From the Guidelines
Lithium can occasionally cause elevated Liver Function Tests (LFTs), though this is not among its common side effects. The potential for lithium to affect liver enzymes is noted, but it is not a primary concern in the management of patients on lithium therapy, as emphasized in the practice parameter for the assessment and treatment of children and adolescents with bipolar disorder 1. According to this guideline, before the initiation of lithium therapy, baseline laboratory assessment should include several tests, but liver function tests are specifically recommended for valproate, not lithium. However, it is crucial to monitor patients on lithium for various side effects and laboratory abnormalities, including renal and thyroid function, and urinalyses, every 3-6 months 1.
In clinical practice, while lithium-induced LFT elevations are typically mild and transient, resolving without discontinuation of the medication, patients should have baseline LFTs checked before starting treatment and monitored periodically thereafter. If significant LFT elevations occur, clinicians should evaluate for other causes of liver dysfunction and consider dose reduction or medication change if the elevations persist or worsen. The decision to continue lithium therapy should be made on an individual basis, weighing its potential effects on LFTs against its established efficacy in treating bipolar disorder and other psychiatric conditions.
Key considerations for managing patients on lithium include:
- Baseline laboratory assessments before initiating therapy
- Regular monitoring of lithium levels, renal and thyroid function, and urinalyses
- Awareness of potential side effects, including weight gain and metabolic problems associated with atypical antipsychotics, which may be used concomitantly
- Individualized decision-making regarding the continuation of lithium therapy in the face of elevated LFTs or other adverse effects, as guided by the most recent and highest quality evidence 1.
From the Research
Lithium and Liver Function Tests (LFTs)
- There is no direct evidence in the provided studies that lithium causes elevated Liver Function Tests (LFTs) 2, 3, 4, 5, 6.
- The studies discuss various aspects of LFTs, such as the role of standard liver function tests in current clinical practice 3, the correlation between statin use and abnormal LFTs 4, and the outcomes of routine testing of liver enzymes in institutionalized geriatric patients 5.
- However, none of the studies specifically mention lithium as a cause of elevated LFTs.
- It is worth noting that some medications, such as statins 4 and carbamazepine 6, can cause liver injury or abnormal LFTs, but lithium is not mentioned in this context.
Medications and LFTs
- Certain medications, such as statins, can cause dose-dependent borderline elevations of liver function tests over time 4.
- Carbamazepine is associated with hepatic abnormalities, ranging from an asymptomatic rise in liver function tests to acute liver failure 6.
- The studies suggest that medications can affect liver function, but there is no evidence to suggest that lithium specifically causes elevated LFTs.