Lithium

Lithium Uses, Dosage, Side Effects, Food Interaction and all others data.

Although lithium has been used for over 50 years in treatment of bipolar disorder, the mechanism of action is still unknown.  Lithium's therapeutic action may be due to a number of effects, ranging from inhibition of enzymes such as glycogen synthase kinase 3, inositol phosphatases, or modulation of glutamate receptors. Lithium alters intraneuronal metabolism of catecholamines and sodium transport in neurons and muscle cells.

Lithium's mechanism of action is still unknown. Lithium's therapeutic action may be due to a number of effects, ranging from inhibition of enzymes such as glycogen synthase kinase 3, inositol phosphatases, or modulation of glutamate receptors.

Trade Name Lithium
Generic Lithium Carbonate
Lithium Carbonate Other Names Dilithium carbonate, Lithii carbonas, Lithium carbonate, Lithonate
Type Capsule
Formula CLi2O3
Weight Average: 73.89
Monoisotopic: 74.01675074
Protein binding

Lithium carbonate is not significantly protein bound.

Groups Approved
Therapeutic Class Anti-manic drugs
Manufacturer
Available Country United States
Last Updated: September 19, 2023 at 7:00 am
Lithium
Lithium

Uses

Treatment and prophylaxis of mania, bipolar disorder and recurrent depression.

Lithium is also used to associated treatment for these conditions: Bipolar Disorder (BD), Acute Manic episode

How Lithium works

Lithium's mechanism of action is still unknown. However, the “inositol depletion theory” suggests 3 main potential targets. These targets are inositol monophosphatase, inositol polyphosphatase, and glycogen synthase kinase 3(GSK-3).

The “Inositol depletion theory” suggests lithium behaves as an uncompetitive inhibitor of inositol monophosphatase in a manner inversely proportional to the degree of stimulus. This inhibition lowers levels of inositol triphosphate. However, stronger inhibitors of inositol monophosphatase are not as clinically effective and low levels of inositol triphosphate are associated with memory impairment.

Lithium acts on inositol polyphosphatase as an uncompetitive inhibitor. This inhibition is thought to have multiple downstream effects that have yet to be clarified.

Lithium regulates phosphorylation of GSK-3 which regulates other enzymes through phosphorylation. Lithium can also inhibit GSK-3 through interfering with the magnesium ion in the active site.

Dosage

Lithium dosage

Adult and child over 12 years: initially 1 gm to 1.5 gm daily; prophylaxis, initially 300-400 mg daily. Should be taken with food.

Side Effects

Tiredness, loss of appetite, nausea, vomiting, diarrhoea, hands shaking, memory problems, increased thirst and consequently passing urine more often by day, and perhaps also by night.

Toxicity

In rats, the oral LD50 is 525mg/kg and the inhalation LC50 is >2.17mg/L over 4 hours.

There is insufficient data regarding the carcinogenicity, mutagenicity, or fertility impairment of lithium carbonate. However, studies in rats and mice have shown repeated daily dosing of lithium carbonate result in adverse effects on male reproductive organs, spermatogenesis, and testosterone levels.

There is conflicting evidence regarding the incidence of cardiovascular abnormalities in first trimester administration of lithium. Animal studies have shown adverse effects on the fetus and fertility overall. The risk and benefit of lithium use in pregnancy must be weighed and should lithium treatment continue in pregnancy, serum lithium concentrations should be regularly monitored, dosages should be adjusted, and lithium should be decreased or stopped 2 or 3 days before delivery to avoid maternal and/or neonatal toxicity.

Breastfeeding is not recommended with maternal lithium use but if it is continued, the infant should be monitored for thyroid function and symptoms of lithium toxicity such as hypertonia, hypothermia, cyanosis, and ECG changes.

Safety in effectiveness in patients under 12 years has not been established, however dosing for patients 12 years and older is similar to that of adult patients.

Safety in geriatric patients has not been established, however caution is advised when using lithium as this population is more likely to have impaired renal function.

Patients with creatinine clearance between 30mL/min and 89mL/min should be started at a lower dose and slowly titrated to the correct dose while monitoring serum lithium levels. Patients with a creatinine clearance less than 30mL/min should not take lithium, especially in the case of a low sodium diet.

Precaution

Decreased tolerance to lithium has been reported to ensue from protracted sweating or diarrhoea and, if such occur, supplemental fluid and salt should be administered under careful medical supervision and lithium intake reduced or suspended until the condition is resolved.

Interaction

Reduced serum levels with carbonic anhydrase inhibitors, chlorpromazine, sodium-containing preparations, theophylline, urea. Enhanced hypothyroid effects with iodine salts. Enhanced effects of neuromuscular-blocking agents. Reduced pressor response to sympathomimetics.

Food Interaction

  • Avoid alcohol. Alcohol increased peak serum concentrations of lithium.
  • Avoid iodine-containing foods and supplements. Iodine and lithium may synergistically produce hypothyroidism.
  • Limit caffeine intake. Caffeine may decrease lithium concentrations.
  • Take with food. Food reduces gastrointestinal upset.

Volume of Distribution

Apparent volume of distribution is 0.7 to 1.0L/kg.

Elimination Route

Lithium absorption is rapid and oral bioavailability is close to 100%.

Half Life

The half life of lithium carbonate is 18 to 36 hours. Other sources say it may be 7 to 20 hours.

Clearance

Clearance is generally between 10 and 40mL/min but may be as low as 15mL/min in elderly patients and those with renal impairment.

Elimination Route

Lithium is primarily eliminated through the kidneys and elimination in the feces is insignificant.

Pregnancy & Breastfeeding use

Pregnancy Category D. An increased incidence of cardiovascular abnormality has been noted in infants of women given lithium during the first 3 months of pregnancy, such use should be avoided unless essential. Breast feeding is not advised unless the benefits of lithium use outweigh the advantages.

Contraindication

Renal insufficiency, cardiovascular insufficiency, Addison's disease and untreated hypothyroidism are all contraindications to lithium therapy.

Special Warning

Renal Impairment: CrCl 10-50: 50-75% of normal dose.

Acute Overdose

In the event of accumulation, lithium should be stopped and serum estimations should be carried out every six hours.Under no circumstances should a diuretic be used. Osmotic diuresis (mannitol or urea infusion) or alkalinisation of the urine (sodium lactate or sodium bicarbonate infusion) should be initiated. If the serum lithium level is over 4.0 mmol/L, or if there is a deterioration in the patient's condition, or if the serum lithium concentration is not falling at a rate corresponding to a half-life of under 30 hours, peritoneal or haemodialysis should be instituted promptly. This should be continued until there is no lithium in the serum or dialysis fluid. Serum lithium levels should be monitored for at least a further week to take account of any possible rebound in serum lithium levels as a result of delayed diffusion from body tissues.

Storage Condition

Store at 25° C

Innovators Monograph

You find simplified version here Lithium

Lithium contains Lithium Carbonate see full prescribing information from innovator Lithium Monograph, Lithium MSDS, Lithium FDA label

FAQ

What is Lithium used for?

Lithium is widely used in the processing of metal oxides, and as a drug for the treatment of mood disorders. Lithium is used to treat mania that is part of bipolar disorder. It is also used on a daily basis to reduce the frequency and severity of manic episodes.

How safe is Lithium?

Lithium is generally safe to take for a long time. Most people take it for years with no problems. If you've been taking lithium for some time, it can cause weight gain. It can also cause problems with your kidneys or thyroid gland.

How does Lithium work?

Metal carbonates generally decompose on heating, liberating carbon dioxide from the long term carbon cycle to the short term carbon cycle and leaving behind an oxide of the metal.

What are the common side effects of Lithium?

Common side effects of Lithium are include:

  • loss of appetite.
  • constipation.
  • gas (flatulence)
  • nausea.
  • vomiting.
  • high calcium levels.
  • low phosphate levels.
  • milk-alkali syndrome.

Is Lithium safe during pregnancy?

The risks to your baby with taking Lithium while pregnant .Taking Lithium in early pregnancy can increase the risk that your baby's heart might not develop properly.

Is Lithium safe during breastfeeding?

Recommend not to breastfeed whilst taking Lithium.

Can I drink alcohol with Lithium?

Alcohol can increase the nervous system side effects of lithium such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with Lithium.

Can I drive after taking Lithium?

If you cut out salt from your diet, this can also affect blood levels of Lithium. Lithium may affect your mental alertness or make you drowsy. Do not drive until you know how Lithium will affect you. Avoid alcohol.

When should be taken of Lithium?

You will usually take your Lithium once a day, at night. This is because when you have your regular blood test, you need to have it 12 hours after taking your medicine.

How many time can I take Lithium daily?

Take this Lithium by mouth as directed by your doctor, usually 2-3 times daily.

Is It better to take Lithium with food?

Lithium should therefore preferably be administered after meals.

How long does Lithium take to work?

A reduction in manic symptoms should be noticed within 5 to 7 days but the full therapeutic effect may require 10 to 21 days.

How long does Lithium stay in my system?

Lithium can stay in your body for a long time. It typically takes about 18 to 36 hours for the body to clear half of the medication.

Can I take Lithium for a long time?

Lithium is generally safe to take for a long time. Most people take it for years with no problems. If you've been taking Lithium for some time, it can cause weight gain.

Who should not take Lithium?

You should not take Lithium if you have; high amount of calcium in the blood. low amount of sodium in the blood. very serious loss of body water. serotonin syndrome, a type of disorder with high serotonin levels.

What happen If I stop taking Lithium?

Do not stop taking lithium suddenly or change your dose without speaking to your doctor first. It's important you keep taking it, even if you feel better. If you stop taking it suddenly you could become unwell again very quickly.

What happen if I overdose on Lithium?

Lithium toxicity also known as Lithium overdose, is the condition of having too much Lithium. Symptoms may include a tremor, increased reflexes, trouble walking, kidney problems, and an altered level of consciousness. Some symptoms may last for a year after levels return to normal.

Is Lithium safe for heart patients?

Lithium may be used safely in patients with cardiac disease if the dose is adjusted to the rate of Lithium excretion.

Can Lithium affect my kidneys?

Kidney damage due to Lithiumy include acute (sudden) or chronic (long-term) kidney disease and kidney cysts. The amount of kidney damage depends on how long you have been taking Lithium. It is possible to reverse kidney damage caused by Lithium early in treatment, but the damage may become permanent over time.

Can Lithium affects my liver?

The serum aminotransferase elevations that occur on Lithium therapy are usually self-limited and do not require dose modification or discontinuation of therapy. No instances of acute liver failure or chronic liver disease have been attributed to Lithium.

What will Lithium do to a normal person?

Results indicate that such a course of Lithium in normals induces dysphoric mood change and psychomotor slowing, without significant relationship to either plasma or RBC Lithium concentrations.

What does Lithium do to the brain?

Lithium acts on a person's central nervous system (brain and spinal cord). Doctors don't know exactly how Lithium works to stabilize a person's mood, but it is thought to help strengthen nerve cell connections in brain regions that are involved in regulating mood, thinking and behavior.

*** Taking medicines without doctor's advice can cause long-term problems.
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