Drug info - Blood tests and lithium.

Discussion in 'Antidepressants' started by Potter, Apr 15, 2019.

  1. Potter

    Potter Platinum Member & Advisor

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    I don't currently have a primary care doctor and I'm not entirely confident in the Nurse Practitioner who is acting as a psychiatrist at my therapy office. He wants me to try a low dose of Lithium, 150 3x a day.

    My partner feeaked out because they used to require regular blood testing for lithium. I was not given any indicator to get testing. Should I find a second opinion or demand tests? He said this dose isn't as risky as they used to use, but I'm really out of touch on this drug.

    I don't even know if I'll find a second opinion in the next 6 months, it took me that long to get this guy.

    I have not started the lithium, till I get a better grasp of the risk.
     
  2. JaneGault

    JaneGault Seeking Shelter from the Norm Titanium Member

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    I believe concern is warranted. If the prescribing physician doesn't order the blood work, I would order my own (even at considerable expense). Initial testing to establish proper dosage, and regular monitoring of levels should be routine. I would consider using this doctor only as long as it takes to find a replacement.

    Hopefully one of our medically trained members will reply. Perhaps lithium therapy has changed since I was familiar with it.

    Google this for a great PDF on lithium, I realize you are not undergoing inpatient therapy, but it contains much useful information:

    "Guidelines to the Prescribing and Monitoring of Inpatient Lithium Therapy", Sussex Partnership

    Good luck, Jane
     
  3. aemetha

    aemetha Sexy Potato Palladium Member Donating Member

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    I agree with @JaneGault, blood tests are required here for a prescription of lithium to properly assess the titration.

    May I ask what the prescription is intended to treat? There's a few conditions for which lithium is basically a "paper" preferred option. It has both upsides and downsides, and one of the most significant is it tends to "run out" if you will - after 2 years it doesn't have a lot of effect. It is the most effective drug available for treating suicidality if that is an issue, at least within that 2 year period. The most commonly prescribed drug for mood stabilisation now is valproate, which while having higher incidents of suicide, tends to provide a therapeutic effect longer. Anyway, that's a little basic overview in case you don't want to share what it's being prescribed for. You can DM me if you want any more info, or want me to check anything for you and aren't comfortable sharing it in the forum.
     
  4. jazzyj9

    jazzyj9 Titanium Member Donating Member

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    I believe blood levels are routinely done for this medication. Would Lamictal (lamotrigine) be an alternative? I take the latter, less potential kidney problems and no blood tests required. Nurse practitioners in my state usually have consulting physicians as well, so not entirely solo in practice. But no provider really is solo, usually consults other providers. The dose 450mg of lithium is pretty low. Is it an adjunct to an antidepressant? If so, Lamictal is used also for that purpose now. At that low of a dose, perhaps they don't do blood testing. I would ask them about it and not be shy about getting all the info you need about your care so that you feel comfortable continuing with them as your health care provider.

    I would also encourage you to research any medication independently so that you know about more of the potential side effects and can be better informed at your appointment.
     
  5. chibi curmudgeon

    chibi curmudgeon Gold Digger Gold Member Donating Member

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    What the actual fuck? You ALWAYS get lithium levels, especially when first starting it, regardless of the dose!
     
  6. jazzyj9

    jazzyj9 Titanium Member Donating Member

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    Here's something I found online about lithium. https://psycheducation.org/treatmen.../lithium/#How_much_is_enough_low-dose_lithium

    In my opinion, this medication seems hard on the body with potential effects like kidney dysfunction and thyroid impairment. I'm sure this is dose dependent, but nevertheless, I am reluctant to take things that can have such a profound impact on vital organs.

    I think you are wise to question what you put into your body and what kind of lab tests are required. Getting a second opinion won't hurt.
     
    Last edited: Apr 16, 2019
  7. Potter

    Potter Platinum Member & Advisor

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    It has been 2 decades since I last considered a mood stabilizer. As my appointment was already running well past my allotted time and I was really stressed by other aspects of the appointment, I really didn't have the spoons to try to call him out on another thing.

    Now I need to figure out where and how to get this done, I might see if the pharmacy can tell at him for me. I do have the number of a walk in clinic my therapist have me, but ugh... I wish I could find someone just to be my primary who I feel comfortable with.

    Thanks Chibi, Gil was just asking me to ask you as I was writing this.

    Thanks for the reassurance, glad my partner is pretty on top of things and reminded me about this. This sort of thing posses me off to no end, I wonder how many people he has on this without being properly tested?

    Thanks again folks.
     
  8. aemetha

    aemetha Sexy Potato Palladium Member Donating Member

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    @Potter, you might find this helpful in getting the problem addressed. It's the FDA prescribing information for Lithium. Section 2.1 and 2.6 are the important parts.

    2.1 Pre-treatment Screening Before initiating treatment with lithium, renal function, vital signs, serum electrolytes, and thyroid function should be evaluated. Concurrent medications should be assessed, and if the patient is a woman of childbearing potential, pregnancy status and potential should be considered.

    2.6 Serum Lithium Monitoring Blood samples for serum lithium determination should be drawn immediately prior to the next dose when lithium concentrations are relatively stable (i.e., 12 hours after the previous dose). Total reliance must not be placed on serum concentrations alone. Accurate patient evaluation requires both clinical and laboratory analysis.

    In addition to regular monitoring of serum lithium concentrations for patients on maintenance treatment, serum lithium concentrations should be monitored after any change in dosage, concurrent medication (e.g., diuretics, non-steroidal antiinflammatory drugs, renin-angiotensin system antagonists, or metronidazole), marked increase or decrease in routinely performed strenuous physical activity (such as an exercise program) and in the event of a concomitant disease [See Boxed Warning, Warnings and Precautions (5.1), Drug Interactions (7.1)].

    Patients abnormally sensitive to lithium may exhibit toxic signs at serum concentrations that are within what is considered the therapeutic range. Geriatric patients often respond to reduced dosage, and may exhibit signs of toxicity at serum concentrations ordinarily tolerated by other patients [see Specific Populations (8.5)].

    Full document attached.
     

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  9. chibi curmudgeon

    chibi curmudgeon Gold Digger Gold Member Donating Member

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    Thank you, @aemetha, for reminding me, Potter is on a medication that interacts with lithium. Which is not really surprising, because nearly all drugs interact with lithium. The amount of freakin' sodium in your diet affects lithium levels; you're supposed to maintain a strictly consistent intake of water and sodium so your levels don't fluctuate much. Lithium also has a very narrow therapeutic window, and at "therapeutic" levels can still wreak havoc on your body. While I wouldn't go so far as to consider it a drug of last resort, @Potter, I get the impression if things were bad enough that you needed to try lithium, I would have heard about it. Also, I'm not anti-nurse or anything--some of my best friends are nurses--but as prescribers they consistently disappoint me.
     
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