Lithium remains the gold standard treatment for bipolar disorder after over 60 years of clinical use, with expanding therapeutic applications in neurodegenerative conditions. Despite its proven efficacy, lithium presents unique challenges due to its narrow therapeutic window and complex side effect profile. This comprehensive review synthesizes current evidence on lithium toxicity, adverse effects, and discontinuation management from 2019-2025, incorporating significant earlier studies. Lithium demonstrates efficacy in treating bipolar disorder, with approximately two-thirds of patients experiencing clinically significant improvement and more than half achieving remission. Additionally, it shows promising anti-suicidal properties, though careful management is required when discontinuing the medication. The manuscript examines lithium's pharmacokinetics and toxicity classification (acute, acute-on-chronic, and chronic), with detailed analysis of system-specific adverse effects including renal, neurological, cardiovascular, and endocrine manifestations. Risk factors for toxicity include age, comorbidities, drug interactions (particularly with NSAIDs, diuretics, and ACE inhibitors), and environmental factors. The review provides evidence-based recommendations for diagnostic evaluation, management protocols for toxicity cases, and monitoring guidelines to minimize adverse effects. Special attention is given to lithium discontinuation, highlighting the importance of gradual tapering to prevent relapse and withdrawal syndromes. For patients requiring alternative medication, the manuscript offers guidance on transition strategies to maintain mood stability. This comprehensive review aims to provide clinicians with practical guidance to optimize lithium therapy while minimizing risks.
{"title":"Lithium: A review of its adverse effects, toxicity and discontinuation.","authors":"Sakshi Prasad, Vasudha Sharma, Wafa Sosal, Praachi Mehta, Ajiya Fatima, Sayed Mohammad Milad Fekrat, Suchitha Kolloju, Marcos Rocha, Elzar Matmusaeva, Sasidhar Gunturu","doi":"10.1016/j.disamonth.2026.102064","DOIUrl":"https://doi.org/10.1016/j.disamonth.2026.102064","url":null,"abstract":"<p><p>Lithium remains the gold standard treatment for bipolar disorder after over 60 years of clinical use, with expanding therapeutic applications in neurodegenerative conditions. Despite its proven efficacy, lithium presents unique challenges due to its narrow therapeutic window and complex side effect profile. This comprehensive review synthesizes current evidence on lithium toxicity, adverse effects, and discontinuation management from 2019-2025, incorporating significant earlier studies. Lithium demonstrates efficacy in treating bipolar disorder, with approximately two-thirds of patients experiencing clinically significant improvement and more than half achieving remission. Additionally, it shows promising anti-suicidal properties, though careful management is required when discontinuing the medication. The manuscript examines lithium's pharmacokinetics and toxicity classification (acute, acute-on-chronic, and chronic), with detailed analysis of system-specific adverse effects including renal, neurological, cardiovascular, and endocrine manifestations. Risk factors for toxicity include age, comorbidities, drug interactions (particularly with NSAIDs, diuretics, and ACE inhibitors), and environmental factors. The review provides evidence-based recommendations for diagnostic evaluation, management protocols for toxicity cases, and monitoring guidelines to minimize adverse effects. Special attention is given to lithium discontinuation, highlighting the importance of gradual tapering to prevent relapse and withdrawal syndromes. For patients requiring alternative medication, the manuscript offers guidance on transition strategies to maintain mood stability. This comprehensive review aims to provide clinicians with practical guidance to optimize lithium therapy while minimizing risks.</p>","PeriodicalId":51017,"journal":{"name":"Dm Disease-A-Month","volume":" ","pages":"102064"},"PeriodicalIF":4.3,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-22DOI: 10.1016/j.disamonth.2026.102063
Jerrold B Leikin
{"title":"Foreword: Lithium: A review of its adverse effects, toxicity and discontinuation.","authors":"Jerrold B Leikin","doi":"10.1016/j.disamonth.2026.102063","DOIUrl":"https://doi.org/10.1016/j.disamonth.2026.102063","url":null,"abstract":"","PeriodicalId":51017,"journal":{"name":"Dm Disease-A-Month","volume":" ","pages":"102063"},"PeriodicalIF":4.3,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.disamonth.2025.102026
Dr. Jerrold B Leikin
{"title":"Foreword: Chronic kidney disease for the primary care provider","authors":"Dr. Jerrold B Leikin","doi":"10.1016/j.disamonth.2025.102026","DOIUrl":"10.1016/j.disamonth.2025.102026","url":null,"abstract":"","PeriodicalId":51017,"journal":{"name":"Dm Disease-A-Month","volume":"72 1","pages":"Article 102026"},"PeriodicalIF":4.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.disamonth.2025.102027
William Doak , Edgar Lerma , Ankur D. Shah
Chronic kidney disease (CKD) affects approximately 15% of U.S. adults and 9% of the global population, representing a growing public health challenge driven by aging populations and rising rates of diabetes and hypertension. Primary care providers (PCPs) play a pivotal role in CKD identification, risk stratification, and management, given their longitudinal relationships with patients and capacity for early intervention. This review provides a comprehensive framework for CKD management in primary care, synthesizing current evidence on diagnosis, risk prediction, and treatment. Key topics include appropriate use of estimated glomerular filtration rate (eGFR) and albuminuria for diagnosis and staging, risk-based screening in high-risk populations, and evidence-based pharmacotherapy including renin-angiotensin-aldosterone system inhibitors, sodium-glucose cotransporter-2 inhibitors, mineralocorticoid receptor antagonists, and glucagon-like peptide-1 receptor agonists. The review emphasizes risk-based nephrology referral strategies that integrate eGFR decline, albuminuria severity, and kidney failure risk equations to optimize specialist resource use. PCPs are positioned to slow disease progression, reduce cardiovascular morbidity, and coordinate timely specialty referral while managing polypharmacy and supporting shared decision-making about renal replacement therapy. Strengthening CKD care within primary care is essential to mitigating the rising global burden of kidney disease.
{"title":"Chronic kidney disease for the primary care provider","authors":"William Doak , Edgar Lerma , Ankur D. Shah","doi":"10.1016/j.disamonth.2025.102027","DOIUrl":"10.1016/j.disamonth.2025.102027","url":null,"abstract":"<div><div>Chronic kidney disease (CKD) affects approximately 15% of U.S. adults and 9% of the global population, representing a growing public health challenge driven by aging populations and rising rates of diabetes and hypertension. Primary care providers (PCPs) play a pivotal role in CKD identification, risk stratification, and management, given their longitudinal relationships with patients and capacity for early intervention. This review provides a comprehensive framework for CKD management in primary care, synthesizing current evidence on diagnosis, risk prediction, and treatment. Key topics include appropriate use of estimated glomerular filtration rate (eGFR) and albuminuria for diagnosis and staging, risk-based screening in high-risk populations, and evidence-based pharmacotherapy including renin-angiotensin-aldosterone system inhibitors, sodium-glucose cotransporter-2 inhibitors, mineralocorticoid receptor antagonists, and glucagon-like peptide-1 receptor agonists. The review emphasizes risk-based nephrology referral strategies that integrate eGFR decline, albuminuria severity, and kidney failure risk equations to optimize specialist resource use. PCPs are positioned to slow disease progression, reduce cardiovascular morbidity, and coordinate timely specialty referral while managing polypharmacy and supporting shared decision-making about renal replacement therapy. Strengthening CKD care within primary care is essential to mitigating the rising global burden of kidney disease.</div></div>","PeriodicalId":51017,"journal":{"name":"Dm Disease-A-Month","volume":"72 1","pages":"Article 102027"},"PeriodicalIF":4.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145395126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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