Lithium

Lithium is indicated to treat bipolar disorder.

Lithium is available under the following different brand names: Eskalith, and Lithobid.

Dosage Forms and Strengths

Tablet, extended release

• 300 mg
• 450 mg

Tablet

• 300 mg

Capsule

• 150 mg
• 300 mg
• 600 mg

Solution

• 8 mEq/5mL

Dosage Considerations – Should be Given as Follows:

Bipolar Disorder

Adult

• Immediate release: 900-2400 mg/day orally divided every 6-8 hours
• Extended release: 900-1800 mg/day orally divided every 12 hours
• Lower initial dosage may be used to minimize adverse drug reactions
• Serum lithium should be monitored 12 hours after dose, twice weekly until serum concentration and clinical condition stabilize, and every other month thereafter
• Desirable range for serum lithium: 0.6-1.2 mEq/L; although higher serum concentrations may be needed, not to exceed 1.5 mEq/L

Pediatric (Off-label)

• Children younger than 6 years: Safety and efficacy not established
• Children 6-12 years: 15-60 mg/kg/day orally divided every 6-8 hours; not to exceed adult dosage
• Children over 12 years: Immediate release, 900-2400 mg/day orally divided every 6-8 hours; extended release, 900-1800 mg/day orally divided every 12 hours

Huntington's Disease (Orphan)

• Lithium citrate tetrahydrate (in reverse micelle formulation)
• Orphan indication sponsor
  • Medesis Pharma; L'Oree des Mas, 34 670 Baillargues, France

Administration

• Preferably taken with food

Dosage Considerations

• Dosing in elderly patients should be cautious, usually starting at low end of range
• Elderly patients often respond to reduced dosage and may exhibit signs of toxicity at serum concentrations ordinarily tolerated by younger patients

Side effects associated with use of Lithium, include the following:

• Increased white blood cell count (leukocytosis) (most patients)
• Increased urination
• Excess thirst
• Dry mouth
• Hand tremor (45% initially, 10% after 1 year of treatment)
• Confusion
• Decreased memory
• Headache
• Muscle weakness (30% initially, 1% after 1 year of treatment)
• Electrocardiographic (ECG) changes
• Nausea, vomiting, diarrhea (10-30% initially, 1-10% after 1-2 years of treatment)
• Overactive reflexes
• Muscle twitch
• Spinning sensation (vertigo)

Less common side effects of lithium include:

• Extrapyramidal symptoms (i.e., muscle spasms, restlessness, slowness of movement, tremor, and irregular/jerky movements)
• Goiter
• Hypothyroidism
• Acne
• Hair thinning

Other side effects of lithium include:

• Coma
• Lethargy
• Seizures
• Renal toxicity

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Severe Interactions of lithium include:
  • None
• Lithium has serious interactions with at least 75 different drugs.
  • azilsartan
  • candesartan
  • desvenlafaxine
  • eprosartan
  • irbesartan
  • isocarboxazid
  • linezolid
  • lorcaserin
  • losartan
  • mefloquine
  • olmesartan
  • phenelzine
  • procarbazine
  • sacubitril/valsartan
  • sodium phosphate rectal
  • telmisartan
  • tranylcypromine
  • valsartan
  • vilazodone
  • vortioxetine
• Lithium has moderate interactions with at least 134 different drugs.
• Lithium has mild interactions with at least 64 different drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

Warnings

• Toxicity is closely related to serum lithium concentrations and may occur at dosages close to therapeutic levels; monitor therapy by measuring serum lithium
• Equipped facilities should be identified before initiation of therapy to provide prompt and accurate serum lithium concentration data
• This medication contains lithium. Do not take Eskalith or Lithobid if you are allergic to lithium or any ingredients contained in this drug
• Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately

Contraindications

• Documented hypersensitivity
• Severe cardiovascular disease
• Pregnancy in 1st trimester
• Unstable renal function, sodium depletion, severe dehydration
• Severe debilitation

Effects of Drug Abuse

• No information provided

Short-Term Effects

• See "What Are Side Effects Associated with Using Lithium?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Lithium?"

Cautions

• Cardiovascular disease; reports of possible association between lithium treatment and unmasking of Brugada syndrome (abnormal ECG and risk of sudden death)
• Use with caution in patients with thyroid disease
• Narrow therapeutic index
• Risk of nephrogenic diabetes insipidus; such patients should be carefully managed to avoid dehydration with resulting lithium retention and toxicity; condition is usually reversible when lithium is discontinued
• Lithium-sensitive patients may experience toxicity symptoms with serum lithium concentrations of 1-1.5 mEq/L
• Lithium toxicity is closely related to serum levels and can occur at therapeutic dosages; if manifestations of toxicity occur, discontinue for 24-48 hours, then resume at lower dosage
• Mainitain geriatric patients on dosages that produce serum lithium concentrations at lower end of desired range
• May cause central nervous system (CNS) depression and impair ability to operate heavy machinery
• Hypercalcemia reported with or without hyperparathyroidism; women and older patients are possibly at greater risk; onset does not appear to be associated with duration of therapy
• Monitor changes in renal function; chronic therapy may diminish renal concentrating ability; usually reversible when lithium therapy discontinued
• Use caution in debilitated patients; may increase risk of lithium toxicity
• Use with caution in patients at risk for suicide
• The risk of lithium toxicity is increased in patients with significant renal or cardiovascular disease, severe debilitation or dehydration, or sodium depletion, and for patients receiving prescribed medications that may affect kidney function, such as angiotensin converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs), diuretics (loops and thiazides) and NSAIDs; for these patients, consider starting with lower doses and titrating slowly while frequently monitoring serum lithium concentrations and signs of lithium toxicity
• Cases consistent with nephrotic syndrome reported with use of lithium; discontinuation of lithium in patients with nephrotic syndrome has resulted in remission of nephrotic syndrome
• Routine urinalysis and other tests may be used to evaluate tubular function (e.g., urine specific gravity or osmolality following a period of water deprivation, or 24-hour urine volume) and glomerular function (e.g., serum creatinine, creatinine clearance, or proteinuria); during lithium therapy, progressive or sudden changes in renal function, even within normal range, indicate the need for re-evaluation of treatment
• An encephalopathic syndrome (characterized by weakness, lethargy, fever, tremulousness and confusion, extrapyramidal symptoms, leukocytosis, elevated serum enzymes, BUN, and FBS) has reported in a few patients treated with lithium plus a neuroleptic, most notably haloperidol; in some instances, the syndrome was followed by irreversible brain damage; because of possible causal relationship patients receiving such combined therapy or patients with organic brain syndrome or other CNS impairment should be monitored closely for early evidence of neurologic toxicity and treatment discontinued promptly if such signs appear; encephalopathic syndrome may be similar to or the same as Neuroleptic
• Malignant Syndrome (NMS)
• Lithium may prolong effects of neuromuscular blocking agents; neuromuscular blocking agents should be given with caution to patients receiving lithium

Pregnancy and Lactation

• Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk
• Positive evidence of human fetal risk
• Drug is excreted in breast milk; use not recommended