Generic name:Lithium Carbonate(li´thee-um)
Brand Name:Eskalith, Eskalith CR, Lithane, Lithobid, Lithonate, Lithotabs
Classifications:central nervous system agent; psychotherapeutic agent; antimanic
150 mg, 300 mg, 600 mg capsules; 300 mg tablets; 300 mg, 450 mg sustained release tablets; 300 mg/5 mL syrup
The lithium ion behaves in the body much like the sodium ion; but its exact mechanism of action is unclear. Competes with various physiologically important cations: Na+, K+, Ca++, Mg++; therefore, it affects cell membranes, body water, and neurotransmitters. At the synapse, it accelerates catecholamine destruction, inhibits the release of neurotransmitters and decreases sensitivity of postsynaptic receptors.
Inhibits neurotransmitters; decreases over-activity of receptors involved in stimulating manic states. Response evidenced by changed facial affect, improved posture, assumption of self-care, improved ability to concentrate, improved sleep pattern.
Control and prophylaxis of acute mania and the acute manic phase of mixed bipolar disorder.
Significant cardiovascular or kidney disease, brain damage, severe debilitation, dehydration or sodium depletion; patients on low-salt diet or receiving diuretics; pregnancy, especially first trimester (category D), lactation, children <12 y.
Older adults; thyroid disease; epilepsy; concomitant use with haloperidol and other antipsychotics; parkinsonism; diabetes mellitus; severe infections; urinary retention.
Route & dosage
adult: PO Loading Dose 600 mg t.i.d. or 900 mg sustained-release b.i.d. or 30 mL (48 mEq) of solution t.i.d.
PO Maintenance Dose 300 mg t.i.d. or q.i.d. or 15–20 mL (24–32 mEq) solution in 2–4 divided doses (max: 2.4 g/d)
child:PO 15–60 mg/kg/d in divided doses
- Give with meals.
- Ensure that sustained release tablets are not chewed or crushed; must be swallowed whole.
- Protect from light and moisture.
CNS:Dizziness, headache, lethargy, drowsiness, fatigue, slurred speech, psychomotor retardation, giddiness, incontinence, restlessness, seizures, confusion, blackout spells, disorientation, recent memory loss, stupor, coma, EEG changes.
CV:Arrhythmias, hypotension, vasculitis, peripheral circulatory collapse, ECG changes.
SpecSenses:Impaired vision, transient scotomas, tinnitus.
Endocrine:Diffuse thyroid enlargement, hypothyroidism, nephrogenic diabetes insipidus, transient hyperglycemia, glycosuria, hyponatremia.
GI:Nausea, vomiting, anorexia, abdominal pain, diarrhea, dry mouth, metallic taste.
Musculoskeletal:Fine hand tremors, coarse tremors, choreoathetotic movements; fasciculations, clonic movements, incoordination including ataxia, muscle weakness, hyperreflexia, encephalopathic syndrome (weakness, lethargy, fever, tremors, confusion, extrapyramidal symptoms).
Skin:Thought to be toxicity rather than allergy: Pruritus, maculopapular rash, hyperkeratosis, chronic folliculitis, transient acneiform papules (face, neck, intertriginous areas), anesthesia of skin, cutaneous ulcers, drying and thinning of hair, allergic vasculitis.
Hematologic:Reversible leukocytosis (14,000 to 18,000/mm3).
Urogenital:Albuminuria, oliguria, urinary incontinence, polyuria, polydipsia, increased uric acid excretion.
BodyWhole:Edema, weight gain (common) or loss, exacerbation of psoriasis; flu-like symptoms.
Assessment & Drug Effects
- Monitor response to drug. Usual lag of 1–2 wk precedes response to lithium therapy. Keep physician informed of progress.
- Monitor lithium level: Generally dosage regimen is designed to maintain serum lithium levels of 1.0–1.5 mEq/L in acute mania and 0.6–1.6 mEq/L during maintenance treatment; blood sample to determine serum lithium level is drawn prior to next dose (8–12 h after last dose) when lithium level is fairly stable.
- Monitor for S&S of lithium toxicity, often when lithium levels are 1.5–2.0 mEq/L (e.g., vomiting, diarrhea, lack of coordination, drowsiness, muscular weakness, slurred speech). Withhold one dose and call physician. Drug should not be stopped abruptly.
- When lithium levels are above 2.0 mEq/L, symptoms may include ataxia, blurred vision, giddiness, tinnitus, muscle twitching or coarse tremors, and a large output of dilute urine.
- Weigh patient daily; check ankles, tibiae, and wrists for edema. Report changes in I&O ratio, sudden weight gain, or edema.
- Polydipsia and polyuria, apparently not dose-related, are common early adverse effects, particularly in older adults. Symptoms may lessen but reappear after several months or even years of maintenance.
- Report early signs of extrapyramidal reactions promptly to physician. The encephalopathic syndrome may be induced when lithium is given concomitantly with haloperidol or with other antipsychotic medication, particularly in older adults.
- Keep physician informed of all presenting S&S. The fine tremor of hand or jaw, polyuria, mild thirst, transient mild nausea, and general discomfort that may occur in early treatment of mania sometimes persist throughout therapy. Usually, however, symptoms subside with temporary reduction of dose. If symptoms persist, drug is withdrawn.
- Monitor thyroid function periodically. Be alert to and report symptoms of hypothyroidism.
- Neonates born of mothers who took lithium during pregnancy may have high serum lithium level manifested by flaccidity, poor reflexes, cardiac dysrhythmia, and chronic twitching.
- Lithane contains tartrazine, which may cause an allergic-type reaction in susceptible patients.
- Monitor older adults carefully to prevent toxicity, which may occur at serum levels ordinarily tolerated by other patients.
Patient & Family Education
- Be alert to increased output of dilute urine and persistent thirst. Dose reduction may be indicated.
- Contact physician if diarrhea or fever develops. Avoid practices that may encourage dehydration: hot environment, excessive caffeine beverages (diuresis).
- Drink plenty of liquids (2–3 L/d) during stabilization period and at least 1–1/2 L/d during ongoing of therapy.