Classes
DEA Class; Rx
Common Brand Names; Eskalith, Lithobid
- Bipolar Disorder Agents
Description
Oral monovalent cation with a narrow therapeutic range
Approved for manic episodes and as maintenance treatment for Bipolar I Disorder adult and pediatric patients 7 years and older (dependent on formulation chosen); used off-label as an adjunct for adults with refractory major depression
Due to risk for toxicity, requires close monitoring of serum lithium concentrations, fluid status, electrolytes, and renal function
Indications
Indicated for the treatment of bipolar disorder (i.e., Bipolar I Disorder), including acute mania and maintenance therapy.
Contraindications
Documented hypersensitivity
Severe cardiovascular disease
Pregnancy in 1st trimester
Unstable renal function, sodium depletion, severe dehydration
Severe debilitation
Adverse Effects
- 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%)
- Coma
- Lethargy
- Seizures
- Renal toxicity
- Acute lithium toxicity
- Lithium-induced polyuria
- Ataxia/gait disturbance
Warnings
Cardiovascular disease; reports of possible association between lithium treatment and unmasking of Brugada syndrome (abnormal ECG and risk of sudden death)
Use with caution in patients with thyroid disease
Narrow therapeutic index
Risk of nephrogenic diabetes insipidus; such patients should be carefully managed to avoid dehydration with resulting lithium retention and toxicity; condition is usually reversible when lithium is discontinued
Lithium-sensitive patients may experience toxicity symptoms with serum lithium concentrations of 1-1.5 mEq/L
Lithium toxicity is closely related to serum levels and can occur at therapeutic dosages; if manifestations of toxicity occur, discontinue for 24-48 hours, then resume at lower dosage
Mainitain geriatric patients on dosages that produce serum lithium concentrations at lower end of desired range
May cause central nervous system (CNS) depression and impair ability to operate heavy machinery
Hypercalcemia reported with or without hyperparathyroidism; women and older patients are possibly at greater risk; onset does not appear to be associated with duration of therapy
Monitor changes in renal function; chronic therapy may diminish renal concentrating ability; usually reversible when lithium therapy discontinued
Use caution in debilitated patients; may increase risk of lithium toxicity
Use with caution in patients at risk for suicide
Cases consistent with nephrotic syndrome reported with use of lithium; discontinuation of lithium in patients with nephrotic syndrome has resulted in remission of nephrotic syndrome
Pregnancy and Lactation
Pregnancy category: D
Lactation: Drug is excreted in breast milk; use not recommended
Maximum Dosage
Maximum dosage not well defined. Individualize dosage to patient disease and response, and lithium concentrations; avoid concentration above 1.5 mEq/L. For most adults, a total daily dosage of 1,200 to 1,800 mg/day PO (in divided doses) will provide appropriate lithium concentrations.
Maximum dosage not well defined. Individualize dosage to patient disease and response, and lithium concentrations; avoid concentration above 1.5 mEq/L. For most adults, a total daily dosage of 1,200 to 1,800 mg/day PO (in divided doses) will provide appropriate lithium concentrations.
Maximum dosage not well defined. Individualize dosage to patient disease and response, and lithium concentrations; avoid concentration above 1.5 mEq/L. For most adolescents, as with adults, a total daily dosage of 1,200 to 1,800 mg/day PO (in divided doses) will provide appropriate lithium concentrations.
7 to 12 years: Maximum dosage not well defined. Individualize dosage to patient disease and response, and lithium concentrations; avoid concentration above 1.5 mEq/L. In children weighing 20 to 30 kg, a total daily dosage up to 1,500 mg/day PO (in divided doses) for acute treatment and 1,200 mg/day PO (in divided doses) for maintenance therapy will provide appropriate lithium concentrations for most patients. In children weighing more than 30 kg, a total daily dosage up to 1,800 mg/day PO (in divided doses) for acute or maintenance therapy will provide appropriate lithium concentrations for most patients.
6 years: Safety and efficacy have not been established. Used off label; dosing must be individualized. One consensus guideline notes that approximate weight-based doses of 10 to 30 mg/kg/day PO (in divided doses) are needed to provide appropriate lithium concentrations. Avoid lithium concentration above 1.5 mEq/L.
Less than 6 years: Safety and efficacy have not been established.
Not indicated.
How supplied
Lithium carbonate
tablet, extended release
- 300mg
- 450mg
tablet
- 300mg
capsule
- 150mg
- 300mg
- 600mg
solution
- 8mEq/5mL