title: A computerised sampling strategy for therapeutic drug monitoring of lithium provides precise estimates and significantly reduces dose-finding time.
abstract: The clinical benefit of implementing Bayesian approach for lithium drug monitoring was evaluated. Intervention group (N = 42) and historical control group (N = 55) patients were each divided into two groups: Dosage with immediate-release lithium carbonate or a sustained-release formulation, lithium citrate. Bayesian approach was performed in the intervention groups, and estimation of lithium steady-state trough concentration was obtained from non-steady-state blood sample, collected about 12 hr after the first lithium study dose. The estimate was compared with the actually measured steady-state concentration. In the control group, lithium monitoring was traditionally performed as steady-state blood sampling. Predicted and measured lithium concentrations were comparable. The desired lithium dose was reached significantly faster in the intervention group compared to control; 2.47 ± 2.22 days versus 9.96 ± 11.24 days (mean ± S.D.) (p = 0.0003). Bayesian approach was an advantage for the clinicians as a fast and safe aid to obtain the optimal lithium treatment dose.
authors.affiliation: Department of Clinical Biochemistry, Bispebjerg University Hospital, Bispebjerg Bakke 23, Copenhagen, Denmark. LHOE0021@bbh.regionh.dk
authors.forename: Lotte Christine Groth
authors.initials: LC
authors.lastname: Hoegberg
authors.forename: Gesche
authors.initials: G
authors.lastname: Jürgens
authors.forename: Vivian Wederking
authors.initials: VW
authors.lastname: Zederkof
authors.forename: Bettina
authors.initials: B
authors.lastname: Holgersson
authors.forename: John Erik
authors.initials: JE
authors.lastname: Andersson
authors.forename: Kim Peder
authors.initials: KP
authors.lastname: Dalhoff
authors.forename: Ejnar Bundgaard
authors.initials: EB
authors.lastname: Larsen
authors.forename: Helle Riis
authors.initials: HR
authors.lastname: Angelo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018692:Antimanic Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D001499:Bayes Theorem; D002951:Citrates / Q000008:administration & dosage* / Q000493:pharmacokinetics; D003692:Delayed-Action Preparations; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D016651:Lithium Carbonate / Q000008:administration & dosage* / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D018692:Antimanic Agents; D002951:Citrates; D003692:Delayed-Action Preparations; D016651:Lithium Carbonate; C070669:lithium citrate