science:
- Endocrinology
- Psychiatry
- Pharmacology
Background:
- Lithium is a primary treatment for bipolar disorder (BD).
- Lithium use can cause endocrine and metabolic side effects, including hypercalcemia.
- Limited treatment options exist for lithium-induced hypercalcemia.
Purpose of the Study:
- To assess the effect of atorvastatin on serum calcium levels in patients with BD using lithium.
- To evaluate changes in thyroid-stimulating hormone (TSH) as a secondary outcome.
Main Methods:
- Secondary analysis of a randomized controlled trial (RCT).
- Participants (n=60) with BD or major depressive disorder (MDD) on lithium were randomized to atorvastatin (n=27) or placebo (n=33).
- Serum calcium and TSH levels were measured at baseline, week 4, and week 12.
Main Results:
- At 12 weeks, atorvastatin treatment was associated with significantly lower corrected serum calcium levels compared to placebo (p=0.03).
- No significant changes in TSH levels were observed between groups.
- The mean corrected serum calcium level in the atorvastatin group was 2.30 mmol/L (SD=0.07) versus 2.33 mmol/L (SD=0.07) in the placebo group.
Conclusions:
- Atorvastatin may reduce serum calcium levels in lithium users with normal baseline calcium.
- These preliminary findings suggest a potential role for atorvastatin in managing lithium-induced hypercalcemia.
- Further RCTs are warranted to investigate atorvastatin's efficacy in treating hypercalcemia in BD patients.
Background:
Although lithium is considered the gold-standard treatment for bipolar disorder (BD), it is associated with a variety of major endocrine and metabolic side effects, including parathyroid hormone (PTH) dependent hypercalcemia. Aside from surgery and medication discontinuation, there are limited treatments for hypercalcemia. This paper will assess data from a randomized controlled trial (RCT).
Methods:
This is a secondary analysis of an RCT that explored the effects of atorvastatin (n = 27) versus placebo (n = 33) on lithium-induced nephrogenic diabetes insipidus (NDI) in patients with BD and major depressive disorder (MDD) using lithium (n = 60), over a 12-week period. This secondary analysis will explore serum calcium levels and thyroid stimulating hormone (TSH) measured at baseline, week 4, and week 12.
Results:
At 12-weeks follow-up while adjusting results for baseline, linear regression analyses found that corrected serum calcium levels were significantly lower in the treatment group (mean (M) = 2.30 mmol/L, standard deviation (SD) = 0.07) compared to the placebo group (M = 2.33 mmol/L, SD = 0.07) (β = - 0.03 (95% C.I.; - 0.0662, - 0.0035), p = 0.03) for lithium users. There were no significant changes in TSH.
Conclusion:
In lithium users with relatively normal calcium levels, receiving atorvastatin was associated with a decrease in serum calcium levels. Although exciting, this is a preliminary finding that needs further investigation with hypercalcemic patients. Future RCTs could examine whether atorvastatin can treat PTH dependent hypercalcemia due to lithium and other causes.
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