Lithium: Anesthetic interactions

Basic, Basic Sciences

Lithium is a commonly used mood stabilizing drug. One of lithium’s proposed mechanisms of action is a reduction in the release of neurotransmitters in the CNS and PNS which also may lead to many of its adverse side effects and anesthetic interactions. Unfortunately, despite its clinical benefit, lithium has a narrow therapeutic ratio. It has numerous side effects including interference of anti-diuretic hormone (ADH) action, cardiac dysrhythmias, gastrointestinal disturbances, and tremor. As lithium is excreted solely by the kidney, patients with renal failure are at increased risk for adverse effects and anesthetic interactions.

Anesthetic interactions include:

• Prolongation of depolarizing neuromuscular block (DNMB),

• Reduction in the requirements of anesthetic agents, 

• NSAIDs, reduce the excretion of lithium by the kidneys, and it can result in toxic plasma levels. 

• Toxic symptoms tend to occur with plasma levels of >1.5 mmol litre−1. Thus, it is generally advised that lithium should be is stopped at least 24 h before surgery.


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Abdullah S. Terkawi, MD