Lithium Carbonate

Indications
 Oral
Mania, Bipolar disorder, Recurrent unipolar depression
Adult: Dose depends on the preparation used. Doses should be adjusted to produce a serum-lithium concentration of 0.4-1 mmol/l. Camcolit® tablets: Treatment: Initiate at 1-1.5 g daily; Prevention: Initiate at 300-400 mg daily. Priadel® tablets: Treatment and prevention: Initially, 400-1,200 mg daily in 1-2 divided doses. Priadel® syrup: Treatment and prevention: Initially, 1.04-3.12 g daily in 2 divided doses. Liskonum® tablets: Treatment: Initially, 450-675 mg bid; Prevention: Initially, 450 mg bid. Doses should be divided throughout the day during the initial period; once-daily dosing may be used when serum-lithium concentrations have stabilised. Adjust initial dose 4-7 days after starting based on results of serum-lithium concentrations. Monitor serum-lithium concentrations once wkly until dosage has remained constant for 4 wk, after which monitoring may be reduced to once every 3 mth.
Child: ≥12 yr: Acute phase: Serum concentrations of 1-1.2 mEq/l. Max dose: 1.5 mEq/l. Initially, 1.8 g lithium carbonate daily as conventional capsules/tablets in 3-4 divided doses, or 30 ml (approx 48 mEq) lithium citrate oral solution daily in 3-4 divided doses. Alternatively, initially 1.8 g lithium carbonate daily as extended-release tablets in 2-3 divided doses. Maintenance: Not established.
Elderly: ≤900 mg lithium carbonate daily. Titrate dose slowly to achieve therapeutic serum concentrations. Maintenance: Maintain serum concentrations at the lower end of 0.6-1.2 mEq/l.
CrCl (ml/min)Dosage Recommendation
10-5050-75% of normal dose.
<1025-50% of normal dose.


Special Populations: Renal disease: Preferable to avoid lithium.
Contraindications
 Severe renal and cardiac disease; severe dehydration, sodium depletion, debilitation.
Warnings / Precautions
 Monitor serum lithium levels (twice wkly or more frequently in acute phase; at least every 2 mth during maintenance). Thyroid disorders, mild to moderate renal or cardiac impairment. Marked fluid loss (protracted sweating, diarrhoea or prolonged fever). Maintain normal fluid and salt intake. Elderly. Monitor changes in renal function. Patients with suicidal tendency. May impair ability to drive or operate machinery. Children <12 yr. Pregnancy and lactation.
Adverse Reactions
 Exacerbation of psoriasis, acne, rash; nausea, diarrhoea, vertigo, muscle weakness, dazed feeling; loss of concentration; tremors; hypothyroidism; wt gain, oedema; cardiac arrhythmias; exophthalmos; restlessness; electrolyte disturbances.
Potentially Fatal: Severe neurotoxicity, leucopenia.
Overdose Reactions
 Symptoms: Sedation, confusion, tremors, joint pain, visual changes, seizures, coma. Management: No specific antidote. Acute overdose: Discontinue admin and remove any unabsorbed drug by gastric lavage. Correct fluid and electrolyte imbalances and provide supportive care. Dialysis (severe cases).
Drug Interactions
 Reduced serum levels with carbonic anhydrase inhibitors, chlorpromazine, sodium-containing preparations, theophylline, urea. Enhanced hypothyroid effects with iodine salts. Enhanced effects of neuromuscular-blocking agents. Reduced pressor response to sympathomimetics.
Potentially Fatal: Increased risk of lithium toxicity with ACE inhibitors, angiotensin receptor antagonists, loop diuretics, metronidazole, phenytoin. Increased risk of neurotoxicity with carbamazepine, calcium-channel blockers, haloperidol, methyldopa, phenothiazines, SSRIs, TCAs. Increased serum levels with COX-2 inhibitors, NSAIDs (except sulindac, aspirin), tetracyclines, thiazide diuretics. Increased risk of encephalopathy with haloperidol. Increased risk of serotonin syndrome with sibutramine. Fatal malignant hyperpyrexia may occur when used with MAOIs.
See Below for More lithium Drug Interactions
Food Interactions
 Caffeine may reduce serum concentrations of lithium.
Mechanism of Actions
 Lithium's exact mechanism is unclear but it alters intraneuronal metabolism of catecholamines and sodium transport in neurons and muscle cells.
Absorption: Readily and completely absorbed from the GI tract (oral); serum levels increase with food. Peak plasma concentrations after 0.5-3 hr (conventional preparation), 2-12 hr (modified-release preparations).
Distribution: Throughout the body, bones, thyroid gland, portions of the brain; crosses the placenta, enters breast milk. Not protein-bound.
Metabolism: Not metabolised.
Excretion: Via urine (as unchanged drug), faeces, saliva, sweat (small amounts). Elimination half-life: 20-24 hr (normal renal function), 36 hr (elderly), 40-50 hr (renal dysfunction).
Administration
 Should be taken with food.
Storage Conditions
 Oral: Store at 25°C (77°F).
ATC Classification
 N05AN - Lithium ; Used in the management of psychosis.
N05AN01 - lithium ; Belongs to the class of lithium antipsychotics.
Storage
 Oral: Store at 25°C (77°F).
Available As
  • Lithium Carbonate 150 mg
  • Lithium Carbonate 250 mg
  • Lithium Carbonate 300 mg
  • Lithium Carbonate 400 mg
  • Lithium Carbonate 450 mg

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