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Risk factors for the development of lithium-induced polyuria

  • K. L. L. Movig (a1), R. Baumgarten (a2), H. G. M. Leufkens (a3), J. H. M. Van Laarhoven (a4) and A. C. G. Egberts (a1)...
Abstract
Background

Polyuria is common in patients with bipolar disorder treated with lithium. However, the risk factors for polyuria in these patients have not been established.

Aims

To estimate the prevalence of polyuria associated with the use of lithium and to identify additional risk factors.

Method

A 4-month prospective follow-up study in an out-patient lithium clinic. The 75 participants were asked to provide 24-h urine samples; polyuria was defined as a urine volume greater than 3 litres per 24 h. Risk factors examined included demographic variables, medications and medical comorbidities.

Results

The prevalence of polyuria among lithium users was 37%. Concomitant use of serotonergic antidepressants was strongly associated with polyuria (odds ratio 4.25, 95% CI 1.15–15.68) compared with patients not using these agents.

Conclusions

Our data confirm the high prevalence of lithium-induced polyuria. Physicians should be aware that concurrent use of serotonergic antidepressants and lithium significantly enhances the risk of its occurrence. Although limited polyuria is not harmful, it may be troublesome for the patient. In many cases cessation of lithium therapy is not an option because of difficulty in controlling the manic or depressive symptoms.

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Copyright
Corresponding author
Professor dr Antoine Egberts, Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, PO Box 80082, 3508 TB Utrecht, The Netherlands. Tel: 302537324; fax: 302539166; e-mail: A.C.G.Egberts@pharm.uu.nl
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Declaration of interest

None.

Footnotes
References
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  • EISSN: 1472-1465
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Risk factors for the development of lithium-induced polyuria

  • K. L. L. Movig (a1), R. Baumgarten (a2), H. G. M. Leufkens (a3), J. H. M. Van Laarhoven (a4) and A. C. G. Egberts (a1)...
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eLetters

Serotonergic drugs associated with polyuria- how strong is the association?

Sudhir Kumar, Consultant Neurologist, Department of Neurological Sciences
19 May 2003

To the editor,

I read with interest the recent article by Movig KLL et al (April, 2003). Association of serotonin reuptake inhibitors with polyuria is an interesting one.

However, I would like to make some observations. They note that the patients taking serotonergic antidepressants are four times more likely todevelop polyuria as compared to non-users. Looking at Table 1 carefully, we find that out of 25 patients taking serotonergic drugs, 14 (56%) had polyuria and 11 (44%) did not have polyuria. Now, this difference is definitely not a strong one. If the sample size was large enough, strengthof association could have easily been the other way.

Another point to note in Table 2 is that the fluid intake was significantly higher in the group of patients with polyuria; a mean intakeof 4094 ml was noted in the polyuria group as compared to 2362 ml in the group without polyuria. Fluid intake is directly proportional to urine output and therefore high fluid intake could be factor responsible for theobserved polyuria. Polydipsia is commonly seen in chronic psychiatric patients. A prevalence of 20.2% was seen in an earlier study (Ahmed AG et al, 2001). It is possible that the higher fluid intake in the polyuria group was due to the underlying psychiatric disease and not the drugs used.

If the authors were convinced that the polyuria was due to the serotonergic drugs, their finding could have been ascertained if they had substituted the serotonergic antidepressants with another antidepressants and rechecked the urine volumes. A fall in urine volume is expected if theproposed hypothesis is correct.

In conclusion, based on the data presented, it is uncertain that serotonergic antidepressants could lead to polyuria.

References

1.AG Ahmed, Liana M Heigh, KV Ramachandran. Polydipsia, psychosis andfamilial psychopathology. Can J of Psychiatry 2001; 46: 522-527.2.K. L. L. Movig, R. Baumgarten, H. G. M. Leufkens, J. H. M. Van Laarhoven, and A. C. G. Egberts. Risk factors for the lithium-induced polyuria. Br J Psychiatry 2003; 182: 319-323.
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