title: A case of lithium intoxication induced by an antihypertensive angiotensin 1 subtype-specific angiotensin II receptor blocker in an elderly patient with bipolar disorder and hypertension.
abstract: Lithium carbonate is considered to be a first-line treatment for bipolar disorder; however, this drug has a narrow therapeutic window, and lithium intoxication is commonly induced by various drugs interaction and situations. We herein report a case of lithium intoxication induced by the administration of an antihypertensive agent targeting the angiotensin 1 (AT1) subtype of the angiotensin II receptor in a 65-year-old woman with a 40-year history of bipolar disorder type 1, and 1-year history of essential hypertension. Her bipolar disorder had been well-controlled with 600 mg/day of lithium carbonate for more than 10 years. She was later diagnosed with hypertension and the AT1 receptor blocker, azilsartan was thereafter administrated on a daily basis. After 3 weeks of azilsartan administration, she presented with progressive action tremor and showed a gradual deterioration of her physical state. Four months after the start of azilsartan administration, she presented with alternating episodes of diarrhea and constipation. Two weeks before admission to our hospital, she presented with mild consciousness disturbances, myoclonus, truncal ataxia, and appetite loss. She was diagnosed to have lithium intoxication based on an elevated serum lithium concentration of 3.28 mEq/l.It is therefore important to evaluate the serum lithium concentration after the administration of antihypertensive agents, and consider lithium-antihypertensive agent interactions when selecting antihypertensive agents in elderly patients receiving long-term lithium carbonate treatment.
authors.affiliation: Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Shohei
authors.initials: S
authors.lastname: Nishida
authors.forename: Akira
authors.initials: A
authors.lastname: Takekoshi
authors.forename: Muneharu
authors.initials: M
authors.lastname: Murakami
authors.forename: Megumi
authors.initials: M
authors.lastname: Yamada
authors.forename: Akio
authors.initials: A
authors.lastname: Kimura
authors.forename: Akio
authors.initials: A
authors.lastname: Suzuki
authors.forename: Takashi
authors.initials: T
authors.lastname: Inuzuka
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000493:pharmacokinetics; D000959:Antihypertensive Agents; D014150:Antipsychotic Agents / Q000493:pharmacokinetics / Q000506:poisoning*; D001714:Bipolar Disorder / Q000188:drug therapy; D004347:Drug Interactions; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008094:Lithium; D016651:Lithium Carbonate / Q000493:pharmacokinetics / Q000506:poisoning*
chemical_list: D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents; D014150:Antipsychotic Agents; D016651:Lithium Carbonate; D008094:Lithium