Prediction Model of Serum Lithium Concentrations

Author:

Yoshida Kazunari1,Uchida Hiroyuki12,Suzuki Takefumi13,Watanabe Masahiro4,Yoshino Nariyasu5,Houchi Hitoshi6,Mimura Masaru1,Fukuoka Noriyasu5

Affiliation:

1. Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan

2. Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada

3. Department of Psychiatry, Inokashira Hospital, Tokyo, Japan

4. School of Pharmacy, Syujitsu University, Okayama, Japan

5. School of Pharmacy, Nihon University, Chiba, Japan

6. Department of Pharmacy, Kagawa University Hospital, Kagawa, Japan

Abstract

Abstract Introduction Therapeutic drug monitoring is necessary for lithium, but clinical application of several prediction strategies is still limited because of insufficient predictive accuracy. We herein proposed a suitable model, using creatinine clearance (CLcr)-based lithium clearance (Li-CL). Methods Patients receiving lithium provided the following information: serum lithium and creatinine concentrations, time of blood draw, dosing regimen, concomitant medications, and demographics. Li-CL was calculated as a daily dose per trough concentration for each subject, and the mean of Li-CL/CLcr was used to estimate Li-CL for another 30 subjects. Serum lithium concentrations at the time of sampling were estimated by 1-compartment model with Li-CL, fixed distribution volume (0.79 L/kg), and absorption rate (1.5/hour) in the 30 subjects. Results One hundred thirty-one samples from 82 subjects (44 men; mean±standard deviation age: 51.4±16.0 years; body weight: 64.6±13.8 kg; serum creatinine: 0.78±0.20 mg/dL; dose of lithium: 680.2±289.1 mg/day) were used to develop the pharmacokinetic model. The mean±standard deviation (95% confidence interval) of absolute error was 0.13±0.09 (0.10–0.16) mEq/L. Discussion Serum concentrations of lithium can be predicted from oral dosage with high precision, using our prediction model.

Publisher

Georg Thieme Verlag KG

Subject

Pharmacology (medical),Psychiatry and Mental health,General Medicine

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