From the Guidelines
Lithium dosing in patients with a gastric sleeve requires careful consideration due to altered absorption and potential interactions with other medications and supplements.
Key Considerations
- Altered absorption: Patients with a gastric sleeve may have impaired absorption of lithium due to changes in gastric anatomy and physiology 1.
- Dose adjustment: Lithium doses may need to be adjusted to account for altered absorption, and patients should be closely monitored for signs of toxicity or subtherapeutic levels 1.
- Interactions with supplements: Patients with a gastric sleeve often require supplements to prevent nutritional deficiencies, and these supplements can interact with lithium, such as iron and calcium 1.
- Alternative formulations: Consider using liquid or chewable formulations of lithium to improve absorption, or alternative routes of administration such as sublingual or parenteral 1.
- Monitoring: Close monitoring of lithium levels and renal function is essential in patients with a gastric sleeve to minimize the risk of toxicity or subtherapeutic levels 1.
Recommendations
- Start with a low dose: Begin with a low dose of lithium and gradually increase as needed and tolerated, with close monitoring of levels and side effects.
- Monitor levels closely: Regularly monitor lithium levels, renal function, and thyroid function to minimize the risk of toxicity or subtherapeutic levels.
- Consider alternative treatments: In some cases, alternative treatments such as valproate or olanzapine may be considered due to their more predictable pharmacokinetics and lower risk of interactions with supplements 1.
The FDA Drug Labels for lithium (PO) do not address this question.
From the Research
Considerations for Lithium Dosing
- The pharmacokinetics of lithium can be altered following bariatric surgery, such as sleeve gastrectomy, leading to a high risk of lithium toxicity 2, 3, 4, 5, 6.
- Patients undergoing bariatric surgery, especially those with psychiatric disorders, require close monitoring of lithium levels and possible adjustment of the dose to prevent toxicity 2, 4, 6.
- The bioavailability of lithium can be significantly affected after bariatric surgery, and regular postoperative clinical and laboratory monitoring of lithium serum levels is strongly recommended 4, 5, 6.
- Lithium toxicity can occur even after a prolonged period following bariatric surgery, and patients may present with gastrointestinal and neurological symptoms 3, 6.
- A monitoring protocol to prevent toxicity, including regular checks of lithium levels and adjustment of the dose as needed, should be implemented for patients taking lithium after bariatric surgery 5, 6.