Serum Lithium After Initiation of Sodium-Glucose Cotransporter 2 Inhibitor Treatment
Christopher Rohde, Søren Dinesen Østergaard, Klavs Würgler HansenBackground:
Sodium-glucose cotransporter 2 (SGLT2) inhibitors may increase renal clearance of lithium, but prior results are mixed. We investigated this aspect using data from Danish nationwide registers.
Materials and Methods:
We identified all patients with bipolar disorder or unipolar depression between January 1, 2000, and June 1, 2024, who initiated SGLT2 inhibitor treatment (index date). Concurrent lithium treatment was defined by a serum lithium measurement within 90 days before the index date. Changes in serum lithium levels from the pre-index measurement to the first, second, and third post-index measurements were assessed. Furthermore, an analogue positive control analysis based on data from patients who initiated treatment with a thiazide diuretic was performed, as this class of drugs is known to increase lithium levels.
Results:
We identified 131 patients with pre-index and post-index serum lithium measurements (ie, before and after initiation of SGLT2 inhibitor treatment). Mean serum lithium decreased from 0.59 mmol/L pre-index to 0.52 mmol/L at the first post-index measurement [difference: −0.07 (95% CI: −0.11, −0.03) mmol/L,
Conclusions:
Initiation of SGLT2 inhibitor treatment may reduce serum lithium levels to subtherapeutic levels.