Side Effects of macitentan and tadalafil: A Synthesis of Findings from 4 Studies

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Original Abstract of the Article

Main Research Findings

Lithium is commonly prescribed in psychiatric clinical practice. This study aimed to identify the most common endocrine side effects associated with this drug and clarify their pathophysiological basis. 4 All treatment guidelines recommend lithium as a first-line maintenance treatment for bipolar disorder (BD). However, the potential side effects and risks associated with long-term lithium use can sometimes make it challenging to implement these recommendations in daily practice. 3 Lithium is the only drug that received the highest level of recommendation for maintenance therapy in the recent German S3 guidelines on bipolar disorders. It is also the only drug with proven efficacy for the prevention of manic as well as depressive episodes in studies with a non-enriched design. 2

Reasons for Side Effects

Lithium can cause a variety of endocrine side effects, including hypothyroidism, nephrogenic diabetes insipidus, hyperparathyroidism, and hypercalcemia. 4 These side effects are caused by lithium's interactions with various endocrine systems, including the thyroid, kidneys, parathyroid glands, pancreas, and the communication pathways between the pituitary and adrenal glands. 4

Common Side Effects

Kidney

Lithium can slightly reduce glomerular filtration rate and maximum urinary concentration ability. 2 More patients experienced renal failure compared to controls, although renal failure remains a very rare event. 2

Thyroid

Lithium is known to have suppressive effects on the thyroid. 2 Instead of stopping lithium administration, L-thyroxine substitution therapy is indicated for (subclinical) hypothyroidism. 2

Parathyroid

An increase in serum calcium can be observed relatively frequently under lithium therapy. Therefore, regular control of serum calcium is recommended. 2

Body Weight

A relevant increase in body weight is more frequent under lithium than under placebo, but less frequent than under olanzapine. 2

Other Side Effects

No statistically significant increase was found for hair loss, skin disorders, or major congenital abnormalities. 2 Children with conduct disorder, aged 5.08 to 12.92 years, showed a statistically significant correlation between age and the number of side effects, with younger children experiencing more side effects than older children. 1 This correlation remained after adjusting for weight, serum lithium levels, optimal dose, and duration of optimal dose. 1

Side Effects Management

Kidney

Regular monitoring and maintaining appropriate serum lithium levels are crucial for mitigating the risk of renal failure. 2

Thyroid

Regular thyroid function testing is recommended during lithium therapy. 2 If hypothyroidism is detected, L-thyroxine substitution therapy is recommended. 2

Parathyroid

Regular monitoring of serum calcium levels is essential, and appropriate interventions should be taken if necessary. 2

Body Weight

Maintaining a healthy diet and engaging in regular exercise are crucial for preventing weight gain. 2

Research Comparisons

Similarities

All four studies investigated the potential side effects of lithium and highlighted the importance of clinical and paraclinical evaluations. 4 3 2 1

Differences

The studies differed in the types of side effects they focused on and the populations they studied. 4 3 2 1

Real-Life Applications

Lithium is an effective medication for treating bipolar disorder, but it is crucial to understand the risks associated with its potential side effects. 3 If you are taking lithium, it is essential to follow your doctor's instructions and undergo regular checkups. 2

Limitations of Current Research

More research is needed on the long-term effects of lithium. 3 Furthermore, lithium side effects can vary from person to person. 2

Future Research Directions

Further research is required to investigate the long-term effects of lithium and develop new strategies to mitigate its side effects. 3

Conclusion

Lithium is an effective medication for treating bipolar disorder, but it's crucial to understand the potential risks associated with its side effects. 3 If you are taking lithium, follow your doctor's instructions and undergo regular checkups. 2 Further research is needed to investigate the long-term effects of lithium and develop new strategies to mitigate its side effects. 3

Literature analysis of 4 papers
Positive Content
2
Neutral Content
1
Negative Content
1
Article Type
1
1
3
2
4
1.

Predictors of side effects associated with lithium administration in children.

Author: CampbellM, SilvaR R, KafantarisV, LocascioJ J, GonzalezN M, LeeD, LynchN S

Side effects in children

A pooled analysis of three controlled and double-blind studies involving 48 hospitalized children with conduct disorder revealed that younger children experienced more side effects associated with lithium administration than older children. This relationship remained statistically significant after adjusting for factors such as weight, serum lithium levels, optimal dose, and duration of optimal dose.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, U.S. Gov't, P.H.S.Research funding provided by the Public Health Service (PHS).

Language : English

2.

[Side effects and risk profile of lithium: critical assessment of a systematic review and meta-analysis].

Author: BschorT, BauerM

Prevention of depressive episodes
Prevention of manic episodes
Hypothyroidism
Increased body weight
Renal failure

Lithium is the only drug with a strong recommendation for maintenance therapy in bipolar disorders, with proven efficacy for preventing both manic and depressive episodes. This comprehensive review of lithium's risks and side effects confirms its safety when used according to established guidelines. While renal failure is rare, regular monitoring is crucial, especially in patients with high lithium levels. Subclinical hypothyroidism is not an indication to stop lithium but requires thyroid hormone replacement. Lithium use during pregnancy requires careful consideration of both continuing and stopping the medication.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : German

3.

[Lithium treatment and potential long-term side effects: a systematic review of the literature].

Author: AlbertUmberto, De CoriDavid, BlenginoGiovanni, BogettoFilippo, MainaGiuseppe

Bipolar disorder treatment
Lithium side effects

Lithium is a common medication for bipolar disorder and is recommended as a first-line maintenance treatment by all guidelines. However, its long-term use can lead to side effects, making it challenging to implement the recommendations in practice. This study reviews the available literature on the potential long-term side effects of lithium.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : Italian

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