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Lithium linked to increased risk for thyroid and renal problems
McKnight RF. Lancet. 2012;doi:10.1016/S0140-6736(11)61516-X.
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Treatment with lithium is associated with an increased risk for reduced urinary concentrating ability, hypothyroidism, hyperparathyroidism and weight gain, according to researchers from the University of Oxford in England and Sainte-Marguerite Hospital in Marseille, France.
“Clinical practice guidelines have long recommended lithium as a first-line, long-term treatment for bipolar disorder, but its use has decreased, partly because of safety concerns,” the researchers wrote. “Evidence confirming its efficacy has led to suggestions that lithium should again be more widely used.”
Used widely for the treatment of mood disorders, lithium has raised safety concerns, although a sufficient combination of evidence on adverse events is lacking. To fulfill this need, researchers conducted a systemic review and meta-analysis of 385 randomized controlled trials and observational studies of patients with mood disorders who were assigned to lithium. Main outcome measures were renal, thyroid and parathyroid function; weight change; skin and hair disorders and teratogenicity.
Lithium treatment was associated with a reduction in glomerular filtration rate by –6.22 mL/min (95% CI, 14.65-2.20) and urinary concentrating ability by 15% of normal maximum (–158.43 mOsm/kg; 95% CI, –22.78 to –87.07).
The absolute risk for renal failure demonstrated a minimal increase (18 of 3,369 patients received renal replacement therapy).
Compared with patients assigned placebo, lithium showed a higher prevalence of clinical hypothyroidism (OR=5.78; 95% CI, 2-16.67). There was also an increase in thyroid-stimulating hormone by an average of 4 IU/mL (95% CI, 3.90-4.10). Treatment with lithium was also associated with increased blood calcium (+0.09 mmol/L; 95% CI, 0.02-0.17) and parathyroid hormone (+7.32 pg/mL; 95% CI, 3.42-11.23).
Lithium was also associated with weight gain vs. placebo (OR=1.89; 95% CI, 1.27-2.82). However, patients assigned to olanzapine gained the most weight (OR=0.32; 95% CI, 0.21-0.49).
There was no significant increase in the risk for congenital malformations, alopecia or skin disorders.
“This review provides a comprehensive synthesis of the evidence of harm that should inform clinical decisions and draw attention to key questions in urgent need of further classification,” the researchers said.
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