title: Drug-induced lithium toxicity in the elderly: a population-based study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Population-based nested case-control study.
  
  
  METHODS
  Ontario, Canada.
  
  
  METHODS
  Ontario residents aged 66 and older treated with lithium.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  The use of loop diuretics or ACE inhibitors significantly increases the risk of hospitalization for lithium toxicity, particularly in naïve recipients.
authors.affiliation: Clinical Epidemiology and Healthcare Research Program, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. david.juurlink@ices.on.ca
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Mamdani
authors.forename: Alexander
authors.initials: A
authors.lastname: Kopp
authors.forename: Paula A
authors.initials: PA
authors.lastname: Rochon
authors.forename: Kenneth I
authors.initials: KI
authors.lastname: Shulman
authors.forename: Donald A
authors.initials: DA
authors.lastname: Redelmeier
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D001581:Benzothiadiazines; D016022:Case-Control Studies; D016001:Confidence Intervals; D004232:Diuretics / Q000008:administration & dosage / Q000009:adverse effects*; D004347:Drug Interactions; D005260:Female; D006760:Hospitalization; D006801:Humans; D008094:Lithium / Q000493:pharmacokinetics / Q000627:therapeutic use / Q000633:toxicity*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012306:Risk; D049993:Sodium Chloride Symporter Inhibitors / Q000009:adverse effects; D013997:Time Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal; D001581:Benzothiadiazines; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D008094:Lithium