Lithium(lith’ ee um)
Lithium Carbonate
Apo-Lithium Carbonate (CAN), Carbolith (CAN), Duralith (CAN), Lithane (CAN), LithobidDNC, Lithonate, Lithotabs, PMS-Lithium Carbonate (CAN)
Lithium Citrate
PREGNANCY CATEGORY D
Drug class
Antimanic drug
Therapeutic Actions
Mechanism is not known; alters sodium transport in nerve and muscle cells; inhibits release of norepinephrine and dopamine, but not serotonin, from stimulated neurons; slightly increases intraneuronal stores of catecholamines; decreases intraneuronal content of second messengers and may thereby selectively modulate the responsiveness of hyperactive neurons that might contribute to the manic state.
Indications
Treatment of manic episodes of bipolar disorder; maintenance therapy to prevent or diminish frequency and intensity of subsequent manic episodes
Unlabeled uses: Prophylaxis of cluster headache and cyclic migraine headache, treatment of SIADH, hypothyroidism (doses of 600–900 mg/day), borderline personality disorder, major depression
Contraindications and Cautions
Contraindicated with hypersensitivity to tartrazine; significant renal or CV disease; severe debilitation, dehydration; sodium depletion, patients on diuretics (lithium decreases sodium reabsorption, and hyponatremia increases lithium retention); use of ACE inhibitors; pregnancy; lactation.
Use cautiously with protracted sweating and diarrhea; suicidal or impulsive patients; infection with fever.
Available Forms
Capsules—150, 300, 600 mg; tablets—300 mg; SR tabletsDNC—300 mg; syrup—300 mg/5 mL
Dosages
Individualize dosage according to serum levels and clinical response.
Adults
Acute mania: 600 mg PO tid or 900 mg slow-release form PO bid to produce effective serum levels between 1 and 1.5 mEq/L. Serum levels should be determined twice per week in samples drawn immediately before a dose (at least 8–12 hr after previous dose).
Long-term use: 300 mg PO tid–qid to produce a serum level of 0.6–1.2 mEq/L. Serum levels should be determined at least every 2 mo in samples drawn immediately before a dose (at least 8–12 hr after previous dose).
Conversion from conventional to slow-release dosage forms: Give the same total daily dose divided into two or three doses.
Pediatric patients
Safety and efficacy for children younger than 12 yr not established.
Geriatric patients and patients with renal impairment
Reduced dosage may be needed. Elderly patients often respond to reduced dosage and may exhibit signs of toxicity at serum levels tolerated by other patients. Plasma half-life is prolonged in renal impairment.
Pharmacokinetics
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