Lithium is first line therapy for Bipolar Disorder, mainly in acute manic face, after initiating lithium therapy, most common side effect is tremors.
1. why tremors, mechanism?
2. treatment for tremors - propranolol?
3. most accepted mechanism of action of lithium?
Please go to the following link and get the attachment
http://cpnp.org/resource/mhc/2012/01/lithium-and-valproate-induced-tremors
Thank You, Bhakta
I read both article, The etiology of lithium tremor is not fully understood. propranolol found to be more effective.
Here i would like to mention few points
Any adverse event due to medication can be.. directly related to pharmacological action of a drug or may be some other cause.. if u see lithium toxicity profile most of ADR related to their proposed mechanism of action. like for example polyuria- cAMP or Na
hypothyroidism- Iodine( Cation) . .. i asked this Q to know what may be correlation between tremor and lithium...
One more thing if u notice all proposed mechanism of action of lithium are neurodepressor or inhibitory.. ex: inhibition of inositol monophophatase, interfere with activity of G protein, inhibition of glutamate release, PKC inhibition, monovalent/divalent cation transport interference.
Tremors is of various type, if it is reduced by propranolol, it should be due to excitation cause..
I want to know more views/thoughts about this.
Since, we don't know exact mechanism of action of Lithium, even after 50yr of discovery . all these appears to be hypothesis.
Here is a very recent comprehensive review article on this topic by a well respected team:
Baek JH, Kinrys G, Nierenberg AA. Lithium tremor revisited: pathophysiology
and treatment. Acta Psychiatr Scand. 2014 Jan;129(1):17-23. doi:
10.1111/acps.12171. Epub 2013 Jul 3. PubMed PMID: 23834617.
Hope this helps!
Tremor is a typical and common side effect of lithium. It can be alleviated by reducing the dose of lithium, reducing the amount of coffee you drink, stopping other tremor drugs, or by using regular or appropriate beta-blockers (eg 10 to 40 mg of propranolol 1 to 3 times a day). If tremor occurs only when lithium plasma levels peak (1 to 2 hours after dosing), tremor may be avoided by taking the entire dose in a single evening dose. (M Huttunen, 2017)
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