Lithium teratogenic effects

The issue of lithium-induced dysmorphogenesis is not settled. An earlier report suggested an increase in cardiac anomalies—especially Ebstein s anomaly —in lithium babies, and it is listed as such in Table 59-1 in this book. However, more recent data suggest that lithium carries a relatively low risk of teratogenic effects. Further research is needed in this important area. 

The teratogenic effects of lithium have been reviewed in several articles (466,467,488) two reviews of drug-related congenital malformation briefly mentioned lithium and cardiovascular teratogenesis (480,489). The authors concluded that while the risk of cardiovascular malformation is lower than once believed, it is nevertheless increased. 

Warner JP. Evidence-based psychopharmacology 3. Assessing evidence of harm what are the teratogenic effects of lithium carbonate J Psychopharmacol 2000 14(l) 77-80. 

Carbamazepine is an anticonvulsant beneficial in the treatment of bipolar I disorder, and, as in the case of valproate, it may be more advantageous than lithium in non-classical bipolar conditions such as mixed mood states and rapid cycling conditions. It appears to have a teratogenic effect and, like valproate, has been associated with an increased risk of neural tube defects. ... 

Doses of verapamil reported to have antimanic effects have ranged from 80 mg b.i.d. to 160 mg t.i.d. Typically, the initial dose is 80 mg two or three times daily, with rapid escalation up to, but not exceeding, 480 mg/day. (Personal communication with Dubovsky and Giannini indicates some patients may require and safely tolerate doses up to 640 mg/day.) The drug is usually well tolerated, and no specific laboratory monitoring is required. Further, its lack of teratogenic potential makes this (and perhaps other CCAs) attractive alternatives to agents such as lithium, VPA, and CBZ. 

SAFETY PROFILE An experimental teratogen. Other experimental reproduedve effects. Readily forms an explosive peroxide. A very dangerous fire hazard when exposed to heat, flame, or oxidizers. Mixture with lithium tetrahydroaluminate may ignite or... 

A young female patient who suffers from bipolar affective disorder (BAD) has been managed with lithium. If she becomes pregnant, which one of the following drugs is likely to be effective in bipolar affective disorder with minimal risk of teratogenicity ... 

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