Lithium Eskalith Eskalith CR Lithonate

A. Lithium has been the mainstay of treatment of mania and bipolar disorder.

B. Lithium, in addition to being an anti-manic agent, possesses modest but significant antidepressant properties. However, lithium is less effective than valproate (Depakote) in rapid cycling mania.

C. Regular and slow-release forms of lithium carbonate are available and either form may be given twice daily initially switching to once daily dosing after several weeks.

D. Healthy young adults can usually tolerate 300-600 mg of lithium carbonate, twice daily at the start of therapy. The dose is increased over seven to ten days until the plasma level is 0.80-1.20 mEq/L (0.80 to 1.20 mMol/L). Serum lithium levels are measured 12 hours after the preceding dose of lithium.

E. Common side effects of lithium include polyuria, thirst, edema, weight gain, fine tremor, mild nausea (especially if the drug is not taken with food), and diarrhea.

F. Lithium toxicity is manifest by coarse tremor, stupor, ataxia, seizures, persistent headache, vomiting, slurred speech, confusion, incontinence, and arrhythmias. Toxicity may occur when a patient becomes ill and ceases to eat and drink normally, but continues to take lithium as prescribed. A patient who cannot eat and drink normally should temporarily discontinue lithium.

G. Nonsteroidal anti-inflammatory drugs, such as ibuprofen or aspirin, and ACE inhibitors elevate the plasma lithium level. Lithium levels should be carefully monitored. A reduction of lithium dose may be required.

H. Lithium levels rise 20-25 percent when diuretics such as chlorothiazide (Diuril) are initiated. A reduction of lithium dose may be required.

I. Laboratory evaluation prior to beginning treatment with lithium should include blood urea nitrogen, creatinine, electrolytes, fasting blood sugar, TSH, free T4 levels, and an ECG in patients over 40 years or with preexisting cardiac disease.

J. Divided doses, or a single daily dose of lithium may attenuate the side effects, such as tremor. The usual adult dosage ranges from 600-2400 mg/day. Two weeks are required for effect, and the drug should be continued for four to eight weeks before evaluating efficacy.

K. Serum levels must be drawn weekly the first one to two months, then every two to four weeks. Serum levels should be kept between 0.8-1.2 mMol/L

L. Serum creatinine and TSH are monitored every 6 months.

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