II. Indication
III. History
- Lithium has been used since the 1800s as a treatment for gout and Seizure Disorder and as of 1900s for mania
IV. Contraindications
- Pregnancy
- Associated with Ebstein Anomaly when exposure in first trimester
V. Mechanism
- May increase CNS Serotonin levels
- Neuroprotective effect
- Decreases intracellular Inositol monophosphate concentrations
- Mood stabilization effect
- Inhibits Glycogen Synthase Kinase 3 (GSK3B)
- Enzyme involved in Neuronal development and Energy Metabolism
- GSK3B overexpression may be associated with Bipolar Disorder
VI. Pharmacokinetics
- Lithium Carbonate is a simple salt that is excreted and not metabolized
- Lithium is an alkali metal (the smallest metal, having atomic number 3)
- Steady state reached in 5 days
- Check Lithium levels 5 days after starting dose or changing dose
- Therapeutic Trough levels
- Acute mania: 1.0 to 1.2 meq/L
- Maintenance Bipolar Disorder: 0.8 to 1.0 meq/liter
- Increasing dose 300 mg/day raises level 0.2 meq/L
- Excretion
- Renal excretion (and 60% reabsorbed at proximal tubules)
VII. Preparations
- Lithium Carbonate (immediate release)
- Lithobid (sustained release)
- Eskalith (sustained release)
VIII. Dosing
- Blood levels peak 1-2 hours after immediate release products at therapeutic dose (4-6 hours after sustained release)
- Effective dose: 900 to 1800 mg per day divided twice daily (or 3-4 times daily)
- Start: 300 mg orally twice daily
- May adjust dose every 2-3 days as tolerated
IX. Adverse Effects
- Polyuria
-
Hypothyroidism
- Often reversible on stopping Lithium
- Higher Prevalence in women and with increasing age
- Weight gain
- Fine Tremor
- Withdrawal symptoms on stopping
- More common than with Valproate or Lamotrigine
XI. Toxicity
- See Lithium Toxicity
- Precaution
- Toxicity is dose dependent and Overdose can be lethal
- Pregnancy
- Highly Teratogenic
- Cerebellar Signs or symptoms
- Mechanism
- Poor therapeutic window
- Renal excretion
XII. Drug Interactions
XIII. Monitoring
- Serum Lithium level
- Day 5 after starting Lithium
- Then every 1-2 weeks initially
- Then every 3-6 months
- Also check serum levels before and 5 days after dose changes
- Other labs
- Schedule
- Baseline
- Month 3
- Month 6
- Every 6 to 12 months thereafter
- Thyroid Stimulating Hormone (TSH)
- Renal Function tests
- Schedule
XIV. References
- Perrone and Chatterjee (2018) UpToDate, accessed 8/20/2018
Images: Related links to external sites (from Bing)
Related Studies
lithium carbonate (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
LITHIUM CARBONATE 150 MG CAP | Generic | $0.08 each |
LITHIUM CARBONATE 300 MG CAP | Generic | $0.06 each |
LITHIUM CARBONATE 300 MG TAB | Generic | $0.13 each |
LITHIUM CARBONATE 600 MG CAP | Generic | $0.15 each |
LITHIUM CARBONATE ER 300 MG TB | Generic | $0.13 each |
LITHIUM CARBONATE ER 450 MG TB | Generic | $0.19 each |