LITHIUM CARBONATE

Psychotherapeutic medicine

Dosage Forms

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Tablet

400 mg

Uses

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  • Acute episodes of mania or hypomania
  • Prophylaxis of recurrent manic-depressive illness and bipolar disorder

Dose and Duration

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All indications

Consult product literature

Adjust dose to achieve a serum lithium concentration of 0.4–1 mmol/litre 12 hours after a dose, on the 4ᵗʰ–7ᵗʰ day day of treatment. Then measure serum lithium concentration every week until the dosage has remained constant for 4 weeks and every 3 months thereafter. Use the lowest effective dose in the elderly.

Initially give in divided doses and then once daily when serum concentration has stabilised

Contraindications

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  • Impaired renal function
  • Cardiac disease
  • Untreated hypothyroidism
  • Addison’s disease
  • Low body sodium levels
  • Hypersensitivity to lithium

Side Effects

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  • Gastrointestinal disturbances
  • Fine tremor
  • Polyuria, polydipsia
  • Nausea
  • Leukocytosis
  • Weight gain and oedema

Interactions

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  • Acetazolamide (increased excretion of lithium)
  • Amiloride, enalapril, hydrochlorothiazide, furosemide, ibuprofen, spironolactone (reduced lithium excretion, hence increased plasma concentration and toxicity)
  • Fluoxetine (increased risk of CNS effects)
  • Methyldopa (increased risk of neurotoxicity)

Patient Instructions

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  • Maintain adequate fluid intake and avoid dietary changes which reduce or increase sodium intake.
  • Seek medical attention if signs of hypothyroidism (e.g. feeling cold, lethargy) develop; more likely in women

Pregnancy

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  • Do not use in 1ˢᵗ trimester

Breast-feeding

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  • Can be used

⚠️ Caution

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  • Avoid abrupt withdrawal, withdraw over a period of at least 2 weeks
  • Avoid use or reduce dose in renal impairment
  • In a breast-feeding mother, monitor the infant for toxicity (especially in risk of dehydration)
  • Risk of teratogenicity when lithium is used in the 1ˢᵗ trimester of pregnancy. Dose requirements increase in the 2ⁿᵈ and 3ʳᵈ trimesters but reduce abruptly to normal on delivery. Monitor serum concentration
  • Monitor renal function and thyroid function every 6–12 months since there is a risk of hypothyroidism
  • Maintain adequate fluid and sodium intake. Reduce dose or discontinue in diarrhoea, vomiting, and intercurrent infection (especially if associated with profuse sweating)
  • Lithium may exacerbate psoriasis
  • Different preparations vary widely; change in preparation requires the same precaution as initial treatment