lithium carbonate

Apo-Lithium Carbonate (CA), Apo-Lithium Camcolit (UK), Carbolith (CA), Carbonate SR (CA), Liskonum (UK), Lithane, Lithobid, Lithonate (UK), PMS-Lithium Carbonate (CA), Priadel (UK)
Pharmacologic class: Miscellaneous CNS drug
Therapeutic class: Antimanic drug
Pregnancy risk category D

FDA Boxed Warning

• Lithium toxicity is closely related to lithium blood level and can occur at doses close to therapeutic levels. Before starting therapy, ensure that resources for prompt, accurate blood lithium testing are available.

Action

Unknown. Thought to disrupt sodium exchange and transport in nerves and muscles and control reuptake of neurotransmitters.

Availability

Capsules: 150 mg, 300 mg, 600 mg
Capsules (slow-release): 150 mg, 300 mg
Syrup (citrate): 300 mg (8 mEq lithium)/5 ml
Tablets: 300 mg
Tablets (controlled-release): 450 mg
Tablets (extended-release): 300 mg, 450 mg
Tablets (slow-release): 300 mg
Adults and children ages 12 and older: 900 to 1,800 mg P.O. daily in divided doses (for example, 300 to 600 mg t.i.d. or 450 to 900 mg b.i.d. of controlled- or slow-release form) to achieve blood level of 1 to 1.5 mEq/L; measure blood level twice weekly until patient stabilizes. Maintenance dosage is 900 to 1,200 mg/day in divided doses (for example, 300 to 400 mg t.i.d. or 450 to 600 mg b.i.d. of controlled- or slow-release form) to maintain blood level of 0.6 to 1.2 mEq/L. Monitor blood level at least q 2 months.

Dosage adjustment

• Impaired renal function
• Elderly patients

Off-label uses

• Acute manic episodes in children
• Corticosteroid-induced psychosis
• Neutropenia secondary to antineoplastic therapy
• Tardive dyskinesia
• Alcoholism
• Bulimia

Contraindications

None

Precautions

Use cautiously in:
• hepatic or thyroid disease, severe cardiovascular or renal disease, diabetes mellitus, seizure disorders, systemic infections, brain trauma, organic brain syndrome, urinary retention, severe sodium depletion
• elderly patients
• pregnant or breastfeeding patients
• children (safety not established).

Administration

☞ Be aware that dosages are individualized according to lithium blood level and response.
• Give with food or milk to minimize GI upset.
• Make sure patient swallows slow-release tablet whole without chewing or crushing.
• When switching patient from immediate-release to controlled- or slow-release form, give same total daily dosage.
• Know that immediate-release tablets typically are given three or four times daily.