Class: Antipsychotic agent
- Capsules 300 mg lithium carbonate (8.12 mEq lithium)
- Tablets, slow-release 300 mg lithium carbonate (8.12 mEq lithium)
- Capsules 300 mg lithium carbonate (8.12 mEq lithium)
- Tablets 300 mg lithium carbonate (8.12 mEq lithium)
Apo-Lithium Carbonate SR (Canada)
PMS-Lithium Carbonate (Canada)
PMS-Lithium Citrate (Canada)
Specific mechanism unknown; alters sodium transport in nerve and muscle cells and effects shift toward intraneuronal metabolism of catecholamines.
Readily absorbed from the GI tract. Absorption is not significantly impaired by food. T max is 0.5 to 3 h. Therapeutic serum level is 0.4 to 1 mEq/L. Steady state is reached in 5 to 7 days.
Distribution space of lithium approximates that of total body water. Not protein bound. Distribution across the blood-brain barrier is slow; however, the CSF lithium level is about 40% of the plasma concentration.
About 95% eliminated by the kidney; primarily excreted in the urine. Renal excretion is proportional to its plasma concentration. The t ½ is about 24 h (10 to 50 h).
Decreases rate of excretion; increases incidence of toxic effects. Therefore, lower doses and more frequent monitoring are recommended.
Indications and Usage
Management of bipolar disorder and manic episodes of manic-depressive illness.
Treatment of neutropenia; unipolar depression; schizoaffective disorder; prophylaxis of cluster headaches; premenstrual tension; tardive dyskinesia; hyperthyroidism; SIADH, postpartum affective psychosis; corticosteroid-induced psychosis.
History of leukemia.
Dosage and AdministrationAdults
PO 900 to 1800 mg/day in 2 to 4 divided doses. Give regular capsules 3 or 4 times daily; slow-release tablets 2 or 3 times daily. Max dose, 2,400 mg/day.Children 12 yr of age and older
15 to 20 mg/kg/day in 2 to 3 divided doses.
- Administer with meals to minimize GI upset.
- Do not crush, chew, or break extended-release capsules or coated tablets.
Store at room temperature. Protect capsules from moisture.
Drug InteractionsAcetazolamide, osmotic diuretics, theophyllines, urinary alkalinizers
Increased renal excretion of lithium.ACE inhibitors, fluoxetine, loop diuretics, NSAIDs, thiazide diuretics
Increased lithium serum levels.Carbamazepine, haloperidol, methyldopa
Increased neurotoxic effects despite therapeutic serum levels and normal dosage range.Iodide salts
Increased risk of hypothyroidism.Neuromuscular blocking agents, tricyclic antidepressants
Increased pharmacological effects of additive drug.Phenothiazines
Neurotoxicity, decreased phenothiazine concentrations, or increased lithium concentrations may occur.Verapamil
Reductions in lithium levels and lithium toxicity have occurred.
Laboratory Test Interactions
None well documented.
Arrhythmias; hypotension; bradycardia; peripheral circulatory collapse.
Tremor; muscle hyperirritability; headache; fatigue; ataxia; dizziness; psychomotor retardation; confusion; dystonia; hallucinations; blackouts; seizures; pseudotumor cerebri; drowsiness; poor memory and intellectual function; muscular weakness; slurred speech.
Drying or thinning hair; dry skin; pruritus; exacerbation of psoriasis; acne.
Blurred vision; tinnitus.
Anorexia; nausea; vomiting; diarrhea; sialorrhea; dry mouth; parotitis.
Urinary urgency; stress incontinence; polyuria; albuminuria; sexual dysfunction; symptoms of nephrogenic diabetes; decreased CrCl.
Hypothyroidism; hypercalcemia; hyperparathyroidism; hyponatremia; dehydration; weight gain.
Taste distortion; thirst; fever; swollen joints.
Toxicity is closely related to serum concentrations and may occur at doses close to therapeutic levels. Equipped facilities should be identified prior to initiation of therapy to provide prompt and accurate serum concentration data.
Category D .
Excreted in breast milk.
Safety and efficacy not established in children less than 12 yr.
Chronic use may lead to nephrogenic diabetes insipidus. Patients who have reduced renal function, including elderly, should take lower doses.
Some products contain tartrazine, which may cause allergic-type reactions in susceptible individuals.
Encephalopathic syndrome has occurred in patients also taking a neuroleptic and may cause irreversible brain damage. Characterized by weakness, lethargy, fever, tremors, confusion, extrapyramidal symptoms, leukocytosis, and elevated serum enzymes, BUN, and fasting blood sugar.
Has occurred with chronic use. Thyroid hormone replacement therapy may be required.
Reduction in dose or discontinuation may be required if patient has infection with fever, especially if accompanied by protracted sweating, vomiting, or diarrhea.
Because drug decreases renal sodium absorption, patients must maintain adequate salt and fluid intake.
Toxicity can occur even at therapeutic doses. Toxicity risk is greater in patients with renal or CV disease, debilitation, dehydration, or sodium depletion.
ECG changes, slurred speech, seizures, acute renal failure, coma, diarrhea, vomiting, drowsiness, muscle weakness, ataxia.
- Explain that therapeutic improvement will be noted in 1 to 3 wk.
- Instruct patient to take medication regularly even if feeling well. Symptoms may return if medication is discontinued.
- Advise patient not to decrease or increase dietary sodium intake.
- Tell patient to drink 8 to 10 glasses of water or other caffeine-free liquids daily.
- Caution patient to avoid excessive caffeine intake, as caffeine may increase urinary excretion of drug.
- Advise patient that thirst, frequent polyuria, taste distortion, and fine hand tremors are common adverse reactions.
- Instruct patient to report the following symptoms to health care provider immediately: nausea, vomiting, diarrhea, muscular weakness, ataxia, blurred vision or tinnitus.
- Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
- Emphasize need for serum lithium level monitoring every 1 or 2 mo or as advised by health care provider.
- Encourage patient to wear medical identification (eg, card, bracelet) at all times stating medication name and dosage.
Copyright © 2009 Wolters Kluwer Health.
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