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Drug‐Induced Lithium Toxicity in the Elderly: A Population‐Based Study
Author(s) -
Juurlink David N.,
Mamdani Muhammad M.,
Kopp Alexander,
Rochon Paula A.,
Shulman Kenneth I.,
Redelmeier Donald A.
Publication year - 2004
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2004.52221.x
Subject(s) - medicine , lithium (medication) , toxicity , population , relative risk , confidence interval , diuretic , pharmacology , environmental health
Objectives: To study the association between hospital admission for lithium toxicity and the use of diuretics, angiotensin‐converting enzyme (ACE) inhibitors, and nonsteroidal antiinflammatory drugs (NSAIDs) in the elderly. Design: Population‐based nested case‐control study. Setting: Ontario, Canada. Participants: Ontario residents aged 66 and older treated with lithium. Measurements: Estimated relative risk of hospital admission for lithium toxicity. Results: From January 1992 to December 2001, 10,615 elderly patients continuously receiving lithium were identified, of whom 413 (3.9%) were admitted to the hospital at least once for lithium toxicity. After adjustment for potential confounders, a dramatically increased risk of lithium toxicity was seen within a month of initiating treatment with a loop diuretic (relative risk (RR)=5.5, 95% confidence interval (CI)=1.9–16.1) or an ACE inhibitor (RR=7.6, 95% CI=2.6–22.0). Conversely, neither thiazide diuretics nor NSAIDs were independently associated with a significantly increased risk of hospitalization for lithium toxicity. Conclusion: The use of loop diuretics or ACE inhibitors significantly increases the risk of hospitalization for lithium toxicity, particularly in naïve recipients.