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Lithium Pregnancy and Breastfeeding Warnings

Lithium is also known as: Eskalith, Eskalith-CR, Lithium Carbonate ER, Lithobid, Lithonate, Lithotabs

Lithium Pregnancy Warnings

One retrospective study of 101 women concluded that rates of recurrence of bipolar disorder during the first 40 weeks after lithium discontinuation were similar for pregnant and nonpregnant women but then sharply increased postpartum.

Lithium has been assigned to pregnancy category D by the FDA. Use of lithium in the first trimester has been associated with congenital defects, particularly cardiac defects such as Ebstein's anomaly, although recent studies (including a prospective study of 148 women on lithium) have concluded that lithium is not a major human teratogen. Lithium toxicity (such as cyanosis, hypotonia, atrial flutter and bradycardia) has been reported in neonates whose mothers took lithium during pregnancy. There is no controlled data in human pregnancy. Lithium should only be given during pregnancy when there are no alternatives and benefit outweighs risk.

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Lithium Breastfeeding Warnings

Lithium toxicity in breast- fed infants, including cyanosis, electrocardiogram abnormalities, and hypotonia have also been reported. Some feel this toxicity may be due to the relatively immature kidney function in neonates and is especially likely to occur during times of dehydration. In a study involving 10 nursing mothers (mean lithium dose 850 mg/day; range 600 to 1200 mg/day), breast milk and maternal serum lithium concentrations averaged 0.35 meq/L and 0.76 meq/L, respectively, compared with a mean infant serum concentration of 0.16 meq/L. The breast milk/maternal serum and infant serum/breast milk lithium concentration ratios averaged 0.53 meq/L and 0.50 meq/L, respectively, and the infant/maternal serum lithium concentration ratio was 0.24 meq/L. There were no obvious adverse growth or developmental effects on the infants; however, several instances of elevated thyroid-stimulating hormone (TSH), blood urea nitrogen, and creatinine were reported.

Lithium is excreted into and accumulates in human milk. Lithium achieves serum levels in nursing infants which are one-third to one-half of therapeutic levels. Lithium is considered contraindicated during breast-feeding by the American Academy of Pediatrics (as well as by the manufacturer).

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References for pregnancy information

  1. Tunnessen WW, Hertz CG "Toxic effects of lithium in newborn infants: a commentary." J Pediatr 81 (1972): 804-7
  2. Wilson N, Forfar JC, Godman MJ "Atrial flutter in the newborn resulting from maternal lithium ingestion." Arch Dis Child 58 (1983): 538-49
  3. Jacobson SJ, Jones K, Johnson K "Prospective multicenter study of pregnancy outcome after lithium exposure during first trimester." Lancet 339 (1992): 530-3
  4. Koren G, Pastuszak A, Ito S "Drugs in pregnancy." N Engl J Med 338 (1998): 1128-37
  5. Nora JJ, Nora AH, Toews WH "Lithium, Ebstein's anomaly, and other congenital heart defects." Lancet 2 (1974): 594-5
  6. Kuller JA, Katz VL, Mcmahon MJ, Wells SR, Bashford RA "Pharmacologic treatment of psychiatric disease in pregnancy and lactation: fetal and neonatal effects." Obstet Gynecol 87 (1996): 789-94
  7. "Product Information. Eskalith (lithium)." SmithKline Beecham, Philadelphia, PA.
  8. Cohen LS, Friedman JM, Jefferson JW, Johnson EM, Weiner ML "A reevaluation of risk of in utero exposure to lithium." JAMA 271 (1994): 146-50
  9. Woody JN, London WL, Wilbanks GD "Lithium toxicity in a newborn." Pediatrics 47 (1971): 94-6
  10. Kallen B, Tandberg A "Lithium and pregnancy." Acta Psychiatr Scand 68 (1983): 134-9
  11. Viguera AC, Nonacs R, Cohen LS, Tondo L, Murray A, Baldessarini RJ "Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance." Am J Psychiat 157 (2000): 179-84

References for breastfeeding information

  1. Sykes PA, Quarrie J, Alexander FW "Lithium carbonate and breast-feeding." Br Med J 2 (1976): 1299
  2. Committee on Drugs, 1992 to 1993 "The transfer of drugs and other chemicals into human milk." Pediatrics 93 (1994): 137-50
  3. Schou M, Amdisen A "Lithium and pregnancy--III, lithium ingestion by children breast-fed by women on lithium treatment." Br Med J 2 (1973): 138
  4. Viguera AC, Newport DJ, Ritchie J, et al. "Lithium in breast milk and nursing infants: clinical implications." Am J Psychiatry 164 (2007): 342-5
  5. Roberts RJ, Blumer JL, Gorman RL, et al "American Academy of Pediatrics Committee on Drugs: Transfer of drugs and other chemicals into human milk." Pediatrics 84 (1989): 924-36
  6. Tunnessen WW, Hertz CG "Toxic effects of lithium in newborn infants: a commentary." J Pediatr 81 (1972): 804-7
  7. "Product Information. Eskalith (lithium)." SmithKline Beecham, Philadelphia, PA.
  8. Kuller JA, Katz VL, Mcmahon MJ, Wells SR, Bashford RA "Pharmacologic treatment of psychiatric disease in pregnancy and lactation: fetal and neonatal effects." Obstet Gynecol 87 (1996): 789-94
  9. Fries H "Lithium in pregnancy." Lancet 1 (1970): 1233

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