Case: Rising serum creatinine in a patient on lithium

Question from a Member: I have a patient with Bipolar II, currently on lithium and lamotrigine; her creatinine level is trending up (1.05, then 1.12 two months later) and GFR is trending down ([recently] 56). She has not tolerated divalproex, oxcarbazepine, or carbamazepine, and had disinhibiting behavior with five atypical antipsychotics that have been tried….