Eskalith-CR

Generic Name: lithium (Oral route)

LITH-ee-um

Oral route(Solution)

Lithium toxicity is closely related to serum lithium levels, and can occur at doses close to therapeutic levels. Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy .

Oral route(Tablet;Tablet, Extended Release;Capsule)

Lithium toxicity is closely related to serum lithium levels, and can occur at doses close to therapeutic levels. Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy .

Commonly used brand name(s)

In the U.S.

  • Eskalith
  • Eskalith-CR
  • Lithobid

Available Dosage Forms:

  • Capsule
  • Solution
  • Syrup
  • Tablet, Extended Release
  • Tablet

Therapeutic Class: Nutriceutical

Uses For Eskalith-CR

Lithium is used to treat mania that is part of bipolar disorder (manic-depressive illness). It is also used on a daily basis to reduce the frequency and severity of manic episodes. Manic-depressive patients experience severe mood changes, ranging from an excited or manic state (e.g., unusual anger or irritability or a false sense of well-being) to depression or sadness.

Slideshow: Breaking Down Bipolar Disorder - 12 Things You Need To Know

It is not known how lithium works to stabilize a person's mood. However, it does act on the central nervous system. It helps you to have more control over your emotions and helps you cope better with the problems of living.

It is important that you and your family understand all the effects of this medicine. These effects depend on your individual condition and response and the amount of lithium you use. You also must know when to contact your doctor if there are problems with using the medicine.

This medicine is available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, lithium is used in certain patients with the following medical conditions:

  • Cluster headaches.
  • Mental depression.
  • Neutropenia (a blood condition where there is a decreased number of a certain type of white blood cells).

Before Using Eskalith-CR

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of lithium extended-release tablets in children younger than 12 years of age. Safety and efficacy have not been established.

No information is available on the relationship of age to the effects of lithium capsules, solution, and tablets in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies on the relationship of age to the effects of lithium have not been performed in the geriatric population. However, elderly patients are more likely to have age-related heart and kidney problems, which may require caution and an adjustment in the dose for patients receiving lithium.

Pregnancy

Pregnancy Category Explanation
All Trimesters D Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Amifampridine

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acetophenazine
  • Almotriptan
  • Amitriptyline
  • Amoxapine
  • Azosemide
  • Bemetizide
  • Bendroflumethiazide
  • Benzthiazide
  • Bromperidol
  • Bumetanide
  • Buthiazide
  • Candesartan Cilexetil
  • Canrenoate
  • Chlorothiazide
  • Chlorpromazine
  • Chlorprothixene
  • Chlorthalidone
  • Clozapine
  • Cyclothiazide
  • Desvenlafaxine
  • Domperidone
  • Droperidol
  • Duloxetine
  • Ethacrynic Acid
  • Ethopropazine
  • Fentanyl
  • Flupenthixol
  • Fluphenazine
  • Furosemide
  • Haloperidol
  • Hydrochlorothiazide
  • Hydroflumethiazide
  • Indapamide
  • Irbesartan
  • Levomilnacipran
  • Linezolid
  • Lorcaserin
  • Losartan
  • Loxapine
  • Melperone
  • Meperidine
  • Mesoridazine
  • Methotrimeprazine
  • Methyclothiazide
  • Metolazone
  • Milnacipran
  • Molindone
  • Olanzapine
  • Olmesartan
  • Penfluridol
  • Periciazine
  • Perphenazine
  • Phenelzine
  • Pimozide
  • Pipamperone
  • Pipotiazine
  • Piretanide
  • Polythiazide
  • Prochlorperazine
  • Promazine
  • Promethazine
  • Quinethazone
  • Remoxipride
  • Risperidone
  • Sertindole
  • Sibutramine
  • Spironolactone
  • Sulpiride
  • Thiopropazate
  • Thioproperazine
  • Thioridazine
  • Thiothixene
  • Tiapride
  • Torsemide
  • Tramadol
  • Trazodone
  • Trichlormethiazide
  • Trifluoperazine
  • Triflupromazine
  • Trimeprazine
  • Tryptophan
  • Valsartan
  • Vortioxetine
  • Xipamide
  • Zotepine
  • Zuclopenthixol

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Alacepril
  • Benazepril
  • Bromfenac
  • Calcitonin
  • Carbamazepine
  • Celecoxib
  • Cilazapril
  • Cisplatin
  • Citalopram
  • Clometacin
  • Clovoxamine
  • Diclofenac
  • Diltiazem
  • Dipyrone
  • Escitalopram
  • Femoxetine
  • Fluoxetine
  • Fluvoxamine
  • Fosinopril
  • Ibuprofen
  • Indomethacin
  • Ketoprofen
  • Ketorolac
  • Lisinopril
  • Mazindol
  • Mefenamic Acid
  • Meloxicam
  • Metronidazole
  • Naproxen
  • Paroxetine
  • Perindopril
  • Piroxicam
  • Quinapril
  • Rofecoxib
  • Sertraline
  • Spirapril
  • Succinylcholine
  • Sulindac
  • Telmisartan
  • Tenidap
  • Tenoxicam
  • Tiaprofenic Acid
  • Tolmetin
  • Trandolapril
  • Valdecoxib
  • Verapamil
  • Yohimbine
  • Zimeldine
  • Zofenopril

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Brugada syndrome (heart disorder), or family history of or
  • Decreased urination or
  • Diarrhea, prolonged or
  • Infection, severe with fever or
  • Kidney disease or
  • Sweating, prolonged or
  • Vomiting, prolonged—May increase risk for serious side effects.
  • Dehydration, severe or
  • Heart or blood vessel disease or
  • Hyponatremia (low sodium in the blood) or
  • Kidney disease, severe or
  • Muscle weakness, severe or
  • Weakened physical condition—Should not be used in patients with these conditions.
  • Encephalopathic syndrome (brain disease) or
  • Goiter or other thyroid problems or
  • Nervous system problems—Use with caution. May make these conditions worse.
  • Kidney disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of lithium

This section provides information on the proper use of a number of products that contain lithium. It may not be specific to Eskalith-CR. Please read with care.

Take this medicine exactly as directed by your doctor. Do not take more or less of it, do not take it more or less often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

You might have to take this medicine for several weeks before you begin to feel better. Talk to your doctor if you have any questions.

Make sure that your doctor knows if you are on a low-sodium or low-salt diet. Too little salt in your diet could lead to serious side effects.

Talk to your doctor about the correct amount of fluid to take with this medicine. Some people need to drink extra fluid every day with the lithium.

Swallow the extended-release tablet whole. Do not break, crush, or chew it.

Measure the oral solution with a marked measuring spoon, oral syringe, or medicine cup. A regular teaspoon may not measure the correct amount of medicine.

There are several different forms of lithium. The dose for each is different and they are used at different times of the day. Do not change the type of medicine you take without talking to your doctor first.

In order for lithium to work properly, it must be taken every day in regularly spaced doses as ordered by your doctor. This is necessary to keep a constant amount of lithium in your blood. To help keep the amount constant, do not miss any doses and do not stop taking the medicine even if you feel better.

Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage forms (capsules, solution, and tablets):
    • For acute mania:
      • Adults—600 milligrams (mg) or 10 milliliters (mL) three times a day. Your doctor may adjust your dose if needed.
      • Children—Use and dose must be determined by your doctor.
    • For long-term treatment of mania:
      • Adults—300 milligrams (mg) or 5 milliliters (mL) three or four times a day. Your doctor may adjust your dose if needed.
      • Children—Use and dose must be determined by your doctor.
  • For oral dosage form (extended-release tablets):
    • For acute mania:
      • Adults—900 milligrams (mg) two times a day, or 600 mg three times a day.
      • Teenagers and children 12 years of age—Use and dose must be determined by your doctor.
      • Children younger than 12 years of age—Use is not recommended.
    • For long-term treatment of mania:
      • Adults—600 milligrams (mg) two times a day, or three times a day up to 1200 mg per day.
      • Teenagers and children 12 years of age—Use and dose must be determined by your doctor.
      • Children younger than 12 years of age—Use is not recommended.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using Eskalith-CR

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted side effects.

Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.

Stop using this medicine and call your doctor right away if you have diarrhea, vomiting, drowsiness, muscle weakness, tremors, unsteadiness, or other problems with muscle control or coordination.

Make sure your doctor knows if you have a heart disorder called Brugada syndrome. Brugada syndrome can be life-threatening and requires immediate medical attention. Call your doctor or the emergency department right away if you have a fast, pounding, or uneven heartbeat; unexplained fainting; lightheadedness; shortness of breath; or troubled breathing after taking this medicine.

Encephalopathic syndrome (brain problem) may occur in patients taking this medicine together with haloperidol (Haldol®). Check with your doctor right away if you have the following symptoms while taking this medicine: a fever, confusion, drowsiness, difficulty with speaking, uncontrolled body movements, and unusual tiredness or weakness.

This medicine may cause some people to become dizzy, drowsy, or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert.

Use extra care in hot weather and during activities that cause you to sweat heavily, such as hot baths, saunas, or exercising. If you have an infection or illness that causes heavy sweating, vomiting, diarrhea, shakiness, or muscle weakness, check with your doctor right away. The loss of too much water and salt from your body could lead to serious side effects from this medicine.

Do not go on a diet to lose weight and do not make a major change in your diet without first checking with your doctor. Improper dieting could cause the loss of too much water and salt from your body and could lead to serious side effects from this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Eskalith-CR Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common
  • Confusion, poor memory, or lack of awareness
  • fainting
  • fast or slow heartbeat
  • frequent urination
  • increased thirst
  • irregular pulse
  • stiffness of the arms or legs
  • troubled breathing (especially during hard work or exercise)
  • unusual tiredness or weakness
  • weight gain
Rare
  • Blue color and pain in the fingers and toes
  • coldness of the arms and legs
  • dizziness
  • eye pain
  • headache
  • noise in the ears
  • vision problems
Incidence not known
  • Dry, rough skin
  • fast, irregular, pounding, or racing heartbeat or pulse
  • hair loss
  • hoarseness
  • lightheadedness
  • mental depression
  • sensitivity to cold
  • shortness of breath
  • swelling of the feet or lower legs
  • swelling of the neck
  • unusual excitement

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose
  • Blurred vision
  • clumsiness or unsteadiness
  • convulsions (seizures)
  • diarrhea
  • drowsiness
  • increase in the amount of urine
  • lack of coordination
  • loss of appetite
  • muscle weakness
  • nausea or vomiting
  • ringing in the ears
  • slurred speech
  • trembling (severe)

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common
  • Acne or skin rash
  • bloated feeling or pressure in the stomach
  • muscle twitching (slight)

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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