Lithium Brand Names
Eskalith | Eskalith CR | Lithobid
What is Lithium
Lithium is a monovalent cation similar to sodium and potassium. For clinical use, it is administered orally as the carbonate and the more water-soluble citrate salts.
Immediate-release lithium is indicated for the treatment of manic episodes, and as maintenance treatment for Bipolar I Disorder in adults and pediatric patients 7 years and older; clinically, the drug has been used in children as young as 6 years of age.
Extended-release lithium is indicated for the treatment of Bipolar I Disorder in adults and pediatric patients 12 years and older.
Lithium is useful as an adjunct for refractory depression and for reducing the risk of suicide and all-cause mortality in patients with mood disorders and is used off-label for these purposes.
While other clinical uses for lithium have been described, the drug is rarely used off-label for non-psychiatric medical purposes due to its narrow therapeutic range, lack of sufficient trials for these uses, and the propensity for lithium toxicity.
Lithium toxicity is closely related to serum lithium concentrations and can occur at doses close to therapeutic concentrations.
A boxed warning requires that facilities for prompt and accurate determinations of lithium concentrations be readily available during use of the drug.
Due to risk for toxicity, requires close monitoring of serum lithium concentrations, electrolytes, and renal function. Common conditions that can cause lithium toxicity include urinary retention, hyponatremia, dehydration, and infection.
The use of lithium dates back to 1841, and lithium chloride was used as a salt substitute during the 1940’s. A
fter several cases of lithium toxicity were associated with indiscriminate use, lithium use fell out of favor until 1949 when it was discovered that lithium was beneficial in the management of mania.
However, lithium prescription products were initially approved by the FDA in 1970.
Indications
- bipolar disorder
- depression
- mania
For the treatment of bipolar disorder (i.e., Bipolar I Disorder), including acute mania and maintenance therapy
Side Effects
- abdominal pain
- acne vulgaris
- alopecia
- angioedema
- anorexia
- arrhythmia exacerbation
- arthralgia
- ataxia
- AV block
- blurred vision
- bradycardia
- cardiac arrest
- cheilitis
- choreoathetosis
- coma
- confusion
- dehydration
- dental caries
- diabetes insipidus
- diarrhea
- dizziness
- drowsiness
- Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
- dysarthria
- dysgeusia
- dystonic reaction
- EEG changes
- exophthalmos
- fatigue
- fecal incontinence
- fever
- flatulence
- folliculitis
- glomerulonephritis
- glycosuria
- goiter
- hallucinations
- headache
- hypercalcemia
- hyperchloremic acidosis
- hyperglycemia
- hyperreflexia
- hypersalivation
- hyperthyroidism
- hyponatremia
- hypotension
- hypothyroidism
- impaired cognition
- impotence (erectile dysfunction)
- interstitial nephritis
- lethargy
- leukocytosis
- memory impairment
- metallic taste
- myasthenia
- myoclonia
- nausea
- nephrotic syndrome
- neuroleptic malignant syndrome
- new primary malignancy
- nystagmus
- oliguria
- palpitations
- papilledema
- peripheral edema
- polydipsia
- polyuria
- proteinuria
- pruritus
- pseudotumor cerebri
- psoriasis
- psychomotor impairment
- QT prolongation
- rash
- renal failure (unspecified)
- renal tubular acidosis (RTA)
- restlessness
- scotomata
- seizures
- serotonin syndrome
- skin ulcer
- ST-T wave changes
- syncope
- teratogenesis
- tinnitus
- tremor
- urinary incontinence
- vertigo
- vomiting
- weight gain
- weight loss
- xerosis
- xerostomia
Monitoring Parameters
- blood pressure
- CBC with differential
- pregnancy testing
- serum calcium
- serum creatinine/BUN
- serum electrolytes
- serum lithium concentrations
- thyroid function tests (TFTs)
- urinalysis
Contraindications
- apheresis
- AV block
- bradycardia
- breast-feeding
- Brugada syndrome
- cardiomyopathy
- celiac disease
- children
- contraception requirements
- dehydration
- diarrhea
- driving or operating machinery
- encephalopathy
- females
- fever
- geriatric
- heart failure
- human immunodeficiency virus (HIV) infection
- hypercalcemia
- hyperparathyroidism
- hyperthyroidism
- hypocalcemia
- hypokalemia
- hypomagnesemia
- hyponatremia
- hypothermia
- hypothyroidism
- hypovolemia
- infants
- infection
- initial treatment
- labor
- leukemia
- long QT syndrome
- mental status changes
- metabolic acidosis
- myocardial infarction
- neonates
- obstetric delivery
- Parkinson’s disease
- parkinsonism
- pheochromocytoma
- polyuria
- pregnancy
- pregnancy testing
- psoriasis
- QT prolongation
- renal disease
- renal failure
- renal impairment
- reproductive risk
- rheumatoid arthritis
- seizure disorder
- serum lithium concentration monitoring
- sick sinus syndrome
- sickle cell disease
- sleep deprivation
- sodium restriction
- stroke
- suicidal ideation
- syncope
- systemic lupus erythematosus (SLE)
- thyroid disease
Interactions
- Acarbose
- Acebutolol
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Codeine
- Acetaminophen; Dextromethorphan; Doxylamine
- Acetaminophen; Dichloralphenazone; Isometheptene
- Acetaminophen; Diphenhydramine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Tramadol
- Aclidinium; Formoterol
- Acrivastine; Pseudoephedrine
- Acyclovir
- Albuterol
- Albuterol; Ipratropium
- Aldesleukin, IL-2
- Alfentanil
- Alfuzosin
- Aliskiren
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Aliskiren; Hydrochlorothiazide, HCTZ
- Aliskiren; Valsartan
- Alkalinizing Agents
- Alogliptin
- Alogliptin; Metformin
- Alogliptin; Pioglitazone
- Alpha-glucosidase Inhibitors
- Alprazolam
- Amiodarone
- Amitriptyline; Chlordiazepoxide
- Amlodipine
- Amlodipine; Atorvastatin
- Amlodipine; Benazepril
- Amlodipine; Celecoxib
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
- Amobarbital
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Amphetamine; Dextroamphetamine Salts
- Anagrelide
- Angiotensin II receptor antagonists
- Angiotensin-converting enzyme inhibitors
- Anxiolytics; Sedatives; and Hypnotics
- Apomorphine
- Arformoterol
- Argatroban
- Aripiprazole
- Arsenic Trioxide
- Artemether; Lumefantrine
- Asenapine
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Oxycodone
- Atenolol
- Atenolol; Chlorthalidone
- Atomoxetine
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Azithromycin
- Barbiturates
- Bedaquiline
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Bendroflumethiazide; Nadolol
- Benzodiazepines
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Benzphetamine
- Beta-adrenergic blockers
- Betaxolol
- Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Bisoprolol
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- Blinatumomab
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- Brimonidine; Timolol
- Brompheniramine
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Guaifenesin
- Brompheniramine; Dextromethorphan; Phenylephrine
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Budesonide; Formoterol
- Buprenorphine
- Buprenorphine; Naloxone
- Buspirone
- Butabarbital
- Caffeine
- Caffeine; Ergotamine
- Calcitonin
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- Canagliflozin
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- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pyrilamine
- Carbinoxamine
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Phenylephrine
- Carbinoxamine; Pseudoephedrine
- Carbonic anhydrase inhibitors
- Carteolol
- Carvedilol
- Ceritinib
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chlorcyclizine
- Chlordiazepoxide
- Chlordiazepoxide; Clidinium
- Chloroquine
- Chlorpheniramine
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dextromethorphan
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Chlorpromazine
- Cimetidine
- Ciprofloxacin
- Cisapride
- Cisplatin
- Citalopram
- Clarithromycin
- Clemastine
- Clevidipine
- Clindamycin
- Clofazimine
- Clonazepam
- Clorazepate
- Clozapine
- Codeine
- Codeine; Guaifenesin
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Crizotinib
- Cyclizine
- Dapagliflozin
- Dapagliflozin; Metformin
- Dapagliflozin; Saxagliptin
- Dasatinib
- Degarelix
- Desmopressin
- Desvenlafaxine
- Deutetrabenazine
- Dexchlorpheniramine
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dexmethylphenidate
- Dextran
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Promethazine
- Dextromethorphan; Quinidine
- Diazepam
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Diltiazem
- Dimenhydrinate
- Diphenhydramine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Diphenhydramine; Phenylephrine
- Disopyramide
- Disulfiram
- Dofetilide
- Dolasetron
- Dolutegravir; Rilpivirine
- Donepezil
- Donepezil; Memantine
- Dorzolamide; Timolol
- Doxylamine
- Doxylamine; Pyridoxine
- Dronabinol
- Dronedarone
- Droperidol
- Duloxetine
- Dupilumab
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Eliglustat
- Empagliflozin
- Empagliflozin; Linagliptin
- Empagliflozin; Linagliptin; Metformin
- Empagliflozin; Metformin
- Emtricitabine; Rilpivirine; Tenofovir alafenamide
- Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
- Enalapril; Felodipine
- Encorafenib
- Entrectinib
- Eplerenone
- Eribulin
- Ertugliflozin; Metformin
- Ertugliflozin; Sitagliptin
- Erythromycin
- Erythromycin; Sulfisoxazole
- Escitalopram
- Esmolol
- Estazolam
- Ethanol
- Ethotoin
- Ezogabine
- Felodipine
- Fenfluramine
- Fentanyl
- Filgrastim, G-CSF
- Fingolimod
- Flecainide
- Fluconazole
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluphenazine
- Flurazepam
- Fluticasone; Salmeterol
- Fluticasone; Umeclidinium; Vilanterol
- Fluticasone; Vilanterol
- Fluvoxamine
- food
- Formoterol
- Formoterol; Mometasone
- Foscarnet
- Fosphenytoin
- Gabapentin
- Gallium Ga 68 Dotatate
- Gemcitabine
- Gemifloxacin
- Gemtuzumab Ozogamicin
- Gentamicin
- Gilteritinib
- Glasdegib
- Glipizide; Metformin
- Glyburide; Metformin
- Glycopyrrolate; Formoterol
- Goserelin
- Granisetron
- Green Tea
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Halogenated Anesthetics
- Haloperidol
- Heparin
- Hetastarch
- Histrelin
- Homatropine; Hydrocodone
- Hydantoins
- Hydrochlorothiazide, HCTZ; Methyldopa
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydromorphone
- Hydroxychloroquine
- Hydroxyzine
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Ibritumomab Tiuxetan
- Ibuprofen; Oxycodone
- Ibutilide
- Iloperidone
- Incretin Mimetics
- Indacaterol
- Indacaterol; Glycopyrrolate
- Indapamide
- Inotuzumab Ozogamicin
- Insulins
- Iodine; Potassium Iodide, KI
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- Isradipine
- Itraconazole
- Ivosidenib
- Ketoconazole
- Labetalol
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- Lasmiditan
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- Lenvatinib
- Leuprolide
- Leuprolide; Norethindrone
- Levalbuterol
- Levetiracetam
- Levobetaxolol
- Levobunolol
- Levofloxacin
- Levomilnacipran
- Levorphanol
- Linagliptin
- Linagliptin; Metformin
- Linezolid
- Lisdexamfetamine
- Lofexidine
- Long-acting beta-agonists
- Loop diuretics
- Loperamide
- Loperamide; Simethicone
- Lopinavir; Ritonavir
- Lorazepam
- Lorcaserin
- Loxapine
- Lurasidone
- Macimorelin
- Mannitol
- Maprotiline
- Meclizine
- Mefloquine
- Meglitinides
- Meperidine
- Meperidine; Promethazine
- Mephobarbital
- Metaproterenol
- Metformin
- Metformin; Pioglitazone
- Metformin; Repaglinide
- Metformin; Rosiglitazone
- Metformin; Saxagliptin
- Metformin; Sitagliptin
- Methadone
- Methamphetamine
- Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
- Methohexital
- Methyldopa
- Methylene Blue
- Methylphenidate
- Metoprolol
- Metronidazole
- Midazolam
- Midostaurin
- Mifepristone
- Miglitol
- Milnacipran
- Mirtazapine
- Molindone
- Monoamine oxidase inhibitors
- Morphine
- Morphine; Naltrexone
- Moxifloxacin
- Nabilone
- Nadolol
- Nalbuphine
- Nebivolol
- Nebivolol; Valsartan
- Netupitant, Fosnetupitant; Palonosetron
- Neuromuscular blockers
- Nicardipine
- Nifedipine
- Nilotinib
- Nimodipine
- Nisoldipine
- Nonsteroidal antiinflammatory drugs
- Norfloxacin
- Octreotide
- Ofloxacin
- Olanzapine
- Olodaterol
- Ondansetron
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Oxazepam
- Oxycodone
- Oxymorphone
- Ozanimod
- Paliperidone
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- Panobinostat
- Paroxetine
- Pasireotide
- Pazopanib
- Pegfilgrastim
- Pemoline
- Penbutolol
- Pentamidine
- Pentobarbital
- Perindopril; Amlodipine
- Perphenazine
- Perphenazine; Amitriptyline
- Phendimetrazine
- Phenelzine
- Phenobarbital
- Phentermine; Topiramate
- Phenylephrine; Promethazine
- Phenytoin
- Pimavanserin
- Pimozide
- Pindolol
- Pirbuterol
- Pitolisant
- Polymyxins
- Posaconazole
- Potassium Chloride
- Potassium Iodide, KI
- Potassium-sparing diuretics
- Pramlintide
- Primaquine
- Primidone
- Procainamide
- Prochlorperazine
- Promethazine
- Propafenone
- Propranolol
- Quazepam
- Quetiapine
- Quinidine
- Quinine
- Ramelteon
- Ranolazine
- Regular Insulin
- Remifentanil
- Ribociclib
- Ribociclib; Letrozole
- Rilpivirine
- Risperidone
- Romidepsin
- Salmeterol
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- Saxagliptin
- Secobarbital
- Selegiline
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- Serotonin-Receptor Agonists
- Sertraline
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- Sibutramine
- Simvastatin; Sitagliptin
- Siponimod
- Sitagliptin
- Sodium Chloride
- Sodium Iodide
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- Solifenacin
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- St. John’s Wort, Hypericum perforatum
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- Thyroid hormones
- Timolol
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- Venlafaxine
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- Vilazodone
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- Vortioxetine
- Ziprasidone
