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Re: Lithium blood levels - is more better? » Squiggles

Posted by Larry Hoover on August 28, 2007, at 18:03:07

In reply to Re: Lithium blood levels - is more better? » Larry Hoover, posted by Squiggles on August 28, 2007, at 17:49:07

> > The potential for therapeutic effects, as well as that for side effects, will increase with increasing dose.
>
> But not indefinitely-- after a certain point 1200mg i think, it becomes dangerous and has the greater potential for toxicity.

No, that is incorrect. Toxicity is not based on dose. It is based on blood concentration. I know someone who takes 1800 mg to achieve a blood concentration of 1.0 mmol/L.

Each person has a linear dose/concentration response, but the slope of each line is different, individual, idiosyncratic.

> Yes, your doctor may increase your dose, to magnify the response. As it stands now, you're barely into the blood concentration range that is considered to be therapeutic (0.6-1.2 mmol/L).
>
> Europe uses lower therapeutic ranges than the States, Canada, and Australia. I read that somewhere :-)

That's where I included 0.6. I recalled references to a therapeutic range of 0.8-1.2, but I revised my post according to a more liberal range used elsewhere in the world.

>
> Dose is not an infallible measure of blood concentration,
>
>
> dose is an infallible measure of blood concentration in the 24 hour cycle,

No, it is not.

> but not an infallible measure of brain accumulation of lithium [after Schou]

Brain accumulation is a function of blood concentration which is a function of dose. Each function has different coefficients in different individuals. Brain equilibration is a term that is appropriate, not accumulation. It is believed to take about six weeks after a stable blood concentration is created, before the brain lithium concentration equilibrates.

> which is why you need to get blood work done. Because you have already exhibited some mood stabilization, I would expect your doctor to talk to you about increasing the dose.
> >
> > Lar
> >
>
>
> No offense Larry, just some footnotes.
>
> Squiggles

<Spock eyebrow>

Lar

 

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