lithium

Class: Mood Stabilizer
FDA Indications: Acute Mania
Off-Label Use: Bipolar Disorder Maintenance, Augmentation Of Antidepressants, Migraines, Graves' Disease, Cluster Headaches, Neutropenia, SIADH
Prescribing
Forms: 150, 300, 600mg tablet; 300, 450mg Extended Release tablet; 8 mEq/5 mL soln
Dose Range: 900-1800 mg/day
Starting: Start at 300 mg bid or tid and ↑ dose as tolerated to target serum levels
Stopping: Prudent to decrease by 300 mg q 2-4 weeks; abrupt discontinuation (≥2 weeks) may precipitate episode
Monitoring: Serum Li+—target range 0.6-1.2 mEq/L for bipolar mania and 0.4-0.8 mEq/L for augmentation

NAMI drug fact sheet

Precautions
Contraindications: Severe cardiovascular or renal disease, severe debilitation, dehydration, sodium depletion, concurrent use with diuretics
Serious Side Effects: Li+ toxicity
mmol/L s/sx
1.0-1.5 ↓ concentration, lethargy, tremor, slurred speech, nausea
1.6-2.5 confusion, disorientation, drowsiness, unsteady gait, dysarthria, muscle fasciculations
>2.5 impaired consciousness → coma, delirium, ataxia, ↓ renal function & convulsions

Possible Risk of TdP, Drugs to Avoid in Congenital Long QT
Side Effects: visual changes, xerostomia, tremor, diarrhea, nausea, dysgeusia, polyuria, polydipsia, hypothyroidism, ↓ renal function, cognitive slowing, leukocytosis, weight gain, vomiting, alopecia, ECG Δ's
Pharmacodynamics
1° MOA: Thought To Alter Cation Transport Across Cell Membranes In Nerve And Muscle Cells, Influence The Reuptake Of 5-HT And/or NE, And Inhibit 2nd Messenger Systems Involving The Phosphatidylinositol Cycle
Pharmacokinetics
t½: 24 (18-36)° TMAX: 1-2°
Substrate of: Renally cleared
Inhibits: ∅ ; Induces:
Active Metabolites:
DDIs
  • - HCTZ, NSAIDs, & ACEIs can ↑ levels
  • - caffeine may ↓ levels
Misc
  • - more effective in preventing mania than in preventing depression
  • - has a suicide protective effect over the long-term course in patients with mood disorders
  • - any cause of dehydration can ↑ Li+ levels, including ↑ sweating, vomiting, diarrhea, ↓ fluid intake, low-Na+ diet
Special Populations

Category D—Cardiac malformations, including Ebstein anomaly, are associated with 1st trimester use. AEs include polyhydramnios, cardiac arrhythmias, hypoglycemia, DI, Δ in thyroid function, premature delivery, floppy infant syndrome, Li+ toxicity

Breast-feeding should be be avoided. Li+ is excreted in breast milk (RID 10-50%). Hypotonia, hypothermia, cyanosis, ECG Δ's, & lethargy have been reported in nursing infants

Li+ clearance ↓'s with age & ↓CrCl, thus elderly patients usually require lower Li+ dosages to achieve a target serum concentrations

Li+ clearance ↓'d in patients with abnormal renal function ∴ the risk of Li+ toxicity is ↑'d. Contraindicated severe renal insufficiency. Dosages must be adapted accordingly in mild or moderate reduction in renal function

No dosing adjustment required in liver disease

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Last updated July 08 2018 15:58:23. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.