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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Angela5 on October 19, 2000, at 12:11:07
Can anyone tell me where I can find info on this? I know that "normal" is between .5 and 1.9, and "toxic" at 2. However, I wanted to find more detailed info, i.e. how this is normally expected to correlate with doseage, etc.
My first test result, after a week (4 days on 300 mg/day, 3 days on 600 mg/day) is 0.6.
Posted by noa on October 19, 2000, at 13:37:33
In reply to Lithium serum blood test results, posted by Angela5 on October 19, 2000, at 12:11:07
My pdoc told me that he tries to keep lithium levels from going over 1.0, and uses other mood stabilizers to augment the lithium beyond that.
I guess your target level depends on whether you are using the lithium as a primary mood stabilizer, in combo with another mood stabilizer, or as an augmentation agent for antidepressants. When I was on it, .8 seemed to be the right level for me.
Posted by Sunnely on October 19, 2000, at 20:59:49
In reply to Lithium serum blood test results, posted by Angela5 on October 19, 2000, at 12:11:07
Hi Angela,
The following range is generally considered to be the "therapeutic" blood levels of lithium: 0.8 to 1.2. However, this is not etched in stone. Some people, such as the elderly, generally require much lesser blood level. A lithium level of 0.3 - 0.5 usually is "therapeutic" for them.
Staying within the "therapeutic" level of lithium does not always necessarily mean absence of toxicity. There are people who are more sensitive and may show signs and symptoms of lithium toxicity even within the "therapeutic" level. When it comes to lithium treatment, the clinical picture still remains the best parameter of effectiveness and/or toxicity.
People who are in acute manic stage may require higher lithium level (i.e., at least 0.8 - 1.2) to obtain a clinical response. When the symptoms of mania are stabilized, a lower level (e.g., 0.5 - 0.8) is usually good enough to maintain a remission. However, this issue is also not etched in stone. Everyone is different when it comes to (psychotropic) medication response and sensitivity.
Lithium has a narrow "therapeutic index" (the margin between therapeutic and toxic level). Therefore, it is clinically prudent to stay within the generally considered "therapeutic" levels, and at the same correlating this level with the corresponding clinical picture.
Posted by SLS on October 19, 2000, at 21:51:30
In reply to Re: Lithium serum blood test results » Angela5, posted by Sunnely on October 19, 2000, at 20:59:49
Hi Sunnely.
> Lithium has a narrow "therapeutic index" (the margin between therapeutic and toxic level). Therefore, it is clinically prudent to stay within the generally considered "therapeutic" levels, and at the same correlating this level with the corresponding clinical picture.
I once saw a doctor who used fine hand tremors as a clinical indicator of therapeutic dosing of lithium. He would adjust the dosage to the minimum that still produced a slight tremor. Have you ever heard of this?
- Scott
Posted by Angela5 on October 20, 2000, at 0:05:10
In reply to Re: Lithium serum blood test results » Sunnely, posted by SLS on October 19, 2000, at 21:51:30
My pdoc said that, in his experience, the tremor tends to go away after initial treatment.
Also, can anyone shed light on ibuprofen usage, i.e. if it is safe to take with Lithium or not?
Thanks,
Angela
Posted by Jonathan on October 20, 2000, at 7:13:17
In reply to Re: Lithium serum blood test results » Angela5, posted by Sunnely on October 19, 2000, at 20:59:49
> Hi Angela,
>
> The following range is generally considered to be the "therapeutic" blood levels of lithium: 0.8 to 1.2. However, this is not etched in stone. Some people, such as the elderly, generally require much lesser blood level. A lithium level of 0.3 - 0.5 usually is "therapeutic" for them.Hi Sunnely,
This may be an 'off-label' use in the US, but here in the UK lithium is sometimes administered for unipolar depression, often to augment an SSRI or other antidepressant. Dr Bob's tips actually mentions this use, during the transition period from SSRI to MAOI therapy (e.g. before starting an MAOI, a patient on Prozac needs at least five weeks wash-out because of the long half-life of norfluoxetine and consequent risk of serotonin syndrome):
http://www.dr-bob.org/tips/split/Li-bridge-antidep-switch.html
The recommended dose of lithium in unipolar depression is usually lower: a plasma level twelve hours after the last dose of 0.4 to 0.8 mmol/l, typically achievable by taking 300-400 mg of lithium carbonate daily in a single dose.
Higher concentrations than necessary can cause unnecessary side-effects, including cognitive impairment:
http://www.dr-bob.org/tips/split/Lithium-induced-cognitive-.html
http://www.dr-bob.org/tips/split/Word-finding-difficulties-.html
(only the last tip of the second reference mentions lithium)Best wishes,
Jonathan.
Posted by Angela5 on October 20, 2000, at 15:05:16
In reply to Re: Lithium serum blood test results » Sunnely, posted by Jonathan on October 20, 2000, at 7:13:17
Jonathan -
As you seem to have figured out, what you mentioned is exactly what my pdoc is doing. As of Wednesday, I was on:
150 mg/day Wellbutrin
50 mg/day Zoloft
112.5 mg/day Cylert
3 mg/day Hytrin (to counteract sweating from WB)
and 600 mg/day Lithium Carbonate
The Lithium is being administered in the hope of increasing Wellbutrin's antidepressant effect enough that I can discontinue Zoloft, then switch to an MAOI. This is due to the fact that while SSRIs seem to be about the only thing that keep me from crying in a corner, they also erase all of my motivation (which I normally even have when depressed as hell) and make me want to sleep for years at a time. This just isn't worth the price anymore...
Posted by Sunnely on October 20, 2000, at 18:16:53
In reply to Re: Lithium serum blood test results » Sunnely, posted by Jonathan on October 20, 2000, at 7:13:17
Hi Jonathan,
No disagreement on this part of the globe. My previous posts regarding the "therapeutic" level of lithium pertains only as anti-manic levels in healthy adult invidivuals. Again, this is not etched in stone. Indeed, lower doses (and levels) of Lithium do well as augmentation treatment with antidepressants.
Indeed, the use of lithium as augmentation treatment for depression is an "off label" indication. Lithium, here in the US, is only approved for treatment of acute mania and prophylactic treatment of bipolar disorder.
Thanks for your comment.
Posted by Sunnely on October 20, 2000, at 18:21:28
In reply to Re: Lithium treatment - SLS, Sunnely, posted by Angela5 on October 20, 2000, at 0:05:10
> Also, can anyone shed light on ibuprofen usage, i.e. if it is safe to take with Lithium or not?
>
> Thanks,
>
> Angela
Hi Angela,Lithium level tends to rise when used in combination with ibuprofen (Motrin, Advil, etc.) and most of the NSAIDs. It is not an absolute contraindication but your lithium blood level should be checked a week or so later after starting an NSAID and the lithium dose adjusted accordingly. You may experience lithium toxicity if this is not monitored. There are other meds that can cause increase lithium levels. Will post later for more. Need to attend to something, quick.
Posted by Sunnely on October 20, 2000, at 22:34:05
In reply to Lithium serum blood test results, posted by Angela5 on October 19, 2000, at 12:11:07
I. DRUGS THAT CAN POTENTIALLY INCREASE LITHIUM LEVELS:
A. ANTIHYPERTENSIVE DRUGS:
1. Amiloride (Midamor)
2. Ethacrynic acid (Edecrin)
3. Methyldopa (Aldomet)
4. Spironolactone (Aldactone)
5. Triamterene (Dyazide, Dyrenium)
6. Furosemide (Lasix)
7. Propranolol (Inderal)
8. ACE INHIBITORS: a. Benazepril (Lotensin, b. Captopril (Capoten), c. Enalapril (Vasotec), d. Fosinopril (Monopril), e. Lisinopril (Zestril, Prinivil), f. Losartan (Cozaar), g. Quinapril (Accupril), and h. Ramipril (Altace)
9. CALCIUM CHANNEL BLOCKERS: a. Diltiazem (Cardizem), and b. Verapamil (Calan)B. NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs):
1. Diclofenac (Cataflam)
2. Ibuprofen (Motrin, Advil, etc.)
3. Indomethacin (Indocin)
4. Ketoprofen (Orudis, Oruvail)
5. Ketorolac (Toradol)
6. Naproxen (Naprosyn)
7. Phenylbutazone (Butazolidin)
8. Piroxicam (Feldene)
9. Zomepirac (Zomax)
Note: Sulindac (Clinoril) and aspirin appear to be generally safe when combined with lithium.C. ANTIBIOTICS:
1. Ampicillin
2. Tetracycline
3. Spectinomycin (Trobicin)
4. Metonidazole (Flagyl)II. DRUGS THAT CAN POTENTIALLY DECREASE LITHIUM LEVELS:
1. Aminophylline/Theophylline
2. Acetazolamide (Diamox)
3. Psyllium (Metamucil)
4. Excessive intake of coffeeIII. DRUGS THAT CAN POTENTIALLY CAUSE CENTRAL NERVOUS SYSTEM DISTURBANCE (e.g., NMS, Serotonin syndrome, Delirium, or symptoms of lithium toxicity) WHEN COMBINED WITH LITHIUM:
A. SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs):
1. Fluoxetine (Prozac)
2. Paroxetine (Paxil)
3. Sertraline (Zoloft)
4. Fluvoxamine (Luvox)
5. Citalopram (Celexa)B. ANTIPSYCHOTIC DRUGS:
1. Clozapine (Clozaril)
2. Haloperidol (Haldol)
3. Molindone (Moban)
4. Perphenazine (Trilafon)
5. Thioridazine (Mellaril)
6. Thiothixene (Navane)C. ANTICONVULSANT DRUGS:
1. Carbamazepine (Tegretol)
2. Phenytoin (Dilantin)
Posted by Angela5 on October 21, 2000, at 2:07:47
In reply to More lithium and other drug interactions..., posted by Sunnely on October 20, 2000, at 22:34:05
Thanks, Sunnely. My pharmacist told me that Tylenol is the only OTC med that I can take for a headache that won't interfere with Lithium levels. Unfortunately, Tylenol does absolutely nothing for me. Any suggestions?
Thanks,
Angela
Posted by Noa on October 21, 2000, at 13:53:05
In reply to Re: Lithium serum blood test results » Sunnely, posted by Jonathan on October 20, 2000, at 7:13:17
I was on lithium briefly for depression without hypomania or mania. The doc was thinking maybe my depression was in the BP family, a la Akiskal, who seems to have a BP category for depression alone (BP type III, I think). The lithium did seem to add antidepressant effect.
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