Priadel - Information, specialists, frequent questions.

Usage of Priadel

Indications: 1. In the management of acute manic or hypomanic episodes. 2. In the management of episodes of recurrent depressive disorders where treatment with other antidepressants has been unsuccessful. 3. In the prophylaxis against bipolar affective disorders. 4. Control of aggressive behaviour or intentional self harm
Contra Indications: • Hypersensitivity to lithium or to any of the excipients. • Cardiac disease. • Clinically significant renal impairment. • Untreated hypothyroidism. • Breast-feeding. • Patients with low body sodium levels, including for example dehydrated patients or those on low sodium diets. • Addison's disease

Adverse and side effects

Side effects are usually related to serum lithium concentration and are less common in patients with plasma lithium concentrations below 1.0 mmol/l. Initial therapy: fine tremor of the hands, polyuria and thirst may occur. Body as a whole: muscle weakness, peripheral oedema. Cardiovascular: cardiac arrhythmia (NOS), mainly bradycardia, sinus node dysfunction, peripheral circulatory collapse, hypotension, oedema, ECG changes such as reversible flattening or inversion of T-waves and QT prolongation, cardiomyopathy. CNS: ataxia, hyperactive deep tendon reflexes, extrapyramidal symptoms, seizures, slurred speech, dizziness, nystagmus, stupor, coma, pseudotumor cerebri, myasthenia gravis, vertigo, giddiness, dazed feeling, memory impairment. Dermatology: alopecia, acne, folliculitis, pruritus, aggravation or occurrence of psoriasis, allergic rashes, acneiform eruptions, papular skin disorders, cutaneous ulcers. Endocrine: euthyroid goitre, hypothyroidism, hyperthyroidism and thyrotoxicosis. Lithium-induced hypothyroidism may be managed successfully with concurrent levothyroxine. Hypercalcaemia, hypermagnesaemia, hyperparathyroidism have been reported. Gastrointestinal: anorexia, nausea, vomiting, diarrhoea, excessive salivation, dry mouth, abdominal discomfort, taste disorder, gastritis. Haematological: leucocytosis. Metabolic and Nutrional: weight gain, hyperglycaemia. Renal: polydipsia and/or polyuria, symptoms of nephrogenic diabetes insipidus, histological renal changes with interstitial fibrosis after long term treatment. High serum concentrations of lithium including episodes of acute lithium toxicity may aggravate these changes. The minimum clinically effective dose of lithium should always be used. In patients who develop polyuria and/or polydipsia, renal function should be monitored, e.g. with measurement of blood urea, serum creatinine and urinary protein levels in addition to the routine serum lithium assessment. Reproductive: sexual dysfunction. Senses: dysgeusia, blurred vision, scotomata. Rare cases of nephrotic syndrome, speech disorder, confusion, impaired consciousness, myoclonus and abnormal reflex have been reported. If any of the above symptoms appear, treatment should be stopped immediately and arrangements made for serum lithium measurement

Special precautions

• When considering Priadel therapy, it is necessary to ascertain whether patients are receiving lithium in any other form. If so, check serum levels before proceeding. • Before beginning a lithium treatment: - it is important to ensure that renal function is normal. - cardiac function should be assessed. - thyroid function should be evaluated. Patients should be euthyroid before initiation of lithium therapy. • Renal, cardiac and thyroid functions should be re-assessed periodically. • The possibility of hypothyroidism and renal dysfunction arising during prolonged treatment should be borne in mind and periodic assessments made. • Patients receiving long term lithium therapy should be warned by the physician and be given clear instructions regarding the symptoms of impending intoxication (see 4.9 Overdose). They should be warned of the urgency of immediate action should these symptoms appear, and also of the need to maintain a constant and adequate salt and water intake. Treatment should be discontinued immediately on the first signs of toxicity. • Patients should be warned to report if polyuria or polydipsia develop. Episodes of nausea, vomiting, diarrhoea, fluid deprivation (e.g. excessive sweating), and/or other conditions leading to salt/water depletion should also be reported. Drugs likely to upset electrolyte balance such as diuretics (including severe dieting) should also be reported. Indeed, sodium depletion increases the plasma lithium concentration (due to competitive reabsorption at the renal level). In these cases, lithium dosage should be closely monitored and reduction of dosage may be necessary. • Caution should be exercised to ensure that diet and fluid intake are normal in order to maintain a stable electrolyte balance. This may be of special importance in very hot weather or work environment. Infectious diseases including colds, influenza, gastro-enteritis and urinary infections may alter fluid balance and thus affect serum lithium levels. Treatment should be discontinued during any intercurrent infection and should only be reinstituted after the patient's physical health has returned to normal. • Elderly patients are particularly liable to lithium toxicity. Use with care as lithium excretion may also be reduced. They may exhibit adverse reactions at serum levels ordinarily tolerated by younger patients

Questions about Priadel

Our experts have answered 1 questions about Priadel

Dr. Richard Fry
Dr. Richard Fry
Child and adolescent psychiatrist, Psychiatrist
Windsor
No. Discuss urgently with your doctor. At the very least you will need close monitoring of your levels and adjustment for reduced renal function. Possibly another medication altogether.
1 answers

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