engleski

Single daily dosing of lithium in patients with affective disorder: Systematic review

OBJECTIVE: Lithium is a mood-stabilizing drug which can be used in multiple or single daily dosing schedule. Advantages and disadvantages of single vs. multiple daily dosing of lithium with the implications for clinical practice are analyzed in this study. METHOD: A systematic review of the available literature has been undertaken to assess the feasibility and effectiveness of single daily dosing of lithium in patients with affective disorder. A Medline search for studies published since 1981 was performed and only English language articles were selected for the review according to previously prepared protocol. RESULTS: We have selected for this analysis only nine comparative studies, and each of them burdened by huge limitations (small sample-size, healthy population sample, short-time studies, retrospective studies, insufficient or no data of pharmacokinetics, concurrent treatment, timing of blood sampling, psychopathology or side effects etc.) In vivo studies unexpectedly showed the absence of a significant difference in average steady-state 12-h lithium serum concentrations when patients were switched from multiple to single daily regimen treated with similar total doses of the same lithium preparation. Single daily dosing of lithium causes transient higher peak lithium concentrations, but in spite of this no comparative study revealed a significant difference in side effects between multiple and single daily dosing group. A number of reports concluded that taking lithium in a single dose prevents, or at least limits, the increase in urine output (and the reduction of osmolality) and subsequent thirst. According to comparative studies and recent systematic reviews there are no strong evidences that single lithium dosing schedule preserves glomerular function. Administering lithium once daily, or even every second day in a dose sufficient to maintain an effective brain lithium concentration during the full 48-h period, it may be possible to preserve the prophylactic effect of lithium while reducing the side effects. One of the limitations for single daily dosing might be the occurrence of breakthrough manic symptoms associated with the trough serum lithium concentrations occurring in later stages of drug elimination None of these were seen during comparative studies. CONCLUSION: According to our analysis, it could be reasonable to use lithium as a single daily evening dose in patients who can tolerate this schedule because no studies have suggested any benefit from administration of multiple daily doses. There is a need for further large, prospective long-term trials. Possible advantages of single daily dosing is in preventing renal, particularly tubular impairment, better compliance and possible discontinuation of hypnotic medication.

lithium; single daily dosing; multiple daily dosing; side effects

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