| LITHIUM CARBONATE
Eskalith, Eskalith CR, Lithane, Lithobid, Lithonate, Lithotabs
Classifications: psychotherapeutic agent; mood stabilizer; Therapeutic: mood stabilizer; antimanic and antidepressant
Pregnancy Category: C first trimester; D second and third trimester
Lithium Carbonate: 150 mg, 300 mg, 600 mg capsules; 300 mg, 450 mg sustained release tablets
Lithium Citrate: 300 mg/5 mL syrup
The lithium ion behaves in the body much like the sodium ion; but its exact mechanism of action is unclear. Competes with
various physiologically important cations: Na+, K+, Ca++, Mg++; therefore, it affects cell membranes, body water, and neurotransmitters. At the synapse, it accelerates catecholamine
destruction, inhibits the release of neurotransmitters and decreases sensitivity of postsynaptic receptors.
Inhibits neurotransmitters; decreases over-activity of receptors involved in stimulating manic states. Effective response
evidenced by changed facial affect, improved posture, assumption of self-care, improved ability to concentrate, improved
Control and prophylaxis of acute mania and the acute manic phase of mixed bipolar disorder.
Acute and recurrent depression (unipolar affective disorder), schizophrenic disorders, disorders of impulse control, alcohol
dependence, antineoplastic drug-induced neutropenia, aplastic anemia, SIADH, cyclic neutropenia.
History of ACE inhibitor induced angioedema; significant cardiovascular or kidney disease, brain damage, severe debilitation,
dehydration or sodium depletion; patients on low-salt diet or receiving diuretics; pregnancy (category C in first trimester,
category D in second and third trimester), lactation, children <12 y.
Older adults; thyroid disease; epilepsy; concomitant use with haloperidol and other antipsychotics; cardiac disease, cardiac
arrhythmias, dehydration, diarrhea; older adults; fever, hyponatremia, hypothyroidism, concurrent infection; leukemia; mental
status changes, organic brain syndrome, parkinsonism; psoriasis; renal disease, renal impairment; seizure disorder, sick
sinus syndrome, sodium restriction, suicidal ideation, thyroid disease, urinary retention; diabetes mellitus; severe infections;
Route & Dosage
Adult: PO Loading Dose 600 mg t.i.d. or 900 mg sustained-release b.i.d. or 30 mL (48 mEq) of solution t.i.d. PO Maintenance Dose 300 mg t.i.d. or q.i.d. or 1520 mL (2432 mEq) solution in 24 divided doses (max: 2.4 g/d)
Child: PO 1560 mg/kg/d in divided doses
- Give with meals.
- Ensure that sustained release tablets are not chewed or crushed; must be swallowed whole.
- Protect from light and moisture.
Adverse Effects (≥1%)CNS:
Dizziness, headache, lethargy,
slurred speech, psychomotor retardation, giddiness, incontinence, restlessness, seizures, confusion, blackout spells, disorientation,
recent memory loss,
stupor, coma, EEG changes. CV:
Arrhythmias, hypotension, vasculitis, peripheral circulatory collapse,
ECG changes. Special Senses:
Impaired vision, transient scotomas, tinnitus. Endocrine:
enlargement, hypothyroidism, nephrogenic diabetes insipidus,
transient hyperglycemia, glycosuria, hyponatremia. GI: Nausea, vomiting, anorexia, abdominal pain, diarrhea, dry mouth,
metallic taste. Musculoskeletal: Fine hand tremors,
coarse tremors, choreoathetotic movements; fasciculations, clonic movements, incoordination including ataxia, muscle weakness,
hyperreflexia, encephalopathic syndrome (weakness, lethargy, fever, tremors, confusion, extrapyramidal symptoms). Skin:
Thought to be toxicity rather than allergy: Pruritus, maculopapular rash, hyperkeratosis, chronic folliculitis, transient
acneiform papules (face, neck, intertriginous areas), anesthesia of skin, cutaneous ulcers, drying and thinning of hair,
allergic vasculitis. Hematologic: Reversible leukocytosis
(14,000 to 18,000/mm3
Albuminuria, oliguria, urinary incontinence, polyuria, polydipsia, increased uric acid excretion. Body as a Whole:
Edema, weight gain (common) or loss, exacerbation of psoriasis; flu-like symptoms.
InteractionsDrug: Carbamazepine, haloperidol, phenothiazines
increase risk of neurotoxicity, extrapyramidal effects, and tardive dyskinesias; diuretics
, methyldopa, probenecid, tetracyclines
decrease renal clearance of lithium
, increasing pharmacologic and toxic effects; theophyllines
, urea, sodium bicarbonate, sodium or potassium citrate
increase renal clearance of lithium
, decreasing its pharmacologic effects.
Readily absorbed from GI tract. Peak:
0.53 h carbonate; 1560 min citrate. Distribution:
Crosses bloodbrain barrier and placenta; distributed into breast milk. Metabolism:
Not metabolized. Elimination:
95% in urine, 1% in feces, 45% in sweat. Half-Life:
Assessment & Drug Effects
- Monitor response to drug. Usual lag of 12 wk precedes response to lithium therapy. Keep physician informed of progress.
- Lab test: Periodic lithium levels (draw blood sample prior to next dose or 812 h after last dose); periodic thyroid
- Monitor for S&S of lithium toxicity (e.g., vomiting, diarrhea, lack of coordination, drowsiness, muscular weakness, slurred
speech when level is 1.52.0 mEq/L; ataxia, blurred vision, giddiness, tinnitus, muscle twitching, coarse tremors,
polyuria when >2.0 mEq/L). Withhold one dose and call physician. Drug should not be stopped abruptly.
- Monitor older adults carefully to prevent toxicity, which may occur at serum levels ordinarily tolerated by other patients.
- Be alert to and report symptoms of hypothyroidism (see Appendix F).
- Weigh patient daily; check ankles, tibiae, and wrists for edema. Report changes in I&O ratio, sudden weight gain, or edema.
- Report early signs of extrapyramidal reactions promptly to physician.
Patient & Family Education
- Be alert to increased output of dilute urine and persistent thirst. Dose reduction may be indicated.
- Contact physician if diarrhea or fever develops. Avoid practices that may encourage dehydration: hot environment, excessive
caffeine beverages (diuresis).
- Drink plenty of liquids (23 L/d) during stabilization period and at least 11? L/d during ongoing therapy.
- Avoid self-prescribed low-salt regimen, self-dosing with antacids containing sodium, and high-sodium foods (e.g., prepared
meats and diet soda).
- Do not drive or engage in other potentially hazardous activities until response to drug is known. Lithium may impair both
physical and mental ability.
- Use effective contraceptive measures during lithium therapy. If therapy is continued during pregnancy, serum lithium levels
must be closely monitored to prevent toxicity.