My eGFR is 39; will lithium orotate be toxic?

QuestionsMy eGFR is 39; will lithium orotate be toxic?
Anonymous asked 7 years ago
Dear Dr DeanI am 64 and was diagnosed with bipolar disorder when I was 41. I am very prone to periods of severe depression and also experience hypomania, so I assume I am type II bipolar.I was taking 1200 mg of lithium carbonate between 1994 and 2012, and 800 mg between 2012 and 2014. In September 2014 I was informed my eGFR was 39 so I stopped taking lithium carbonate.  After a period of trying other drugs I have been taking quetiapine from February 2016 to the present day. I started on 400mg daily and have reduced to 150mg daily.I am very interested in taking lithium orotate rather than quetiapine, but am concerned about lithium toxicity. I am aware that the dose I would need is far less than on lithium carbonate, but would appreciate your opinion on whether 240 mg of lithium orotate (which I presume corresponds to 9.2mg of elemental lithium) would present a toxicity problem for me. Or is 240mg too much to start with?My eGFR has remained stable at 39 since March 2014.My psychiatrist has agreed that, were I to take lithium orotate, my eGFR would be monitored.I would value your opinion on this matter.Yours sincerelyBernard Greenwood.
1 Answers
Ward Dean, MD answered 7 years ago
I believe you may be able to get along on as little as 60 mg of Lithium Orotate, and recommend you start with that dose.   Increase by 60 mg each month, if needed.  Doses of lithium orotate should not approach nephrotoxic levels, so your GFR should be unaffected by the lithium orotate.

Other regimens you may employ to try to increase your GFR are one or two teaspoons of sodium or potassium bicarbonate each day, and one or two grams of L-Taurine.  Many of my patients have normalzed their GFRs on this regimen.