Lithium: Complete Detailed Guide with FAQs
Introduction
- Lithium is a mood stabilizer primarily used to treat bipolar disorder and prevent manic and depressive episodes.
- It is one of the oldest and most effective treatments for mood disorders.
- Requires careful monitoring due to its narrow therapeutic index and potential for toxicity.
Class and Mechanism of Action
- Drug Class: Mood stabilizer.
- Mechanism:
- Modulates neurotransmitter levels (e.g., serotonin, dopamine).
- Stabilizes neuronal activity and reduces abnormal mood swings.
Indications
- Bipolar disorder: Prevention and treatment of manic and depressive episodes.
- Augmentation therapy: Enhances the effectiveness of antidepressants in treatment-resistant depression.
- Schizoaffective disorder: Helps manage mood symptoms.
Dosage and Administration
- Forms Available:
- Tablets (immediate-release and extended-release).
- Capsules.
- Oral solution.
Typical Dosages
- Acute Mania:
- Start with 300 mg 2–3 times daily; titrate to a therapeutic serum level.
- Maintenance Therapy:
- 900–1200 mg/day divided into 2–3 doses.
- Serum Levels:
- Therapeutic range: 0.6–1.2 mmol/L (maintenance).
- Toxic range: >1.5 mmol/L.
Administration Guidelines
- Take with food to reduce gastrointestinal upset.
- Maintain consistent salt and fluid intake to avoid fluctuations in lithium levels.
Forms, Brand Names, Manufacturers, and Prices
- Lithium Carbonate:
- Brand Names: Eskalith (Novartis), Lithobid (AbbVie).
- Price: ~$15–$50 per month depending on dosage and brand.
- Lithium Citrate (Oral Solution):
- Brand Names: Generic.
- Price: ~$20–$40 per bottle.
Contraindications and Precautions
- Contraindications:
- Severe kidney or cardiovascular disease.
- Dehydration or sodium imbalance.
- Pregnancy (especially during the first trimester) unless benefits outweigh risks.
- Precautions:
- Avoid in patients with a history of lithium toxicity.
- Use cautiously in the elderly due to reduced renal clearance.
Side Effects
Common Side Effects
- Increased thirst and urination (polyuria).
- Nausea, diarrhea.
- Hand tremors.
- Weight gain.
Less Common Side Effects
- Cognitive dulling or confusion.
- Acne or worsening of psoriasis.
- Edema (swelling).
Rare but Serious Side Effects
- Lithium toxicity: Symptoms include severe nausea, vomiting, tremors, confusion, and seizures.
- Hypothyroidism.
- Nephrogenic diabetes insipidus (chronic excessive urination).
Drug Interactions
- NSAIDs: Increase lithium levels (e.g., ibuprofen, naproxen).
- Diuretics: Particularly thiazides, increase the risk of lithium toxicity.
- ACE Inhibitors/ARBs: Increase lithium levels (e.g., lisinopril, losartan).
- Caffeine: May reduce lithium levels.
Monitoring Parameters
- Serum lithium levels: Measure 5–7 days after starting or changing the dose.
- Kidney function tests (e.g., creatinine, eGFR).
- Thyroid function tests (e.g., TSH, T3/T4 levels).
- Electrolytes: Monitor sodium levels to prevent imbalances.
Patient Counseling Points
- Take lithium at the same time each day to maintain stable blood levels.
- Drink plenty of water (6–8 glasses daily) and avoid dehydration.
- Avoid sudden changes in salt intake, which can affect lithium levels.
- Report symptoms like severe tremors, confusion, or unsteady walking immediately, as these may indicate toxicity.
- Avoid over-the-counter medications like NSAIDs without consulting a doctor.
Use in Children
- Used with caution; doses are weight-based.
- Regular monitoring is essential due to the narrow therapeutic index.
Use in Pregnancy
- Category D: May cause fetal harm, including cardiac malformations (e.g., Ebstein anomaly).
- Avoid during the first trimester unless no safer alternatives exist.
- Use lowest effective dose with close monitoring if necessary.
Use in Elderly
- Start with lower doses due to decreased renal clearance and increased sensitivity to toxicity.
- Monitor kidney and thyroid function more frequently.
FAQs About Lithium
Q1: What is lithium used for?
- Lithium is primarily used to treat and prevent mood swings in bipolar disorder and as an adjunct for depression.
Q2: How long does it take for lithium to work?
- Therapeutic effects may take 1–3 weeks for mania and longer for depression prevention.
Q3: What happens if lithium levels are too high?
- Symptoms of toxicity include severe tremors, confusion, nausea, and seizures. Seek emergency medical attention immediately.
Q4: How is lithium toxicity treated?
- Discontinue lithium and provide supportive care. Severe cases may require dialysis.
Q5: Can I drink alcohol while taking lithium?
- Alcohol should be avoided as it can exacerbate dehydration and mood instability.
Q6: Does lithium cause weight gain?
- Weight gain is a common side effect, often due to increased thirst and fluid retention.
Q7: Do I need regular blood tests on lithium?
- Yes, regular tests for serum levels, kidney function, and thyroid function are essential.
Q8: Can I stop lithium abruptly?
- No, stopping suddenly can lead to mood relapse or withdrawal symptoms. Taper off under medical supervision.
Q9: Does lithium interact with other medications?
- Yes, drugs like NSAIDs, diuretics, and ACE inhibitors can increase lithium levels.
Q10: What dietary changes should I consider on lithium?
- Maintain consistent salt and fluid intake to avoid fluctuations in lithium levels.
Q11: Can lithium cause thyroid problems?
- Yes, hypothyroidism is a potential side effect; regular thyroid function tests are recommended.
Q12: Is lithium addictive?
- No, lithium is not addictive but requires regular use to maintain effectiveness.
Q13: What should I do if I miss a dose?
- Take it as soon as you remember unless it’s close to the next dose. Do not double the dose.
Q14: Can lithium be used for children?
- Yes, but only under strict medical supervision with weight-based dosing and monitoring.
Q15: How does lithium compare to other mood stabilizers?
- Lithium is highly effective for mood stabilization but requires more monitoring compared to newer drugs like lamotrigine.
