Hewick D S, Newbury P, Hopwood S, Naylor G, Moody J
Br J Clin Pharmacol. 1977 Apr;4(2):201-5. doi: 10.1111/j.1365-2125.1977.tb00694.x.
1 We examined the case notes of 82 psychiatric out-patients (aged 21-84 years) receiving lithium prophylaxis and with steady-state plasma lithium levels. 2 The mean weight-related daily dose of lithium prescribed decreased by about 50% between the third and eight decades. 3 The corresponding steady-state plasma lithium levels showed a less marked tendency to decrease, this only being seen in the seventh and eighth decades. 4 In patients aged 50 years or over the daily lithium dose required to give a plasma level of 1 mmol l-1 (0.50 mmol kg-1) was significantly lower than that (0.65 mmol kg-1) in patients aged under 50 years (P less than 0¿5, Student's t-test). In patients aged 70-79 years this dose was 31% lower than in patients under 50 years. However, interindividual variation was great and it was estimated that age only contributed about 14% to the total interpatient variation. 5 Of the 36 patients under 50 years of age, 42% had minor lithium side-effects and 17% were not optimally controlled with lithium. The corresponding figures for the 46 'older' patients were 46% and 28%. 6 Generally the 50% dosage reduction seemed necessary to compensate for an age-related decrease in lithium excretion and to reduce lithium side effects to a level comparable to that acceptable in younger patients.
我们查阅了82名接受锂盐预防性治疗且血浆锂水平处于稳态的精神科门诊患者（年龄在21 - 84岁之间）的病历。
按体重计算的锂盐每日处方剂量在第三个十年和第八个十年之间下降了约50%。
相应的稳态血浆锂水平下降趋势不太明显，仅在第七个十年和第八个十年出现下降。
在50岁及以上的患者中，使血浆水平达到1 mmol l-1（0.50 mmol kg-1）所需的每日锂盐剂量显著低于50岁以下患者（0.65 mmol kg-1）（P < 0.05，Student's t检验）。在70 - 79岁的患者中，该剂量比50岁以下患者低31%。然而，个体间差异很大，据估计年龄仅占患者间总差异的约14%。
在36名50岁以下的患者中，42%有轻微的锂盐副作用，17%未用锂盐得到最佳控制。46名“老年”患者的相应数字分别为46%和28%。
一般来说，似乎有必要将剂量减少50%，以补偿与年龄相关的锂排泄减少，并将锂盐副作用降低到与年轻患者可接受水平相当的程度。
