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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