Journal of the American Geriatrics Society · 2004
Drug-induced lithium toxicity in the elderly: a population-based study.
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Juurlink David N, Mamdani Muhammad M, Kopp Alexander, Rochon Paula A, Shulman Kenneth I, Redelmeier Donald A
Аннотация
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.
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.
Предметные рубрики MeSH
AgedAngiotensin-Converting Enzyme InhibitorsAnti-Inflammatory Agents, Non-SteroidalBenzothiadiazinesCase-Control StudiesConfidence IntervalsDiureticsDrug InteractionsFemaleHospitalizationHumansLithiumLogistic ModelsMaleMultivariate AnalysisOdds RatioRiskSodium Chloride Symporter InhibitorsTime Factors