A Case of GLP-1 Receptor Agonist-Induced Lithium Neurotoxicity

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a hoped-for intervention to reduce nonadherence to psychotropic medications due to metabolic syndrome and, potentially, to reduce metabolic syndrome-related premature cardiovascular death among those undergoing treatment for bipolar disorder. GLP-1 RAs are currently approved by the US Food and Drug Administration for weight loss in patients with type 2 diabetes, for patients with cardiovascular disease, obesity, and type 2 diabetes, and for reduction of risk of sustained low estimated glomerular filtration rate in patients with chronic kidney disease or end-stage renal disease. Research into the use of GLP-1 RAs in patients with metabolic dysfunction-associated steatohepatitis and other conditions is ongoing. The expanding research into indications for the use of GLP-1 RAs will likely include individuals with bipolar disorder and, among them, patients treated with lithium carbonate. Here, we report a case of GLP-1 RA-induced lithium neurotoxicity, which suggests the need for further investigation and enhanced surveillance for lithium toxicity in patients who are coadministered lithium and GLP-1 RAs.