Key result
Creatinine clearance-based pharmacokinetic model predicts serum lithium concentrations with ~0.13 mEq/L mean absolute error.
Observational (n=112)
A creatinine clearance-based pharmacokinetic model can predict serum lithium concentrations with high precision.
May aid lithium dosing in renal impairment; leaves open prospective validation before clinical adoption.
INTRODUCTION: Therapeutic drug monitoring is necessary for lithium, but clinical application of several prediction strategies is still limited because of insufficient predictive accuracy. We herein proposed a suitable model, using creatinine clearance (CLcr)-based lithium clearance (Li-CL). METHODS: Patients receiving lithium provided the following information: serum lithium and creatinine concentrations, time of blood draw, dosing regimen, concomitant medications, and demographics. Li-CL was calculated as a daily dose per trough concentration for each subject, and the mean of Li-CL/CLcr was used to estimate Li-CL for another 30 subjects. Serum lithium concentrations at the time of sampling were estimated by 1-compartment model with Li-CL, fixed distribution volume (0.79 L/kg), and absorption rate (1.5/hour) in the 30 subjects. RESULTS: One hundred thirty-one samples from 82 subjects (44 men; mean±standard deviation age: 51.4±16.0 years; body weight: 64.6±13.8 kg; serum creatinine: 0.78±0.20 mg/dL; dose of lithium: 680.2±289.1 mg/day) were used to develop the pharmacokinetic model. The mean±standard deviation (95% confidence interval) of absolute error was 0.13±0.09 (0.10-0.16) mEq/L. DISCUSSION: Serum concentrations of lithium can be predicted from oral dosage with high precision, using our prediction model.
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Yoshida et al. (2017) conducted an observational in Patients receiving lithium therapy (n=112). Creatinine clearance-based lithium clearance prediction model was evaluated on Absolute error of estimated serum lithium concentrations (Mean absolute error 0.13 mEq/L, 95% CI 0.10-0.16). A creatinine clearance-based pharmacokinetic model predicted serum lithium concentrations with a mean absolute error of 0.13 mEq/L (95% CI 0.10-0.16).
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