OBJECTIVES: To study the association between hospital admission for lithium toxicity and the use of diuretics, angiotensin-converting enzyme (ACE) inhibitors, and nonsteroidal antiinflammatory drugs (NSAIDs) in the elderly. DESIGN: Population-based nested case-control study. SETTING: Ontario, Canada. PARTICIPANTS: Ontario residents aged 66 and older treated with lithium. MEASUREMENTS: Estimated relative risk of hospital admission for lithium toxicity. RESULTS: From January 1992 to December 2001, 10,615 elderly patients continuously receiving lithium were identified, of whom 413 (3.9%) were admitted to the hospital at least once for lithium toxicity. After adjustment for potential confounders, a dramatically increased risk of lithium toxicity was seen within a month of initiating treatment with a loop diuretic (relative risk (RR)=5.5, 95% confidence interval (CI)=1.9-16.1) or an ACE inhibitor (RR=7.6, 95% CI=2.6-22.0). Conversely, neither thiazide diuretics nor NSAIDs were independently associated with a significantly increased risk of hospitalization for lithium toxicity. CONCLUSION: The use of loop diuretics or ACE inhibitors significantly increases the risk of hospitalization for lithium toxicity, particularly in naïve recipients.
OBJECTIVES: To study the association between hospital admission for lithiumtoxicity and the use of diuretics, angiotensin-converting enzyme (ACE) inhibitors, and nonsteroidal antiinflammatory drugs (NSAIDs) in the elderly. DESIGN: Population-based nested case-control study. SETTING: Ontario, Canada. PARTICIPANTS: Ontario residents aged 66 and older treated with lithium. MEASUREMENTS: Estimated relative risk of hospital admission for lithiumtoxicity. RESULTS: From January 1992 to December 2001, 10,615 elderly patients continuously receiving lithium were identified, of whom 413 (3.9%) were admitted to the hospital at least once for lithiumtoxicity. After adjustment for potential confounders, a dramatically increased risk of lithiumtoxicity was seen within a month of initiating treatment with a loop diuretic (relative risk (RR)=5.5, 95% confidence interval (CI)=1.9-16.1) or an ACE inhibitor (RR=7.6, 95% CI=2.6-22.0). Conversely, neither thiazide diuretics nor NSAIDs were independently associated with a significantly increased risk of hospitalization for lithiumtoxicity. CONCLUSION: The use of loop diuretics or ACE inhibitors significantly increases the risk of hospitalization for lithiumtoxicity, particularly in naïve recipients.
Authors: David N Juurlink; Tara Gomes; Dennis T Ko; Paul E Szmitko; Peter C Austin; Jack V Tu; David A Henry; Alex Kopp; Muhammad M Mamdani Journal: CMAJ Date: 2009-01-28 Impact factor: 8.262
Authors: Catherine M Kelly; David N Juurlink; Tara Gomes; Minh Duong-Hua; Kathleen I Pritchard; Peter C Austin; Lawrence F Paszat Journal: BMJ Date: 2010-02-08