The edition · Clinical Pharmacology
Lithium in children: reports point to kidney, thyroid and gut effects to watch for
A VigiBase analysis compares lithium's reported adverse reactions with second-generation antipsychotics across ages. Plus a reassuring PCSK9 inhibitor signal scan, levetiracetam kinetics in cooled newborns, and a sterility recall of compounded tirzepatide vials.
The edition in brief
An analysis of nearly 30,000 lithium adverse-reaction reports in the WHO VigiBase database found that, in children, lithium reports carried proportionally more renal, endocrine, gastrointestinal, skin and cardiac reactions than reports for second-generation antipsychotics, with thyroid reactions relatively prominent in children and renal failure more prominent in older adults. Spontaneous-report data show reporting patterns, not incidence, but support structured renal and thyroid monitoring in young people on lithium. A French nationwide sequence symmetry analysis of 36,163 PCSK9 inhibitor initiators, matched to ezetimibe initiators and checked against VigiBase, found only two potential signals across 700 outcomes — new inhaled corticosteroids and colony-stimulating factors — both judged likely to reflect confounding. A population pharmacokinetic study of levetiracetam in 15 cooled term neonates with hypoxic-ischaemic encephalopathy found clearance rose with creatinine clearance and serum sodium, with no link between drug exposure and seizure reduction. The FDA lists a Class II recall of a compounded tirzepatide multi-dose vial for lack of sterility assurance. The pearl covers the drugs that raise lithium levels.
PCSK9 inhibitors: a 700-outcome signal scan found little to worry about
Reassure patients starting a PCSK9 inhibitor that a large real-world scan found no new serious safety signals.
FDA lists a sterility recall of a compounded tirzepatide multi-dose vial
Check whether patients' GLP-1 injections are licensed products, and treat infections in compounded-product users as possibly product-related.
Levetiracetam in cooled newborns: kidney function and sodium shape clearance
When continuing levetiracetam in cooled neonates, account for changing kidney function rather than escalating doses for better seizure control.
The prescriptions that push lithium into toxicity
Check a lithium level soon after any new thiazide, ACE inhibitor, ARB or NSAID, and during dehydrating illness.
Lithium in young people: renal and thyroid monitoring belongs in the plan from the start
When starting lithium in a young person, schedule renal and thyroid monitoring from the outset and tell families which symptoms to report.
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