Is it safe to take lithium (lithium carbonate) 200mg daily with impaired renal function (eGFR of 49) and elevated creatinine (127)?

Lithium Use with eGFR of 49 and Elevated Creatinine

Lithium at 200mg daily is not recommended with an eGFR of 49 and creatinine of 127 due to increased risk of lithium toxicity and further renal deterioration.

Renal Risk Assessment

The FDA label for lithium clearly states that it should generally not be given to patients with significant renal disease due to very high risk of lithium toxicity 1. Your current renal function shows:

• eGFR of 49 ml/min/1.73m² (CKD Stage 3a)
• Elevated creatinine of 127 μmol/L

Evidence-Based Concerns

1. Nephrotoxicity Risk: KDIGO guidelines specifically recommend temporary discontinuation of potentially nephrotoxic medications, including lithium, in people with GFR <60 ml/min/1.73m² (your current level) 2.

2. Progressive Renal Damage: Long-term lithium use is associated with chronic kidney disease progression. Research shows approximately one-third of patients taking lithium for 10-29 years develop chronic renal failure 3.

3. Monitoring Requirements: The FDA requires extremely close monitoring of lithium levels and renal function in patients with compromised kidney function 1.

Alternative Management Options

If you have bipolar disorder requiring mood stabilization, consider these alternatives:

• Valproate or lamotrigine which have less impact on renal function
• Atypical antipsychotics such as quetiapine or olanzapine for mood stabilization
• Psychotherapy as an adjunctive treatment

If Lithium Must Be Continued

If lithium is absolutely necessary for psychiatric stability and no alternatives are viable:

1. Reduce dosage - 200mg is already a low dose, but may still be problematic with your renal function

2. More frequent monitoring:

   • Weekly serum lithium levels initially
   • Renal function tests every 2-4 weeks
   • Target lower therapeutic lithium levels (0.4-0.6 mmol/L)

3. Nephrology consultation for co-management

Important Considerations

• Research indicates that discontinuation of lithium can lead to improvement in renal function in the majority of patients with CKD 4
• The risk of end-stage renal disease increases with duration of lithium exposure 5
• Even at low doses, lithium can cause further deterioration in patients with existing renal impairment 3

Conclusion

Given your current renal function parameters (eGFR 49, creatinine 127), the risks of continuing lithium therapy likely outweigh the benefits. The FDA contraindication and KDIGO guidelines both suggest avoiding lithium in your situation. Discuss alternative mood stabilization strategies with your psychiatrist while working with a nephrologist to monitor and preserve your remaining kidney function.