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Lithium Dosage

Applies to the following strength(s): 300 mg450 mg150 mg600 mg300 mg/5 mL

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Mania

Acute Control:
-Usual dose: 1800 mg/day
-Extended release formulations: 900 mg orally in the morning and at nighttime
-Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime

Long-term Control:
-Maintenance dose: 900 to 1200 mg/day
-Extended release formulations: 600 mg orally in the morning and at nighttime
-Regular release formulations: 300 mg orally 3 to 4 times a day

Comments:
-Dosing must be individualized according to serum levels and the response to treatment.
-Alternative extended release formulation doses are 600 mg 3 times a day (acute control) and 300 mg 3 to 4 times a day (long-term control).

Uses:
-Treatment of manic episodes of bipolar disorder
-Maintenance treatment for individuals with bipolar disorder

Usual Adult Dose for Bipolar Disorder

Acute Control:
-Usual dose: 1800 mg/day
-Extended release formulations: 900 mg orally in the morning and at nighttime
-Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime

Long-term Control:
-Maintenance dose: 900 to 1200 mg/day
-Extended release formulations: 600 mg orally in the morning and at nighttime
-Regular release formulations: 300 mg orally 3 to 4 times a day

Comments:
-Dosing must be individualized according to serum levels and the response to treatment.
-Alternative extended release formulation doses are 600 mg 3 times a day (acute control) and 300 mg 3 to 4 times a day (long-term control).

Uses:
-Treatment of manic episodes of bipolar disorder
-Maintenance treatment for individuals with bipolar disorder

Usual Pediatric Dose for Mania

12 years and older:
Acute Control:
-Usual dose: 1800 mg/day
-Extended release formulations: 900 mg orally in the morning and at nighttime
-Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime

Long-term Control:
-Maintenance dose: 900 to 1200 mg/day
-Extended release formulations: 600 mg orally in the morning and at nighttime
-Regular release formulations: 300 mg orally 3 to 4 times a day

Comments:
-Dosing must be individualized according to serum levels and the response to treatment.
-Alternative extended release formulation doses are 600 mg 3 times a day (acute control) and 300 mg 3 to 4 times a day (long-term control).
-Maintenance therapy reduces the frequency of manic episodes and diminishes the intensity of the episodes.

Uses:
-Treatment of manic episodes of bipolar disorder
-Maintenance treatment for individuals with bipolar disorder

Usual Pediatric Dose for Bipolar Disorder

12 years and older:
Acute Control:
-Usual dose: 1800 mg/day
-Extended release formulations: 900 mg orally in the morning and at nighttime
-Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime

Long-term Control:
-Maintenance dose: 900 to 1200 mg/day
-Extended release formulations: 600 mg orally in the morning and at nighttime
-Regular release formulations: 300 mg orally 3 to 4 times a day

Comments:
-Dosing must be individualized according to serum levels and the response to treatment.
-Alternative extended release formulation doses are 600 mg 3 times a day (acute control) and 300 mg 3 to 4 times a day (long-term control).
-Maintenance therapy reduces the frequency of manic episodes and diminishes the intensity of the episodes.

Uses:
-Treatment of manic episodes of bipolar disorder
-Maintenance treatment for individuals with bipolar disorder

Renal Dose Adjustments

Mild to moderate renal dysfunction: No adjustment recommended.
Severe renal dysfunction: Begin with lower doses and titrate slowly; closely monitor serum concentrations and signs/symptoms of lithium toxicity.

Any progressive/sudden change in renal function (even within the normal range): Reevaluate treatment

Liver Dose Adjustments

Data not available

Dose Adjustments

Therapeutic drug monitoring/range:
-Acute episodes: 1 to 1.5 mEq/L, not to exceed 2 mEq/L
-Long-term control: 0.6 to 1.2 mEq/L
-Patients who are abnormally sensitive may exhibit toxicity at concentrations of 1 to 1.5 mEq/L.

Serum levels should be drawn immediately prior to the next dose (e.g., 8 to 12 hours after the previous dose).
-Acute episodes: Levels should be determined 2 times a week, and continued until the patient is stable.
-Long-term control: Levels should be assessed at least every 2 months

Elderly patients: Begin at the lower end of the dosing range

Patients with significant cardiovascular disease, debilitation, dehydration, and/or sodium depletion and those receiving drugs that could affect kidney function: Begin with lower doses and titrate slowly; closely monitor serum concentrations and signs/symptoms of lithium toxicity.

Precautions

US BOXED WARNING:
-LITHIUM TOXICITY: Lithium toxicity is closely related to serum lithium levels, which can occur at doses nearing therapeutic levels. Prior to initiating therapy, healthcare providers should ensure the availability of facilities for prompt and accurate serum lithium determinations.

Safety and efficacy have not been established in patients younger than 12 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-Extended/controlled/prolonged/sustained release tablet formulations should not be crushed or chewed.
-Take with food to decrease gastrointestinal side effects.
-This drug should be taken as the same time(s) each day.

Storage requirements:
-The manufacturer product information should be consulted.

General:
-Lithium toxicity is related to serum lithium levels, and may occur at doses close to therapeutic levels.
-Patients in the manic phase are better able to tolerate lithium; tolerance to lithium decreases when manic symptoms subside.
-Mania is characterized by pressure of speech, motor hyperactivity, reduced sleep requirements, flight of ideas, grandiosity, elation, poor judgment, aggressiveness, and/or hostility. Maintenance therapy reduces the frequency of manic episodes and diminishes the intensity of the episodes.

Monitoring:
-ECG, especially in patients at risk of unmasking Brugada syndrome
-Thyroid function, especially in patients with thyroid disorders
-Lithium levels
-Renal function tests (e.g., urinalysis, urine specific gravity, serum creatinine, creatinine clearance), especially in patients who develop polyuria and/or polydipsia

Patient advice:
-Patients should be told to seek immediate medical attention if signs/symptoms of Brugada syndrome, encephalopathic syndrome, or diabetes insipidus occur.
-Patients, family members, and/or caregivers should be instructed to discontinue therapy and immediately report any signs/symptoms of lithium toxicity, change in behavior, or suicidality.
-Inform patients that this drug may cause drowsiness, and they should avoid driving or operating machinery until the full effects of the drug are seen.
-Patients should be counseled on the importance of maintaining adequate salt and water intake.
-Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.

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