Abstract
OBJECTIVE
To compare several parameters considered as proxies for
instability between age groups. Lithium is used both in bipolar
disorder and as augmentation in treatment of resistant
unipolar depression. Long-term treatment is often indicated.
Pharmacokinetic and pharmacodynamic changes in older
age, as well as increasing prevalence of co-morbidities and
polypharmacy, may result in instability of serum lithium
concentrations. The parameters in this study were derived
from studies involving oral anticoagulants.
DESIGN
Retrospective database study.
METHODS
A retrospective study (1995-2004) was conducted using serum
lithium concentrations from the laboratories of three hospitals
in the Netherlands. 759 patients treated with lithium, 40 years or
older, with at least two years follow-up were included. They were
divided into four age groups: 40-49 years, 50-59 years, 60-69
years and ≥ 70 years; the youngest group was used as a reference
group. The variance growth rate and percentage of time below, in
and above treatment range were considered proxies for instability.
Number of days and number of serum lithium concentration
measurements were considered proxies for instability during titration.
They were all analysed between the age categories.
RESULTS
There was no significant difference for these variables between
the reference group and the older age groups. In a subgroup of
454 patients, the parameters considered proxies for instability
during titration were evaluated. No significant difference
was found between the age groups. In a small group of 117
patients, titration and maintenance treatment for at least two
years could be analysed separately. Also in this group, there
was no difference between the age groups.
CONCLUSION
In this study, age was not a determinant of instability in serum
lithium concentration. Therefore, age does not seem to be a
reason to withhold or to discontinue lithium therapy.
van Melick EJM, Souverein PC, den Breejen JH, Tusveld CE, Egberts TCG, Wilt
To compare several parameters considered as proxies for
instability between age groups. Lithium is used both in bipolar
disorder and as augmentation in treatment of resistant
unipolar depression. Long-term treatment is often indicated.
Pharmacokinetic and pharmacodynamic changes in older
age, as well as increasing prevalence of co-morbidities and
polypharmacy, may result in instability of serum lithium
concentrations. The parameters in this study were derived
from studies involving oral anticoagulants.
DESIGN
Retrospective database study.
METHODS
A retrospective study (1995-2004) was conducted using serum
lithium concentrations from the laboratories of three hospitals
in the Netherlands. 759 patients treated with lithium, 40 years or
older, with at least two years follow-up were included. They were
divided into four age groups: 40-49 years, 50-59 years, 60-69
years and ≥ 70 years; the youngest group was used as a reference
group. The variance growth rate and percentage of time below, in
and above treatment range were considered proxies for instability.
Number of days and number of serum lithium concentration
measurements were considered proxies for instability during titration.
They were all analysed between the age categories.
RESULTS
There was no significant difference for these variables between
the reference group and the older age groups. In a subgroup of
454 patients, the parameters considered proxies for instability
during titration were evaluated. No significant difference
was found between the age groups. In a small group of 117
patients, titration and maintenance treatment for at least two
years could be analysed separately. Also in this group, there
was no difference between the age groups.
CONCLUSION
In this study, age was not a determinant of instability in serum
lithium concentration. Therefore, age does not seem to be a
reason to withhold or to discontinue lithium therapy.
van Melick EJM, Souverein PC, den Breejen JH, Tusveld CE, Egberts TCG, Wilt
| Translated title of the contribution | Age as a determinant of instability of serum lithium concentrations |
|---|---|
| Original language | Dutch |
| Pages (from-to) | A1534 |
| Journal | Pharmaceutisch Weekblad |
| Publication status | Published - 2015 |