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lithium (Rx)Brand and Other Names:Eskalith, Lithobid

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet, extended release

  • 300mg
  • 450mg

tablet

  • 300mg

capsule

  • 150mg
  • 300mg
  • 600mg

solution

  • 8mEq/5mL
more...

Bipolar Disorder

Immediate release: 900-2400 mg/day PO divided q6-8hr

Extended release: 900-1800 mg/day PO divided q12hr

Lower initial dosage may be used to minimize adverse drug reactions

Serum lithium should be monitored 12 hours after dose, twice weekly until serum concentration and clinical condition stabilize, and every other month thereafter

Desirable range for serum lithium: 0.6-1.2 mEq/L; although higher serum concentrations may be needed, not to exceed 1.5 mEq/L

Huntington's Disease (Orphan)

Lithium citrate tetrahydrate (in reverse micelle formulation)

Orphan indication sponsor

  • Medesis Pharma; L'Oree des Mas, 34 670 Baillargues, France

Administration

Preferably taken with food

Dosage Forms & Strengths

tablet, extended release

  • 300mg
  • 450mg

tablet

  • 300mg

capsule

  • 150mg
  • 300mg
  • 600mg

solution

  • 8mEq/5mL
more...

Bipolar Disorder (Off-label)

<6 years: Safety and efficacy not established

6-12 years: 15-60 mg/kg/day PO divided q6-8hr; not to exceed adult dosage 

>12 years: Immediate release, 900-2400 mg/day PO divided q6-8hr; extended release, 900-1800 mg/day PO divided q12hr

Dosing in elderly patients should be cautious, usually starting at low end of range

Elderly patients often respond to reduced dosage and may exhibit signs of toxicity at serum concentrations ordinarily tolerated by younger patients

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Interactions

Interaction Checker

lithium and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            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%)

            Frequency Not Defined

            Coma

            Lethargy

            Seizures

            Renal toxicity

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            Warnings

            Black Box Warnings

            Toxicity is closely related to serum lithium concentrations and may occur at dosages close to therapeutic levels; monitor therapy by measuring serum lithium

            Equipped facilities should be identified before initiation of therapy to provide prompt and accurate serum lithium concentration data

            Contraindications

            Documented hypersensitivity

            Severe cardiovascular disease

            Pregnancy in 1st trimester

            Unstable renal function, sodium depletion, severe dehydration

            Severe debilitation

            Cautions

            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

            The risk of lithium toxicity is increased in patients with significant renal or cardiovascular disease, severe debilitation or dehydration, or sodium depletion, and for patients receiving prescribed medications that may affect kidney function, such as angiotensin converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs), diuretics (loops and thiazides) and NSAIDs; for these patients, consider starting with lower doses and titrating slowly while frequently monitoring serum lithium concentrations and signs of lithium toxicity

            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

            Routine urinalysis and other tests may be used to evaluate tubular function (e.g., urine specific gravity or osmolality following a period of water deprivation, or 24-hour urine volume) and glomerular function (e.g., serum creatinine ,creatinine clearance, or proteinuria); during lithium therapy, progressive or sudden changes in renal function, even within normal range, indicate the need for re-evaluation of treatment

            An encephalopathic syndrome (characterized by weakness, lethargy, fever, tremulousness and confusion, extrapyramidal symptoms, leukocytosis, elevated serum enzymes, BUN, and FBS) has reported in a few patients treated with lithium plus a neuroleptic, most notably haloperidol; in some instances, the syndrome was followed by irreversible brain damage; because of possible causal relationship patients receiving such combined therapy or patients with organic brain syndrome or other CNS impairment should be monitored closely for early evidence of neurologic toxicity and treatment discontinued promptly if such signs appear; encephalopathic syndrome may be similar to or the same as Neuroleptic Malignant Syndrome (NMS)

            Lithium may prolong effects of neuromuscular blocking agents; neuromuscular blocking agents should be given with caution to patients receiving lithium

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            Pregnancy & Lactation

            Pregnancy category: D

            Lactation: Drug is excreted in breast milk; use not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Inhibits postsynaptic D2 receptor supersensitivity

            Alters cation transport in nerve and muscle cells and influences reuptake of serotonin or norepinephrine

            Inhibits phosphatidylinositol cycle second messenger systems

            Absorption

            Bioavailability: Immediate release, 95-100%; extended release, 60-90%

            Onset: Initial antimanic effect, 5-7 days; full effect, 10-21 days

            Peak serum time: Immediate release, 0.5-2 hr; extended release, 4-12 hr

            Peak plasma concentration: 0.4-0.9 mEq/L

            Steady-state therapeutic plasma concentration: 0.5-1.3 mEq/L

            Distribution

            Vd: Approximates total body water (0.7-1 L/kg)

            Metabolism

            Not metabolized

            Elimination

            Half-life: 18-24 hr; up to 36 hr with advanced age or renal impairment

            Dialyzable: Yes (hemodialysis, 50-90 mL/min; peritoneal dialysis, 13-15 mL/min)

            Renal clearance: 20-40 mL/min

            Excretion: Urine (95-99%)

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            Images

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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