Lithium Carbonate

Indications

Lithium Carbonate is used for: Bipolar disorder, Mania, Recurrent unipolar depression

Adult Dose

Oral Mania; Bipolar disorder; Recurrent unipolar depression Adult: Treatment and prevention: Initially, 400-1,200 mg daily in 1-2 divided doses. 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

Child Dose

Renal Dose

Renal impairment: CrCl (ml/min) Dosage Recommendation 10-50 50-75% of normal dose. <10 25-50% of normal dose.

Administration

Should be taken with food.

Contra Indications

Renal insufficiency, cardiovascular insufficiency, Addison\'s disease and untreated hypothyroidism are all contraindications to lithium therapy.

Precautions

Decreased tolerance to lithium has been reported to ensue from protracted sweating or diarrhoea and, if such occur, supplemental fluid and salt should be administered under careful medical supervision and lithium intake reduced or suspended until the condition is resolved. Lactation: Drug is excreted in breast milk; use not recommended

Pregnancy-Lactation

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.

Adverse Effects

Side effects of Lithium Carbonate : >10% Leukocytosis (most patients), Polyuria/polydypsia (30-50%), Dry mouth (20-50%), Hand tremor (45% initially, 10% after 1 year of treatment), Confusion (40%), Decreased memory (40%), Headache (40%), Muscle weakness (30% initially, 1% after 1 year of treatment), Electrocardiographic (ECG) changes (20-30%), Nausea, vomiting, diarrhea (10-30% initially, 1-10% after 1-2 years of treatment), Hyperreflexia (15%), Muscle twitch (15%), Vertigo (15%) 1-10% Extrapyramidal symptoms, goiter (5%), Hypothyroidism (1-4%), Acne (1%), Hair thinning (1%) Frequency Not Defined Coma, Lethargy, Seizures, Renal toxicity

Mechanism of Action

Inhibits postsynaptic D2 receptor supersensitivity. Alters cation transport in nerve and muscle cells and influences reuptake of serotonin or norepinephrine. Inhibits phosphatidylinositol cycle second messenger systems.