General
Pronunciation
LITH-ee-um
Trade Name(s)
Carbolith [Canada]
Duralith [Canada]
Eskalith
Lithizine [Canada]
Lithobid
Pregnancy CategoryCategory DTher. class.mood stabilizers
Indications
Manic episodes of manic depressive illness (treatment, maintenance, prophylaxis)
Action
Alters cation transport in nerve and muscle
May also influence reuptake of neurotransmitters
Therapeutic Effect(s): Prevents/decreases incidence of acute manic episodes
Pharmacokinetics
Absorption: Completely absorbed after oral administration
Distribution: Widely distributed into many tissues and fluids; CSF levels are 50% of plasma levels. Crosses the placenta; enters breast milk.
Metabolism and Excretion: Excreted almost entirely unchanged by the kidneys
Half-life: 2027 hr
TIME/ACTION PROFILE (antimanic effects)
| ROUTE | ONSET | PEAK | DURATION |
| PO, POER | 57 days | 1021 days | days |
Contraindication/Precautions
Contraindicated in:
Hypersensitivity
Severe cardiovascular or renal disease
Dehydrated or debilitated patients
Should be used only where therapy, including blood levels, may be closely monitored
Some products contain alcohol or tartrazine and should be avoided in patients with known hypersensitivity or intolerance
Use Cautiously in: Any degree of cardiac, renal, or thyroid disease
Diabetes mellitus
Pregnancy/Lactation: Safety not established
Geri: Initial dosage reduction recommended
Adverse Reactions/Side Effects
CNS: SEIZURES, fatigue, headache, impaired memory, ataxia, sedation, confusion, dizziness, drowsiness, psychomotor retardation, restlessness, stupor.
EENT: aphasia, blurred vision, dysarthria, tinnitus.
CV: ARRHYTHMIAS, ECG changes, edema, hypotension.
GI: abdominal pain, anorexia, bloating, diarrhea, nausea, dry mouth, metallic taste.
GU: polyuria, glycosuria, nephrogenic diabetes insipidus, renal toxicity.
Derm: acneiform eruption, folliculitis, alopecia, diminished sensation, pruritus.
Endo: hypothyroidism, goiter, hyperglycemia, hyperthyroidism.
F and E: hyponatremia.
Hemat: leukocytosis.
Metabolic: weight gain.
MS: muscle weakness, hyperirritability, rigidity.
Neuro: tremors.
*CAPITALS indicates life-threatening.
*italic indicates most frequent.
Interactions
Drug-Drug
May prolong the action of neuromuscular blocking agents
risk of neurologic toxicity with haloperidol or molindone
Diuretics, methyldopa , probenecid, fluoxetine, and NSAIDs may
risk of toxicity
Blood levels may be
by ACE inhibitors
Lithium may
effects of chlorpromazine
Chlorpromazine may mask early signs of lithium toxicity
Hypothyroid effects may be additive with potassium iodide or antithyroid agents
Aminophylline, phenothiazines, and drugs containing large amounts of sodium
renal elimination and
effectiveness
Psyllium can
lithium levels
Drug-Natural Products Caffeine-containing herbs (cola nut, guarana, mate,
tea,
coffee) may
lithium serum levels and efficacy
Drug-FoodLarge changes in sodium intake may alter the renal elimination of lithium.

sodium intake will

renal excretion
Route/Dosage
Precise dosing is based on serum lithium levels. 300 mg lithium carbonate contains 812 mEq lithium
PO (Adults and children >=12 yr):
Tablets/capsules300600 mg 3 times daily initially; usual maintenance dose is 300 mg 34 times daily.
Slow-release capsules200300 mg 3 times daily initially; increased up to 1800 mg/day in divided doses. Usual maintenance dose is 300400 mg 3 times daily.
Extended-release tablets450900 mg twice daily
or 300600 mg 3 times daily initially; usual maintenance dose is 450 mg twice daily
or 300 mg 3 times daily.
PO (Children <12 yr): 1520 mg (0.40.5 mEq)/kg/day in 23 divided doses; dosage may be adjusted weekly.
Availability
Capsules: 150 mg, 300 mg, 600 mg
» Cost:
Generic: 150 mg $18.88/100, 300 mg $17.77/100, 600 mg $42.30/100$0.
Tablets: 300 mg
Controlled-release tablets: 300 mg, 450 mg
» Cost:
Generic: 300 mg $39.97/100, 450 mg $48.32/100.
Slow-release tablets: 300 mg
Syrup: 300 mg (8 mEq lithium)/5 ml
» Cost: $60.00/500 ml.
Assessment
Assess mental status (orientation, mood, behavior) initially and periodically. Assess manic symptoms with Young Mania Rating Scale (YMRS) at baseline and periodically through treatment in patients with mania. Initiate suicide precautions if indicated
Monitor intake and output ratios. Report significant changes in totals. Unless contraindicated, fluid intake of at least 20003000 ml/day should be maintained. Weight should also be monitored at least every 3 mo
Lab Test Considerations Evaluate renal and thyroid function, WBC with differential, serum electrolytes, and glucose periodically during therapy
EKG for patients >50 years old
Toxicity and Overdose Monitor serum lithium levels twice weekly during initiation of therapy and every 23 mo during chronic therapy. Draw blood samples in the morning immediately before next dose. Therapeutic levels range from 0.5 to 1.5 mEq/L
» Assess patient for signs and symptoms of lithium toxicity (vomiting, diarrhea, slurred speech, decreased coordination, drowsiness, muscle weakness, or twitching). If these occur, report before administering next dose
Potential Nursing Diagnoses
Disturbed thought process (Indications)
Ineffective coping (Indications)
Imbalanced nutrition: risk for more than body requirements (Side Effects)
Implementation
Do not confuse Lithobid (lithium) with Levbid (hyoscyamine)
PO: Administer with food or milk to minimize GI irritation. Extended-release preparations should be swallowed whole; do not break, crush, or chew
Patient/Family Teaching
Instruct patient to take medication as directed, even if feeling well. Take missed doses as soon as remembered unless within 2 hr of next dose (6 hr if extended release)
Lithium may cause dizziness or drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known
Advise patient that psychotherapy is beneficial in improving coping skills
Low sodium levels may predispose patient to toxicity. Advise patient to drink 20003000 ml fluid each day and eat a diet with consistent and moderate sodium intake. Excessive amounts of coffee, tea, and cola should be avoided because of diuretic effect. Avoid activities that cause excess sodium loss (heavy exertion, exercise in hot weather, saunas). Notify health care professional of fever, vomiting, and diarrhea, which also cause sodium loss
Advise patient that weight gain may occur. Review principles of a low-calorie diet
Instruct patient to consult health care professional before taking OTC medications or herbal products concurrently with this therapy
Advise patient to use contraception and to consult health care professional if pregnancy is suspected
Review side effects and symptoms of toxicity with patient. Instruct patient to stop medication and report signs of toxicity to health care professional promptly
Explain to patients with cardiovascular disease or over 40 yr of age the need for ECG evaluation before and periodically during therapy. Patient should inform health care professional if fainting, irregular pulse, or difficulty breathing occurs
Emphasize the importance of periodic lab tests to monitor for lithium toxicity
Evaluation/Desired Outcomes
Resolution of the symptoms of mania (hyperactivity, pressured speech, poor judgment, need for little sleep)
Decreased incidence of mood swings in bipolar disorders
Improved affect in unipolar disorders. Improvement in condition may require 13 wk
Remission of depressive symptoms
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