Lithium

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

1. abdominal pain
2. acne vulgaris
3. alopecia
4. angioedema
5. anorexia
6. arrhythmia exacerbation
7. arthralgia
8. ataxia
9. AV block
10. blurred vision
11. bradycardia
12. cardiac arrest
13. cheilitis
14. choreoathetosis
15. coma
16. confusion
17. dehydration
18. dental caries
19. diabetes insipidus
20. diarrhea
21. dizziness
22. drowsiness
23. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
24. dysarthria
25. dysgeusia
26. dystonic reaction
27. EEG changes
28. exophthalmos
29. fatigue
30. fecal incontinence
31. fever
32. flatulence
33. folliculitis
34. glomerulonephritis
35. glycosuria
36. goiter
37. hallucinations
38. headache
39. hypercalcemia
40. hyperchloremic acidosis
41. hyperglycemia
42. hyperreflexia
43. hypersalivation
44. hyperthyroidism
45. hyponatremia
46. hypotension
47. hypothyroidism
48. impaired cognition
49. impotence (erectile dysfunction)
50. interstitial nephritis
51. lethargy
52. leukocytosis
53. memory impairment
54. metallic taste
55. myasthenia
56. myoclonia
57. nausea
58. nephrotic syndrome
59. neuroleptic malignant syndrome
60. new primary malignancy
61. nystagmus
62. oliguria
63. palpitations
64. papilledema
65. peripheral edema
66. polydipsia
67. polyuria
68. proteinuria
69. pruritus
70. pseudotumor cerebri
71. psoriasis
72. psychomotor impairment
73. QT prolongation
74. rash
75. renal failure (unspecified)
76. renal tubular acidosis (RTA)
77. restlessness
78. scotomata
79. seizures
80. serotonin syndrome
81. skin ulcer
82. ST-T wave changes
83. syncope
84. teratogenesis
85. tinnitus
86. tremor
87. urinary incontinence
88. vertigo
89. vomiting
90. weight gain
91. weight loss
92. xerosis
93. 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

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