The authors of this review should be congratulated for the systematic quantification of the potential risks associated with lithium, Dr. Gin S. Malhi and Dr. Michael Berk wrote in an editorial that accompanied the report by Dr. McKnight and her colleagues in the Lancet.
This detailed review and analysis provides meaningful and reassuring advice for clinicians and identifies areas in need of additional research in regard to the safety of lithium, said Dr. Malhi and Dr. Berk. While the available evidence is far from ideal, the study – in the context of efficacy data upgrading the ranking of lithium, and new data that "recalibrate the safety risks of alternative drugs" – provides "timely clarification of the toxicity associated with lithium therapy, and on balance, reaffirms its role as a treatment of choice for bipolar disorder," they noted (Lancet 2012 Jan. 20 [doi:10.1016/S0140-6736(11)61703-0]).
"The renal side-effects of lithium are of greatest concern to both clinicians and patients, and in this regard, the analysis is reassuring in that, even with long-term lithium use, the risk of renal toxicity, specifically end-stage renal failure, is fairly low (0.53% compared to 0.2% in the general population)," they noted.
However, since the data on dosing and its relationship with toxicity were insufficient, matters of dose-related side-effects cannot be informed by the findings.
"Instead, the study provides useful guidance for clinicians considering lithium treatment, and redirects the focus of research to dosage and safety monitoring," said Dr. Malhi and Dr. Berk.
Dr. Malhi is with the University of Sydney. Dr. Berk is with the University of Melbourne. Dr. Malhi has received research support from, and/or served as a speaker or consultant for AstraZeneca, Eli Lilly, Organon, Pfizer, Servier, Wyeth, Janssen-Cilag, Lundbeck, and Ranbaxy. Dr. Berk has received research support from, and/or served as a speaker or consultant for Medical Benefits Funds of Australia, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Organon, Novartis, Mayne Pharma, Servier, Janssen-Cilag, Lundbeck, Merck, Pfizer, Sanofi-Synthelabo, Solvay, and Wyeth.
