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Temporal association as a prerequisite factor of valsartan‐induced lithium toxicity
Author(s) -
Lazarczyk Maciej Jakub,
Giannakopoulos Panteleimon
Publication year - 2014
Publication title -
bipolar disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.285
H-Index - 129
eISSN - 1399-5618
pISSN - 1398-5647
DOI - 10.1111/bdi.12174
Subject(s) - lithium (medication) , valsartan , toxicity , pharmacology , dosing , mood stabilizer , therapeutic index , medicine , bipolar disorder , drug , blood pressure
Objectives Lithium is often the mood stabilizer of choice for the treatment of type I bipolar disorder. However, side effects as well as the narrow therapeutic dosing range often complicate its use. Lithium toxicity can be fatal and its serum level needs to be closely monitored, especially at the time of introduction and titration, or whenever combined with potentially interacting drugs, such as inhibitors of angiotensin‐converting enzyme ( ACE ‐I) or angiotensin receptor 1 ( AT 1 ) blockers. ACE ‐I and AT 1 blockers can increase serum lithium levels, leading to acute lithium toxicity upon their introduction or titration. Methods Here, we report a case of lithium toxicity during concomitant treatment with valsartan, an AT 1 blocker, in a patient who previously displayed a stable serum lithium level. The patient was observed for a few weeks and the serum lithium concentration was measured regularly. Results In contrast to previous reports, the toxicity in our patient occurred not upon introduction or titration of lithium or valsartan but after subtle modifications in daily dosing schedule for lithium. Just before the onset of toxicity, lithium had been split into two doses, whereby half of the lithium daily dose was administrated concomitantly with valsartan. We presumed that this combination had led to simultaneous concentration peaks of valsartan and lithium, promoting lithium retention within a sharp time window. Conclusions Our observation points to the need for caution not only during the introduction and titration of ACE ‐I/ AT 1 blockers in lithium‐treated patients, but also whenever the temporal pattern of drug administration is modified.

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