A new accurate method for predicting lithium clearance and daily dosage requirements in adult psychiatric patients


  • The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.

Corresponding author: Hisham S Abou-Auda, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, PO Box 2457, Riyadh-11451, Saudi Arabia.
Fax: +966 1 467 6229; e-mail: hisham@ksu.edu.sa


Objective:  The present study aimed to derive new equations for estimating lithium clearance and daily dosage requirements needed to achieve an intended lithium serum level for adult psychiatric inpatients and outpatients.

Methods:  Data were retrospectively collected from 60 adult psychiatric patients (34 males and 26 females, aged between 18–80 years) in both inpatient and outpatient settings. All variables that might affect lithium clearance and/or lithium serum concentration were included and analyzed by stepwise multiple linear regression to produce equations describing lithium clearance and daily dosage requirements for these patients. The validation of the developed equations was performed by application to another 60 psychiatric subjects in both the inpatient and outpatient settings. The bias and accuracy of the new methods were also compared to those set forth by the empirical method and the a priori methods developed by Zetin, Pepin, Jermain and Terao and colleagues.

Results:  The following prediction equations for lithium clearance (CLLi) were obtained: CLLi (inpatients) = 0.932 + 0.185CLCr and CLLi (outpatients) = 1.021 + 0.141CLCr. The equations derived for daily dosage requirements were: daily dose (inpatients, mg) = 350.15 + 289.92 (desired lithium level, mmol/L) + 0.84 (weight, kg) − 1.76 (age, years) + 34.43 [tricyclic antidepressant (TCA), yes = 1, no = 0] + 62.1(CLCr, L/h) + 13.1 [blood urea nitrogen (BUN), mmol/L] + 40.9 (sex, male = 1, female = 0) and daily dose (outpatients, mg) = 784.92 + 530.22 (desired lithium level, mmol/L) + 8.61 (weight, kg) − 12.09 (age, years) − 11.14 (TCA, yes = 1, no = 0) − 7.63 (CLCr, L/h) − 42.62 (BUN, mmol/L) − 23.43 (sex, male = 1, female = 0). In the present method, the prediction error for clearance was 10.31% and 6.62% for inpatients and outpatients, respectively, and the prediction error for daily dosage requirements was 3.96% and 2.95% for inpatients and outpatients, respectively.

Conclusions:  Compared to previously reported methods, the present method proved to be accurate and can be safely used for the prediction of lithium clearance and daily dosage requirements in psychiatric inpatients and outpatients.