What is this medication?
Lithium, Carbolith/Lithane/Lithmax (CDN)/Lithobid (US)
Indicated for treatment of bipolar disorder.
“Alert: Black Box Warning
Lithium toxicity is closely related to serum lithium levels and can occur at doses close to therapeutic levels. Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.”
How does this medication work?
The exact mechanism of action of lithium is unknown but it is believed to alter cation transport across the cell membranes in nerve and muscle, influence the reuptake of serotonin and norepinephrine and to affect the phophatidylinositol cycle. It may also have neuroprotective effects mediated by increase glutamate clearance and other mechanisms.
How should I take this medication?
Oral: Immediate release or extended release: Initial: 600 to 900 mg/day in 2 to 3 divided doses; increase based on response and tolerability by 300 to 600 mg every 1 to 5 days to usual therapeutic dose range of 900 mg/day to 1.8 g/day. After 5 to 7 days at a stable therapeutic dose, further adjust as needed based on clinical response, tolerability, and serum concentration For most patients, a therapeutic response occurs with serum concentrations between 0.8 and 1.2 mEq/L; some respond to lower levels (eg, 0.6 mEq/L)
How to Take: Administer with meals to decrease GI upset. ER tablets must be swallowed whole; do not crush or chew. maintain adequate salt and fluid intake.
You Need to Avoid: Do not stop medication abruptly, use a gradual dose reduction to avoid disease recurrence unless discontinuation is due to significant adverse effects. This medication has many drug interactions and so ask your prescriber or pharmacist before starting any new medications (prescription or over the counter), or natural supplements. Caffeine may reduce blood levels of lithium so discuss its use with your prescriber. Nonsteroidal anti-inflammatory drugs (NSAID) like ibuprofen (Advil)/ASA (Aspirin) can increase lithium blood levels and lead to toxicity so they should be avoided unless instructed by prescriber.
What should I watch for while using this medication?
Before starting Lithium, Carbolith/Lithane/Lithmax/Lithobid make sure your physician is aware of any allergies and medications you currently take, if you have cardiovascular disease, if you could be suffering from dehydration, have a history of depression or suicidal ideation, have myasthenia gravis, renal impairment, or thyroid disease. Lithium, Carbolith/Lithane/Lithmax/Lithobid use has been associated with rare but serious adverse events such as CNS depression, heart failure, hypercalcemia, hypothyroidism, pseudotumor cerebri, renal effects, and serotonin syndrome.
Lithium toxicity can occur with only slightly higher blood concentrations than some people require for therapeutic effect (≥1.5 mEq/L; may be seen as low as 1.2 mEq/L in some patients) therefore it should only be used when blood tests can be performed regularly.
What if I miss a dose?
If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.
How should I store this medication?
Keep out of the reach of children at all times. Store at room temperature, 59 to 86° F (15 to 30° C). Protect from light. Keep the container tightly closed. Properly dispose of any unused medication after the expiration date.
What are the possible side effects of using this medication?
Lithium has a very extensive list of potential side effects, but as it has been used for many years prior to the requirement of proper FDA clinical trials so the frequency of said effects have not been properly determined. Commonly reported side effects include dizziness, weakness, nausea, loss of appetite, abdominal pain, increase saliva production, flatulence, xerostomia (dry mouth), dysgeusia (altered taste), joint pain, dry/thinning hair, and alopecia. Refer to an official monograph for a full list of side effects.
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