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Re: Regular Lithium: better than ER...

Posted by dragonblack on May 17, 2011, at 14:47:51

In reply to Re: Regular Lithium: better than ER... dragonblack, posted by SLS on May 17, 2011, at 4:31:25

> > > I'm new to lithium, I've only been on it for 2 months, but I've been reading a lot about it. While titrating up, I've concluded that, for myself, I think I will be sticking with the regular form, rather than seeking the ER form, as well as once nightly dosing, regardless of doseage, as long as I can tolerate it.
> > >
> > > Jim Phelps's site makes mention of single dosing resulting in a slight reduction in the risk of kidney problems. I also came across a medical text in google books (can't remember what) which reviewed Lithium studies and advocated once nightly dosing. The reasons stated were: 1) compliance was increased over split dosing, while preserving the mood stabilizing effect; 2) side effects were mitigated by virtue of the fact that peak plasma levels occurred in subjects' sleep, side effects were heaviest in the morning, a more "convenient" time, for most people, and thereafter lessened in severity during the day. 3) Finally, with once daily dosing, there is a reduced incidence of kidney problems, likely stemming from the fact that there is a window of time prior to the next dose (18-24 hours after a nightly dose) during which the kidneys get a reprieve, and such "rest" does not occur with split dosing.
> >
> > I meant to add to this that the authors also specifically identify regular lithium as requisite for the "give the kidneys a rest" strategy, as the ER form, like split dosing, doesn't give you the needed rest window. Naturally, some tolerate the ER form better and that may trump other concerns. If one tolerates the regular form, though, it seems to me that this idea is compelling and makes a lot of sense to me.
> I often wonder if statements like this are nothing more than one's own theory rather than an evidence-based prescription. Did the authors support their contention with empirical studies? Perhaps the best way to verify it is to do retrospective studies of human dosing behaviors and their association with thyroid or kidney function. To do a prospective study would take years. Maybe one already exists.
> This is a very important issue to me that I should explore more thoroughly. Reading is still difficult for me, though. I apologize if I missed something.
> - Scott

Well, ideally I would recall where I read this. Failing this, here's another source that states that once daily dosing reduces the incidence of adverse renal effects relative to split dosing.




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