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Lithium Use Associated with Injurious Motor Vehicle Accidents Among Older Drivers, But No Similar Association Seen with Carbamazepine Use

Lithium use in older drivers may result in a significantly increased risk of involvement in an injurious motor vehicle accident, while the mood stabiliser, carbamazepine was not associated with such an increased risk, according to the findings of a case-control study conducted in Canada.

Professor Samy Suissa, McGill University Health Centre, Montreal, and colleagues used data from the Quebec Health Insurance Agency to identify lithium and carbamazepine prescriptions in individuals aged 65 and older, and data from the Universal Quebec Automobile Insurance Agency to identify drivers aged between 67 and 84 years old to assess any association between the medication use and injurious motor vehicle accidents.

From June 1, 1990 through May 31, 1993, 5,579 individuals using either drug had a motor vehicle accident involving injuries. The investigators found a higher current use of lithium among individuals involved in such accidents than among a random sample of 13,300 control subjects.

After adjusting for age, sex, urban or rural residence, previous involvement in an injurious motor vehicle accident, chronic disease score, and exposure to central nervous system medications, including antidepressants, anti-epileptics, benzodiazepines, antipsychotics, antimigraine drugs, muscle relaxants, or narcotic analgesics within the 60 days prior to the accident, the investigators identified an odds ratio of 2.08 for injurious motor vehicle accidents among those using lithium within the previous 60 days.

Comparatively, the odds ratio was 0.83 for such motor vehicle accidents among current carbamazepine users.

"Elderly people who use lithium may increase by twofold the risk of being involved in an injurious motor vehicle crash while driving," the authors write adding that, "Patients who are prescribed lithium must be told about the increased risk of motor vehicle crashes."

BMJ doi:10.1136/bmj.38002.514838.94 (published 19 January 2004).

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