Increased Serum Lithium Concentration Secondary to Treatment with Tiaprofenic Acid and Fosinopril

OBJECTIVE: To describe a patient in whom the administration of tiaprofenic acid and fosinopril was associated with decreased lithium clearance, resulting in increased serum lithium concentrations. CASE SUMMARY: A woman treated with lithium for bipolar affective disorder was concurrently treated with tiaprofenic acid 200 mg tid for shoulder pain. Previously initiated treatment with fosinopril was maintained during this time. The urinary lithium clearance was decreased during this combination therapy, necessitating a reduction in the lithium dosage. DISCUSSION: Lithium is approximately 80% reabsorbed in the proximal tubule, and the addition of tiaprofenic acid may have resulted in enhanced tubular lithium reabsorption. The possible influence of concurrent fosinopril therapy may also have contributed to altered lithium pharmacokinetics in this case. CONCLUSIONS: Serum lithium concentrations should be monitored if patients taking lithium are treated with tiaprofenic acid.

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NON PITTING TYPE PEDAL EDEMA WITH LITHIUM: A CASE REPORT

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2017v9i1.15353 ◽

2016 ◽

Vol 9 (1) ◽

pp. 323

Author(s):

Parvathypriya C. ◽

Jeslyn Mary Philip ◽

Christeena George ◽

Lakshmi R.

Keyword(s):

Affective Disorder ◽

Dose Escalation ◽

Lithium Treatment ◽

Lithium Concentration ◽

Bipolar Affective Disorder ◽

Lithium Therapy ◽

Psychotic Symptoms ◽

Drug Induced ◽

Serum Lithium Concentration ◽

Pedal Edema

Objective: To report a case of lithium induced bilateral nonpitting pedal edema.Methods: The clinical data of a bipolar affective disorder patient with current episode of mania and psychotic symptoms who experienced bilateral non pitting pedal edema with lithium.Results: The patient was a 29 yr old female who developed bilateral non-pitting type pedal edema with lithium therapy with normal plasma lithium level (0.72mEq/l). She is a known case of bipolar affective disorder (BPAD) was admitted to psychiatry department with episode of mania with psychotic symptoms. She had history of drug induced hypersensitivity reaction with eosinophilia and systemic symptoms (DRESS) with oxcarbazepine and so the drug was discontinued and was started on tablet lithium 400 mg twice daily. On admission here, the dose of lithium was increased to 1200 mg/day. The patient gradually improved but she developed bilateral non-pitting pedal edema. Serum lithium concentration was normal and there were no other early symptoms of lithium toxicity. But as the patient's distress further increased with increasing pedal edema, it was decided to stop lithium altogether and to maintain the patient on tablet quetiapine 800 mg therapy for BPAD. Within one week of stopping lithium the edema on both her feet decreased significantly. Causality was assessed by naranjo causality assessment scale and a probable relationship was obtained between lithium and pedal edema with a score of 6.Conclusion: This case emphasises that regular physical examination and laboratory investigations are important for patients who are on lithium therapy. Clinicians should always be careful while initiating lithium treatment in a patient with respect to the initial dose and dose escalation even after a period of successful therapy with lithium, as minor dose escalation can cause major changes in the serum lithium concentration and thereby the patient’s tolerability to lithium.

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Validation of the Sinhala version of the Morisky Medication Adherence Scale to determine medication adherence in patients with bipolar affective disorder on lithium therapy

European Journal for Person Centered Healthcare ◽

10.5750/ejpch.v6i1.1378 ◽

2018 ◽

Vol 6 (1) ◽

pp. 30

Author(s):

Uthpali Mannapperuma ◽

Priyadarshani Galappatthy ◽

Varuni A De Silva ◽

Raveen Hanwella ◽

Raveendra Laal Jayakody ◽

...

Keyword(s):

Medication Adherence ◽

Internal Consistency ◽

Lithium Concentration ◽

Bipolar Affective Disorder ◽

Lithium Therapy ◽

Cronbach’S Alpha ◽

Serum Lithium Concentration ◽

Cronbach's Alpha ◽

Morisky Medication Adherence Scale ◽

Adherence Scale

Rationale, aims and objectives: The Morisky Medication Adherence Scale (MMAS-8) is a self-reported scale used in assessing medication adherence in patients on chronic therapy. Medication adherence is a neglected area of research in Sri Lanka and in this study we have attempted to validate the Sinhala translation of the MMAS-8 to determine medication adherence among patients stabilized on lithium therapy for bipolar disorder (BD).Methods: The MMAS-8 was translated to Sinhala with standard forward and backward translations from English to Sinhala. Patients with BD on stable doses of lithium were administered the Sinhala version of the MMAS-8. During the same visit, the serum lithium concentration was measured. Criterion validity was assessed using therapeutic serum lithium concentrations as the gold standard. Internal consistency was assessed using Cronbach’s alpha and Spearman’s rank correlation was used to assess test-retest reliability.Results: From a sample of 240 patients, 82.1% were considered adherent, with serum lithium concentration >0.4 mmol/L. The mean MMAS-8 score was 6.95±1.3. According to the MMAS-8 scale, 13.3% reported low adherence while 43.3% reported medium and high adherence equally using MMAS cut offs <6, 6 to<8 and 8 respectively. The scale sensitivity to identify adherence at a cut-off score of 6 was 86.3%. The test–retest reliability value was 0.708 (p<0.001). Internal consistency was found with a Cronbach’s alpha value of 0.608 for the 8 items of the scale.Conclusion: The Sinhala version of MMAS-8 can be used as a sensitive instrument to identify medication adherence in patients with bipolar disorders.

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