Lithium hypertension with

Unlabeled Uses Treatment of edema associated with CHF, liver cirrhosis, and nephrotic syndrome treatment of hypertension reduces lithium-induced polyuria, slows pulmonary function reduction in cystic fibrosis... 

CCAs (channel blockers influx inhibitors) have been used primarily for the treatment of cardiovascular disorders (e.g., supraventricular arrhythmias, angina, and hypertension). Agents such as verapamil exert their effects by modulating the influx of Ca across the cell membrane, thus interfering with calcium-dependent functions. Based partly on the common effects of lithium and this class of drugs (e.g., effects on Ca "" activity), the CCAs have been studied as a potential treatment for mania. Janicak et al. (251) reported the results of a 3-week, double-blind comparison of verapamil versus placebo, which did not demonstrate a beneficial effect for verapamil (up to 480 mg/day) in 33 acutely manic hospitalized patients. 

Pseudotumor cerebri (benign intracranial hypertension) has been linked to lithium in over 30 cases, with headache, papilledema, increased intracranial pressure, reduced vision, and a risk of blindness (201). The condition tends to improve on withdrawal, but surgical intervention may sometimes be necessary. A review of pseudotumor cerebri devoted one paragraph to induction of this condition by lithium and provided six references but no new information (202). 

CENTRALLY ACTING ANTI HYPERTENSIVES LITHIUM Case reports of lithium toxicity when co-ingested with methyldopa. It was noted that lithium levels were in the therapeutic range Uncertain at present Avoid co-administration if possible if not, watch closely for clinical features of toxicity and do not rely on lithium levels... 

A 77-year-old woman who had been taken lithium carbonate 625 mg/day with a stable lithium concentration of around 0.6 mmol/1 started to take losartan for hypertension. Within 4 weeks she developed ataxia, dysarthria, and confusion, and her serum lithium concentration was 2.0 mmol/1. Her symptoms resolved on withdrawal of losartan. 

Sodium-lithium countertransport, anion exchange, and the leak mechanism are the most important transport routes for lithium in vivo. Lithium appears to substitute for sodium in all of these pathways in the erythrocytes (131) and also in the squid axon membrane (132). Sodium-lithium countertransport has been claimed to be abnormal in patients suffering from essential hypertension and in their close relatives (133). However, despite a decade of experimental study by many different laboratories, there is no consensus with regard to the true basis of the membrane defect, if indeed it is really present. Nor is it clear under what precise conditions the abnormality is manifest (134). 

There may be abnormalities in eiythrocyte membrane transport properties in patients with bipolar affective disorders, though the interpretation is confounded by the uncertainty with regard to the contribution of hypertension in patients who are coincidentally hypertensive and manic depressive. The administration of lithium also may cause adaptive change (93,117,135-137). This results in an increase in erythrocyte lithium concentrations after prolonged lithium therapy, which could be mediated either by increased flux into the cell or via reduction in efflux rate. An increased content of ankyrins, red cell membrane proteins affecting cytoskeletal structure and functions, has been found in some patients with bipolar affective disorder (138) and this raises further the role of erythrocyte membrane defects in the etiology of the disease. 

Group la Lithium - Lithium salts were used indiscriminately over the early part of this century for treatment of gout, epilepsy. Insomnia, hypertension and as salt substitutes in cardiac disease. Unfortunately, toxicity associated with lithium salt therapy was not known at that time. Many cases of serious side effects and deaths resulted which led to their disuse. In recent years judicious use of lithium salts, primarily lithium carbonate, for the control of manic symptoms has reestablished their utility in clinical practice. 

The major receptor-mediated adverse effect is water intoxication, which can occur with desmopressin or vasopressin. Many drugs, including carbamazepine, chlorpropamide, morphine, tricyclic antidepressants and NSAIDs, can potentiate the antidiuretic effects of these peptides, while lithium, demeclocycline and ethanol can attenuate the antidiuretic response to desmopressin. Desmopressin and vasopressin should be used cautiously when a rapid increase in extracellular water may impose risks (e.g., in angina, hypertension, and heart failure) and should not be used in patients with acute renal failure. Patients receiving desmopressin to maintain hemostasis should be... 

In a study of patients with essential hypertension, two doses of nifedipine 20 mg did not affect single-dose lithium clearance, but nifedipine 40 to 80 mg daily for 6 and 12 weeks was found to decrease single-dose lithium clearance by 30%.A man, on lithium carbonate 1.5 g daily with a level of 0.8 mmol/L, developed ataxia and dysarthria 7 days after starting nifedipine 30 mg daily for 48 hours, then 60 mg daily. His lithium dose was reduced by 40%, but his serum-lithium level first increased to 1.1 mmol/L (about 2 weeks after starting the nifedipine), before restabilising at 0.9 mmol/L. In contrast, a patient taking lithium, who developed dysarthria and ataxia after verapamil was added to her treatment (see fcj below), was subsequently well controlled on lithium and nifedipine 40 mg daily... 

As previously discussed, milnacipran is both a serotonin and a norepinephrine reuptake inhibitor and therefore is a medication that has the potential to cause serotonin syndrome when administered with MAOIs or lithium. The development of hyperseroton-ergia (serotonin syndrome) can cause a potentially lethal hypertensive crisis. 

---