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Indomethacin increases plasma lithium.

J C Frölich, R Leftwich, M Ragheb

    British Medical Journal
    |April 28, 1979
    PubMed
    Summary
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    Indomethacin significantly increases plasma lithium levels and reduces renal lithium clearance in both psychiatric patients and healthy volunteers. This suggests a prostaglandin-dependent mechanism may influence lithium excretion.

    Area of Science:

    • Pharmacology
    • Nephrology
    • Psychiatry

    Background:

    • Lithium is a crucial mood stabilizer in psychiatric treatment.
    • Understanding factors affecting lithium pharmacokinetics is vital for patient safety.
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) like indomethacin can alter renal function.

    Purpose of the Study:

    • To investigate the impact of indomethacin on plasma lithium concentrations.
    • To assess the effect of indomethacin on renal lithium clearance.
    • To explore the role of prostaglandins in lithium excretion.

    Main Methods:

    • A crossover study design was employed in psychiatric patients and normal volunteers.
    • Subjects received placebo and indomethacin (50 mg thrice daily) over distinct periods.

    Related Experiment Videos

  • Plasma lithium levels and renal lithium clearance were measured.
  • Prostaglandin synthesis was assessed by measuring PGE2 metabolite levels using mass spectrometry.

    • Main Results:

    • Indomethacin administration led to a 59% increase in plasma lithium in patients and 30% in volunteers.
    • Renal lithium clearance decreased by 31% overall.
    • Prostaglandin synthesis was reduced by 55%.

    Conclusions:

    • Indomethacin significantly reduces renal lithium clearance, potentially leading to clinically important increases in lithium levels.
    • The findings suggest a prostaglandin-dependent mechanism in the distal tubule influences renal lithium clearance.
    • Caution is advised when co-administering indomethacin with lithium therapy.