Lithium

Last updated 20.09.12

 

Index

 

Features

-  Elemental metal used as mood stabiliser

-  Renal excretion

 

Indications

-  Acute mania or prophylaxis in bipolar disorder

-  Schizoaffective disorder, schizophrenia

-  Augmentation for treatment resistant depression

 

Dose

-  Forms

-  Standard 250mg

-  Modified Release 450mg

-  Lower peak concentration

-  Used in cases at risk of Overdose

-  Acute Mania

-  Initial 750 – 1000mg/day (in 2 doses)

-  Increase by 250 – 500mg/day

-  Max dose 2500mg/day

-  Bipolar Prophylaxis

-  250 – 1000mg/day (in 2 doses) for 2 weeks

-  Adjust per blood levels

-  Blood Levels

-  Taken 8 – 12hrs after last dose

-  5-7 days after starting treatment or dose change

-  3 monthly once dose stable

-  More freq during illness, manic or depressive phase or pregnancy

-  Therpeutic Range

-  Acute mania = 0.5 – 1.2mmol/L

-  Prophylaxis = 0.4 – 1.0mmol/L

-  Toxicity = > 1.5mmol/L (>1.2 in elderly)

 

Side Effects

-  Metallic taste

-  Headache

-  Hypothyroidism, euthyroid goitre (esp women)

-  Rx Thyroxine if want to stay on Lithium

-  Nephrogenic diabetes insipidus (polyuria, polydipsia)

-  Toxicity/OD