10 June 2020 : Case report
Unusual or unexpected effect of treatment, Adverse events of drug therapyGuy Philip Armstrong1ABCDEFG*
Am J Case Rep 2020; 21:e923311
BACKGROUND: Empagliflozin selectively reduces apical sodium-glucose co-transporter 2 function in the proximal convoluted tubules, increasing sodium and glucose excretion in the urine, ultimately reducing glucose reabsorption in the kidneys for diabetic management. Lithium, the gold-standard treatment for bipolar disorder, also utilizes sodium transporters in the proximal convoluted tubules.
CASE REPORT: Presenting with a manic relapse of refractory schizoaffective disorder, our patient was found to have subtherapeutic levels of lithium on admission due to poor outpatient medication compliance. Restoration to therapeutic lithium levels allowed inpatient blood glucose measurements, which led to a new diagnosis of type 2 diabetes mellitus. Given his comorbid severe hepatic impairment, obesity, and prior pancreatitis, the patient was started on empagliflozin to safely manage this new diagnosis without collateral organ injury. Routine monitoring found reproducible and clinically significant decreases in serum lithium levels in the presence of empagliflozin therapy, without obvious confounding factors. Subsequent discussion with specialist teams resulted in trialling metformin, which adequately controlled the new diabetic diagnosis without inpatient complications.
CONCLUSIONS: We suspect that empagliflozin reduced sodium-glucose and lithium-glucose reabsorption in the proximal connecting tubules, thereby increasing the renal excretion of sodium, glucose, and lithium. Applications include awareness of the interaction between these medications, support for the role of physiological SGLT-2-mediated lithium transport, and the possibility of using empagliflozin and other SGLT-2 inhibitors to treat life-threatening lithium toxicity.
Keywords: Drug Interactions, Lithium, Sodium-Glucose Transporter 2, Renal Excretion, Antimanic Agents, Benzhydryl Compounds, Diabetes Mellitus, Type 2, Glucosides, Hypoglycemic Agents, Lithium Compounds, medication adherence, Metformin, Psychotic Disorders, Sodium-Glucose Transporter 2 Inhibitors
09 Jan 2024 : Case reportChallenges of Post-Venipuncture Jugular Venous Thrombosis in Patients with Secondary Hyperparathyroidism: A...
Am J Case Rep In Press; DOI: 10.12659/AJCR.943270
09 Jan 2024 : Case reportNeurotrophic Keratopathy in Marfan Syndrome Patient After Micropulse Transscleral Cyclophotocoagulation: A ...
Am J Case Rep In Press; DOI: 10.12659/AJCR.942538
03 Feb 2024 : Case reportDefinitive Closure Using an Ovine Reinforced Tissue Matrix in Contaminated Penetrating Abdominal Trauma
Am J Case Rep In Press; DOI: 10.12659/AJCR.943188
Most Viewed Current Articles
10 Jan 2022 : Case reportA Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...
Am J Case Rep 2022; 23:e935263
19 Jul 2022 : Case reportAtlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19
Am J Case Rep 2022; 23:e936128
05 Mar 2022 : Case reportAcute Limb Ischemia After Self-Injection of Crushed Morphine Tablets into the Radial Artery: Role of Infrar...
Am J Case Rep 2022; 23:e935336