Pharm

Lithium Carbonate

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Lithium Carbonate, Lithium, Eskalith, Lithobid, Lithium Compound, Lithium Salt

  • See Also
  1. Lithium Toxicity
  • Indication
  1. Bipolar Disorder
  • History
  1. Lithium has been used since the 1800s as a treatment for gout and Seizure Disorder and as of 1900s for mania
  • Contraindications
  1. Pregnancy
    1. Associated with Ebstein Anomaly when exposure in first trimester
  • Mechanism
  1. May increase CNS Serotonin levels
  2. Neuroprotective effect
  3. Decreases intracellular Inositol monophosphate concentrations
    1. Mood stabilization effect
  4. Inhibits Glycogen Synthase Kinase 3 (GSK3B)
    1. Enzyme involved in Neuronal development and Energy Metabolism
    2. GSK3B overexpression may be associated with Bipolar Disorder
  • Pharmacokinetics
  1. Lithium Carbonate is a simple salt that is excreted and not metabolized
    1. Lithium is an alkali metal (the smallest metal, having atomic number 3)
  2. Steady state reached in 5 days
    1. Check Lithium levels 5 days after starting dose or changing dose
  3. Therapeutic Trough levels
    1. Acute mania: 1.0 to 1.2 meq/L
    2. Maintenance Bipolar Disorder: 0.8 to 1.0 meq/liter
    3. Increasing dose 300 mg/day raises level 0.2 meq/L
  4. Excretion
    1. Renal excretion (and 60% reabsorbed at proximal tubules)
  • Preparations
  1. Lithium Carbonate (immediate release)
  2. Lithobid (sustained release)
  3. Eskalith (sustained release)
  • Dosing
  1. Blood levels peak 1-2 hours after immediate release products at therapeutic dose (4-6 hours after sustained release)
  2. Effective dose: 900 to 1800 mg per day divided twice daily (or 3-4 times daily)
  3. Start: 300 mg orally twice daily
    1. May adjust dose every 2-3 days as tolerated
  • Adverse Effects
  1. Polyuria
  2. Hypothyroidism
    1. Often reversible on stopping Lithium
    2. Higher Prevalence in women and with increasing age
  3. Weight gain
  4. Fine Tremor
  5. Withdrawal symptoms on stopping
    1. More common than with Valproate or Lamotrigine
  • Adverse Effects
  • Toxicity
  1. Nausea and Vomiting
  2. Diarrhea
  3. Ataxia
  4. Coma
  5. Death
  • Toxicity
  1. See Lithium Toxicity
  2. Precaution
    1. Toxicity is dose dependent and Overdose can be lethal
  3. Pregnancy
    1. Highly Teratogenic
  4. Cerebellar Signs or symptoms
  5. Mechanism
    1. Poor therapeutic window
    2. Renal excretion
  • Drug Interactions
  1. Diuretics
  2. NSAIDs
  3. ACE Inhibitors
  • Monitoring
  1. Serum Lithium level
    1. Day 5 after starting Lithium
    2. Then every 1-2 weeks initially
    3. Then every 3-6 months
    4. Also check serum levels before and 5 days after dose changes
  2. Other labs
    1. Schedule
      1. Baseline
      2. Month 3
      3. Month 6
      4. Every 6 to 12 months thereafter
    2. Thyroid Stimulating Hormone (TSH)
    3. Renal Function tests
      1. Serum Creatinine
      2. Blood Urea Nitrogen
  • References
  1. Perrone and Chatterjee (2018) UpToDate, accessed 8/20/2018