• Mood disorders

Mood disorders:

Indications for Lithium Carbonate Tablets:

Monotherapy for bipolar I disorder.

Adults and Children:

<7yrs: not established. Individualize. ≥7yrs (>30kg): Initially 300mg 3 times daily; titrate by 300mg every 3 days. Usual acute goal: 600mg 2–3 times daily. Usual maintenance goal: 300–600mg 2–3 times daily. (20–30kg): Initially 300mg twice daily; titrate by 300mg weekly. Usual acute goal: usually 600–1500mg in divided doses daily. Usual maintenance goal: 600–1200mg in divided doses daily. Mild to moderate renal impairment: use lower initial dose; titrate slowly and monitor.

Boxed Warning:

Lithium toxicity.

Warnings/Precautions:

Risk of lithium toxicity (esp. recent febrile illness, acute ingestion, volume depletion/dehydration, impaired renal function, cardiovascular disease, changes in electrolytes). Maintain adequate fluid and salt intake, esp. with sweating, diarrhea, infection, or fever. Monitor serum lithium levels frequently (toxic and therapeutic levels are close); draw blood for serum tests 12hrs after previous dose. Monitor serum lithium, electrolytes, and renal function prior to and during treatment. Monitor thyroid function prior to initiation, at 3 months, and every 6–12 months during treatment. Monitor serum calcium levels regularly. Discontinue if diarrhea, vomiting, tremor, ataxia, drowsiness or weakness occur. Avoid in Brugada Syndrome. Severe renal impairment (CrCl <30mL/min): not recommended. Elderly. Neonates. Pregnancy: monitor; discontinue or reduce dose 2–3 days prior to delivery. Nursing mothers: not recommended.

Pharmacologic Class:

Lithium salt.

Interactions:

Lithium toxicity potentiated by diuretics, ACE inhibitors, angiotensin II receptor blockers, indomethacin, ibuprofen, naproxen (possibly other NSAIDs, including COX-2 inhibitors), metronidazole, calcium channel blockers: monitor and adjust lithium dose, if needed. Discontinue if signs of neurologic toxicity occur with antipsychotics (eg, haloperidol, risperidone, thioridazine). Xanthines, acetazolamide, urea, alkalinizing agents may reduce serum lithium levels. May potentiate adverse reactions of methyldopa, phenytoin, carbamazepine. Prolongs effects of neuromuscular blockers (eg, succinylcholine, pancuronium). Hypothyroidism with chronic iodide administration. Serotonin syndrome with concomitant SSRIs, SNRIs, MAOIs; discontinue if occurs.

Adverse Reactions:

Fine hand tremor, polyuria, thirst/polydipsia, nausea, vomiting, general discomfort, thyroid abnormalities, dizziness, rash/dermatitis, ataxia/gait disturbance, decreased appetite, blurry vision; extrapyramidal symptoms, renal toxicity, seizures, lethargy, metallic taste, dry mouth, encephalopathic syndrome, pseudotumor cerebri (discontinue if occurs).

Elimination:

Renal. Half-life: ~18–36 hours.

How Supplied:

Contact supplier.