Lithium drug administration

Pharmacotherapy is the cornerstone of acute and maintenance treatment of bipolar disorder. Mood-stabilizing drugs are the usual first-choice treatments and include lithium, divalproex, carbamazepine, and lamotrigine. Atypical antipsychotics other than clozapine are also approved for treatment of acute mania. Lithium, lamotrigine, olanzapine, and aripiprazole are approved for maintenance therapy. Drugs used with less research support and without Food and Drug Administration (FDA) approval include topiramate and oxcarbazepine. Benzodiazepines are used adjunctively for mania. 

Introduced in clinical practice in the 1960s, lithium was the first mood stabilizer to be used in China. This was followed by carbamazepine and sodium valproate. For many years, these were the only treatment options available as mood stabilizers. Although lamotrigine was approved for maintenance treatment of bipolar I disorder in 2003 by FDA (Food and Drug Administration) in the USA, this indication has not yet been approved by the Chinese authorities. At present, only one atypical antipsychotic drug, risperidone, has been approved for treating acute mania (February 2005 by SFDA [State Food and Drug Administration]) in China (see Table 6.1). 

Lithium, several (but not all) anticonvulsants, and most of the atypical antipsychotic medications are approved by the U.S. Food and Drug Administration (FDA) for the treatment of one of more phases of bipolar disorder. These medications are referred to as mood stabilizers, and they are the foundation of treatment for bipolar disorders. However, the skillful treatment of bipolar disorder requires not only the knowledge of how to prescribe one or more of these medications but also the understanding that some medications are preferred for one phase of the illness but not the other or for long-term use but not necessarily acute use. In this chapter, we first review the clinical use of lithium and the anticonvulsants that are definite or probable mood stabilizers. The general properties of atypical anti-psychotics are reviewed in Chapter 4. In this chapter, we expand on the use of these compounds for the treatment of bipolar disorder. Discussion of the treatment of each phase of bipolar disorder concludes the chapter. 

Carbamazepine. The anticonvulsant carbamazepine was actually the first to be shown to be effective in the manic phase of bipolar disorder, but it has not been approved for this use by regulatory authorities such as the U.S. Food and Drug Administration (FDA). Its mechanism of action may be to enhance GABA function, perhaps in part by actions on sodium and/or potassium channels (Fig. 7—24). Because its efficacy is less well documented and its side effects can include sedation and hematological abnormalities, it is not as well accepted for first-line use in the treatment of mood disorders as either lithium or valproic acid. 

Dr. J. F. J. Cade, an Australian psychiatrist, first reported on the beneficial use of a lithium compound for a psychiatric disorder, namely, manic behavior in 1949. The early human trials were undertaken after initial experiments on rats, which became quite lethargic after treatment with lithium urate. Fairly large doses were required for treating manic behavior and its use for this disorder has been displaced by organic drugs that carry less risk. His report, however, led to its current use as a treatment for bipolar affective disorder (also known as manic-depressive disorder). Its use in the United States was curtailed for a decade and a half by the US. Food and Drug Administration (FDA), which based its decision on incidental poisonings due to overuse of a lithium-based table salt substitute, despite a safe record of controlled psychiatric applications in Europe. It has been estimated that by 1985... 

Modem psychiatric treatments were introduced in 1948, when lithium carbonate was discovered as a treatment for mania by Australian psychiatrist John F. Cade. After Cade s initial report, lithium treatment was principally developed in Denmark by Mogens Schou (1918-), beginning in 1954. After a decade of trials by these and other groups in the USA and abroad, the Psychiatric Association and the Lithium Task Force recommended lithium to the Food and Drug Administration for therapy of mania in 1969, 20 years after its discovery by Cade. In 1970, the FDA approved the prescription drug. A breakthrough had finally been achieved in the treatment and prevention of one of the world s major mental health problems in the form of manic depression, and the genetically related forms of recurrent depression. 

Confusion, mood changes, decreased sexual interest, and weight gain are symptoms that may be unrelated to drug administration. On the other hand, psychiatric drugs, including those used in the treatment of psychotic and affective disorders, may be responsible for such symptoms. Tremor and symptoms of nephrogenic diabetes insipidus are characteristic adverse effects of lithium that may occur at therapeutic blood levels of the dmg. The answer is (D). 

Note-. Because of lithium s ability to inhibit thyroid secretion and inorease retention of iodine within thyroid tissue, it has been used in the treatment of several thyroid diseases. The use of lithium in thyroid disorders is not FDA approved. RAI radioactive iodine FDA Food and Drug Administration. 

Because of concerns of the Food and Drug Administration, lithium vras removed Irom TUP during the early 1950s. At nearly the same time, psychiatrists discovered that the lithium ion has a remarkable therapeutic effect on the mental disorder called bipolar affective disorder, or manic-depressive iUiiess. Over 1 million Americans suffer horn this psychosis, undergoing severe mood swings from deep depression to a manic euphoria. The lithium ion smoothes these mood swin allowing the bipolar patient to function more effectively in daily life. 

High-rate designs are employed in cardiac defibrillators, while moderate rate units find applications in implantable neurosimulators and drug infusion devices. Lithium/SVO batteries are employed for biomedical applications and as such must be produced under the Good Manufacturing Practices (GMP) for medical devices of the U.S. Food and Drug Administration. 

We have shown that the increase in aggressiveness with chronic antidepressant drug administration can be blocked by lithium. Thus it may be that 5-HT plays a role in inhibiting both the... 

In nephrogenic diabetes insipidus the kidney s ability to respond to AVP is impaired by different causes, such as drugs (e.g. lithium), chronic disorders (e.g. sickle cell disease, kidney failure) or inherited genetic disorders (X-linked or autosomal NDI). This type of diabetes insipidus can not be treated by exogenous administration of AVP or AVP analogues. Instead, diuretics (hydrochlorothiazide combined or not with amiloride) and NSAI (indomethacin) are administrated to ameliorate polyuria. 

There is a decreased effectiveness of fluoxetine in patients who smoke cigarettes during administration of die drug. Fluoxetine is not administered witii lithium because this combination can increase lithium levels. The SSRIs are not administered witii herbal preparations containing St. Jbhn s wort because tiiere is an increased risk for severe reactions. 

Oral administration of bicarbonate may decrease the absorption of ketoconazole. Increased blood levels of quinidine, flecainide, or sympatiiomimetics may occur when these agents are administered with bicarbonate There is an increased risk of crystalluria when bicarbonate is administered with the fluoroquinolones. Fbssible decreased effects of lithium, methotrexate, chlorpropamide, salicylates, and tetracyclines may occur when these drag s are administered with sodium bicarbonate. Sodium bicarbonate is not administered within 2 hours of enteric-coated drugs the protective enteric coating may disintegrate before the drug reaches the intestine. 

Lithium is a drug with a narrow therapeutic index and therefore plasma concentrations are regularly monitored. Lithium is used in the prophylaxis and treatment of mania. Concurrent administration of lithium and diuretics, particularly the thiazides, is contraindicated as lithium excretion is reduced, resulting in increased plasma-lithium concentration and hence toxicity. 

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