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Lithium Fact Sheet

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Medication Name (brand): 
Lithium
Medication Name (clinical): 
lithium
Manufacturer: 

Various, depending on formulation; most are available as generics.

Indications: 
  • Acute Mania

  • Prevention of Depression and Mania in Bipolar Disorder
  • Off-label use for augmentation of antidepressants

Mechanism: 

Unclear; may work by affecting G-proteins and 2nd messengers.

Dosing: 
  • Most clinicians dose lithium at bedtime, whether using the immediate release or slow release versions.

  • Start at 300-600 mg QHS, gradually increasing to a target blood lithium level of 0.8 meq/L, which will often be in the 900-1200 mg QHS range.
  • With Eskalith CR, start with 450 mg QHS, and increase gradually from there.
  • When converting from IR lithium to Eskalith CR or Lithobid, prescribe as close to the identical dose as possible (only a potential problem with Eskalith CR).
  • No dosing adjustment required in liver disease; if you dare to use it in a patient with chronic renal impairment, decrease the dose substantially, using the patient’s GFR as your guide.

Side Effects: 
  • Nausea/diarrhea (strategies: split dosing, take with meals, switch to Li Citrate or slow release formulations).

  • Fine tremor (treat with Inderal LA 60 mg QAM or regular Inderal 20 mg BID-TID).
  • Polyuria/excessive thirst (dose at night, try low dose hydrochlorthiazide).
  • Memory problems (minimize dose, try cholinesterase inhibitors).
  • Weight gain.
  • Renal impairment (usual problem is benign, reversible decrease in concentrating ability; true kidney damage is very rare, but check yearly BUN/Cr just in case).
  • Cardiac (rare sinus node dysfunction causing bradycardia; baseline EKG only required in patients with documented cardiac disease).

Drug-drug Interactions: 
  • Mnemonic for drugs that increase Li levels: “No ACE in the Hole” (NSAIDS, Ace Inhibitors, and Hydrochlorothiazide); excess sweating can increase levels.

  • Caffeine may decrease levels.

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