Safer lithium treatment

Patients prescribed lithium should be monitored in accordance with the National Institute for Health and Clinical Excellence Guidelines published in 2006. Both kidney function (eGFR) and thyroid function (TFTs) should be measured before starting treatment and then every six months because the blood level of lithium is dependent on kidney function, and lithium can interfere with both kidney and thyroid function. Serum lithium levels should be measured weekly until a steady level is achieved and then repeated every three months. (A recent audit had found that the guidelines for each of the three tests had not been followed in at least half the patients who were on lithium during the previous year.)

Prescribers and pharmacists should check that the monitoring tests have been done and that it is safe to prescribe or dispense lithium.

At the start of lithium therapy and throughout treatment patients should be given verbal and written information, including the known side effects and the symptoms that can result from lithium levels that are too high. (The audit had found that only 42% of patients starting treatment were recorded as having been informed of risk factors for toxicity.) The National Patient Safety Agency has produced an excellent information booklet for patients that has these chapter headings: