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Re: Lithium levels

Posted by PeterMartin on November 22, 2021, at 13:00:15

In reply to Lithium levels, posted by Markwell on July 14, 2021, at 10:37:45

> I am currently on 900 mgs of lithium for BPD. I am currently 65 years old and have been on this amount for 5 years. I am afraid of developing a kidney issue as I age and continue on this dose. The lithium has been effective for me and I do horribly with AP's. One doctor suggested dosing once in the evening to help the kidneys. I also read where patients over 65 can use less dosage. Any thoughts or insights?
> Mark

There's a new study (Sept '21), which found Metformin attenuates kidney damage caused by Lithium in rats. Based on Metformin's track record it's likely that it would also help in humans.

Metformin is very cheap, and pretty easy to get prescribed. It has a lot of benefits and is pretty tolerable. I still take a small amount (500mg) to prevent antipsychotic weight gain, and for neuroprotective effects.

If I were you I'd ask your doctor to consider it.

Protective effect of metformin on lithium-induced nephrogenic diabetes insipidus: An experimental study in rats.


Lithium is widely used in the treatment of bipolar disorders and may lead to nephrogenic diabetes insipidus (NDI), following long-term treatment. Metformin is considered the preferred initial therapy for patients with type 2 diabetes mellitus (T2D).

To investigate the protective effect of metformin on the kidney damage caused by lithium administration.

Material and methods
Using an animal model of chronic lithium-induced NDI, rats were divided into 4 groups: sham, metformin, lithium, and lithium + metformin. The effects of these treatments were examined using serum electrolytes, blood and tissue total antioxidant status, total oxidant status, the oxidative stress index, urine and blood osmolality, and tissue aquaporin-2 (AQP2) levels. Additionally, histopathological changes, including congestion, hydropic swelling, tubular necrosis, tubular atrophy, and Bowman's capsule dilatation, were evaluated. The total histopathological score was obtained by summing the scores for each pathological finding.

In the lithium group, biochemical variables indicating NDI, including sodium, chloride and blood osmolality, increased, and urine osmolality decreased, compared to the sham group. With metformin treatment, the blood osmolality decreased from 328.17 mOsm/kg to 306.33 mOsm/kg, and urine osmolality increased from 349.67 mOsm/kg to 754.50 mOsm/kg (p = 0.004 and p = 0.001, respectively). Tissue AQP2 levels decreased with lithium administration but stabilized with metformin treatment. Additionally, in comparison to the lithium group, the total histopathological score in the metformin group declined from 8.0 to 2.0 (p = 0.002).

Metformin may help protect the kidneys from lithium-induced NDI through the AQP2 regulating effect and a reduction in oxidative stress.




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