Lithium Carbonate

Aka: Lithium Carbonate, Lithium, Eskalith, Lithobid, Lithium Compound, Lithium Salt

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II. History

  1. Lithium has been used since the 1800s as a treatment for gout and Seizure Disorder and as of 1900s for mania

III. Indications

  1. Bipolar Disorder

IV. Contraindications

  1. Pregnancy
    1. Associated with Ebstein Anomaly when exposure in first trimester

V. Mechanism

  1. Lithium may increase CNS Serotonin levels
  2. Neuroprotective effect
  3. Decreases intracellular Inositol monophosphate concentrations
    1. Mood stabilization effect
  4. Inhibits Glycogen Synthase Kinase 3 (GSK3B)
    1. Enzyme involved in Neuronal development and Energy Metabolism
    2. GSK3B overexpression may be associated with Bipolar Disorder

VI. Pharmacokinetics

  1. Lithium Carbonate is a simple salt that is excreted and not metabolized
    1. Lithium is an alkali metal (the smallest metal, having atomic number 3)
  2. Steady state reached in 5 days
    1. Check Lithium levels 5 days after starting dose or changing dose
    2. Steady state will take >5 days to reach in the elderly or reduced Renal Function
  3. Blood levels peak
    1. Following immediate release dose: 1-2 hours
    2. Following sustained release dose: 4-6 hours
  4. Therapeutic Trough levels
    1. Narrow therapeutic window (low threshold for toxicity)
    2. Acute mania: 1.0 to 1.2 meq/L
    3. Maintenance Bipolar Disorder: 0.8 to 1.0 meq/liter
    4. Increasing dose 300 mg/day raises level 0.2 meq/L
  5. Excretion
    1. Renal excretion (and 60% reabsorbed at proximal tubules)
    2. Drug Clearance is directly proportional to GFR

VII. Medications

  1. Lithium Carbonate (immediate release)
    1. Capsules or Tablet: 150 mg, 300 mg, 600 mg
    2. Oral Solution: 8 mEq/5 ml (8 mEq = 300 mg)
    3. Syrup: 300 mg/ 5 ml
  2. Extended Release (Lithobid; Eskalith): 300 mg, 450 mg

VIII. Dosing: Adults

  1. Precautions
    1. Maintain oral hydration and avoid Salt Restriction
    2. Adverse effects are reduced by dividing doses 3-4 times daily and by using extended release forms
  2. Start: 300 mg orally twice daily
    1. May adjust dose every 2-3 days as tolerated
  3. Effective dose
    1. Target 900 to 1800 mg per day divided twice daily (or 3-4 times daily)
    2. Acute Mania: 1800 mg/day divided 2 to 3 times daily orally
    3. Bipolar Maintenance: 900 to 1200 mg/day divided 2 to 3 times daily
  4. Titration based on trough serum Lithium concentration
    1. Acute Therapy: 0.8 to 1.2 mEq/L
    2. Maintenance: 0.6 to 1 mEq/L

IX. Dosing: Children

  1. FDA approved for children ages 7 years and older
  2. Precautions
    1. Maintain oral hydration and avoid Salt Restriction
  3. Weight 20 to 30 kg
    1. Start 300 mg capsules (or 8 mEq of solution) orally twice daily
  4. Weight >30 kg
    1. Start 300 mg capsules (or 8 mEq of solution) orally three times daily
  5. Titration based on trough serum Lithium concentration
    1. Acute Therapy: 0.8 to 1.2 mEq/L
    2. Maintenance: 0.8 to 1 mEq/L

X. Adverse Effects: General

  1. Polyuria
  2. Hypothyroidism
    1. Often reversible on stopping Lithium
    2. Higher Prevalence in women and with increasing age
  3. Weight gain
  4. Fine Tremor
  5. Withdrawal symptoms on stopping
    1. More common than with Valproate or Lamotrigine

XI. Adverse Effects: Toxicity

  1. See Lithium Toxicity
  2. Precautions
    1. Toxicity is dose dependent and Overdose can be lethal
  3. Nausea and Vomiting
  4. Diarrhea
  5. Ataxia
  6. Coma
  7. Death
  8. Cerebellar Signs or symptoms

XII. Safety

  1. Avoid in Lactation
  2. Pregnancy Category D
    1. Highly Teratogenic
    2. Associated with Ebstein Anomaly when exposure in first trimester

XIII. Drug Interactions

  1. Drugs that increase Lithium levels
    1. Diuretics
    2. NSAIDs
      1. Aspirin and Sulindac do not increase Lithium levels
    3. ACE Inhibitors
    4. Angiotensin Receptor Blockers

XIV. Monitoring

  1. Serum Lithium level
    1. Day 5 after starting Lithium
    2. Then every 1-2 weeks initially
    3. Then every 3-6 months
    4. Also check serum levels before and 5 days after dose changes
  2. Other labs
    1. Schedule
      1. Baseline
      2. Month 3
      3. Month 6
      4. Every 6 to 12 months thereafter
    2. Thyroid Stimulating Hormone (TSH)
    3. Renal Function tests
      1. Serum Creatinine
      2. Blood Urea Nitrogen

XV. Resources

  1. Lithium Immediate Release
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7dc9c6d2-6d9a-49e4-a8ab-437b0ed5f84e
  2. Lithium Extended Release
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=525a9d9b-cbb1-4644-a28a-8bba96f09348

XVI. References

  1. Perrone and Chatterjee (2018) UpToDate, accessed 8/20/2018

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Related Studies

Cost: Medications

lithium carbonate (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
LITHIUM CARBONATE 150 MG CAP Generic $0.08 each
LITHIUM CARBONATE 300 MG CAP Generic $0.06 each
LITHIUM CARBONATE 300 MG TAB Generic $0.13 each
LITHIUM CARBONATE 600 MG CAP Generic $0.15 each
LITHIUM CARBONATE ER 300 MG TB Generic $0.13 each
LITHIUM CARBONATE ER 450 MG TB Generic $0.19 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Ontology: Lithium (C0023870)

Definition (MSH) An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight [6.938; 6.997]. Salts of lithium are used in treating BIPOLAR DISORDER.
Definition (NCI) An element with atomic symbol Li, atomic number 3, and atomic weight 6.941.
Definition (NCI_NCI-GLOSS) A soft metal. Lithium salts are used to treat certain mental disorders, especially bipolar (manic depressive) disorder. Lithium salts include lithium carbonate and lithium citrate.
Definition (PSY) Used for documents that do not specify the type of lithium used, e.g., carbonate, chloride, or bromide. Use a more specific term if possible.
Definition (CSP) white metal, symbol Li, atomic number 3; lithium salts are used in treating the manic phase of bipolar disorder.
Concepts Pharmacologic Substance (T121) , Element, Ion, or Isotope (T196)
MSH D008094
SnomedCT 321719003, 85899009
LNC LP16175-9, MTHU004197
English Lithium, Lithium product, lithium (medication), Lithium [Chemical/Ingredient], LITHIUM, Lithium Metallicum, Li, Li element, Li+ element, lithium, Li - Lithium, Lithium (product), Lithium (substance), Lithium, NOS, Lithium product (product), Lithium product (substance)
Swedish Litium
Czech lithium
Finnish Litium
Russian LITII, ЛИТИЙ
Spanish litio, producto (producto), litio (producto), litio, producto, litio (sustancia), litio, producto (sustancia), litio, Litio
Croatian LITIJ
Latvian Litijs
Polish Lit
Norwegian Litium
French Lithium
German Lithium
Italian Litio
Portuguese Lítio
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Lithium Carbonate (C0085217)

Definition (NCI) The carbonate salt of lithium, a soft alkali metal, with antimanic and hematopoietic activities. Lithium interferes with transmembrane sodium exchange in nerve cells by affecting sodium, potassium-stimulated adenosine triphosphatase (Na+, K+-ATPase); alters the release of neurotransmitters; affects cyclic adenosine monophosphate (cAMP) concentrations; and blocks inositol metabolism resulting in depletion of cellular inositol and inhibition of phospholipase C-mediated signal transduction. The exact mechanism through which lithium exerts its mood-stabilizing effect has not been established. In addition, lithium stimulates granulocytopoiesis and appears to increase the level of pluripotent hematopoietic stem cells by stimulating the release of hematopoietic cytokines and/or directly acting on hematopoietic stem cells.
Definition (MSH) A lithium salt, classified as a mood-stabilizing agent. Lithium ion alters the metabolism of BIOGENIC MONOAMINES in the CENTRAL NERVOUS SYSTEM, and affects multiple neurotransmission systems.
Definition (PDQ) The carbonate salt of lithium, a monovalent cation with antimanic activity. Lithium carbonate interferes with transmembrane sodium exchange in nerve cells by affecting sodium, potassium-stimulated adenosine triphosphatase (Na+, K+-ATPase); alters the release of neurotransmitters; affects cyclic adenosine monophosphate (cAMP) concentrations; and blocks inositol metabolism resulting in depletion of cellular inositol and inhibition of phospholipase C-mediated signal transduction. The exact mechanism through which lithium carbonate exerts its mood-stabilizing effect has not been established. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39491&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39491&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C1318" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Inorganic Chemical (T197)
MSH D016651
SnomedCT 16977003, 387095003
English Carbonate, Lithium, Carbonate, Dilithium, Carbonic acid, dilithium salt, Dilithium Carbonate, lithium carbonate, lithium carbonate (medication), LITHIUM CARBONATE, Lithium Carbonate [Chemical/Ingredient], carbonate lithium, of lithium carbonate, Lithium carbonate, Lithium carbonate preparation, Lithium carbonate (product), Lithium carbonate (substance), Lithium Carbonate
French Carbonate de lithium, Li2CO3
Swedish Litiumkarbonat
Czech lithiumkarbonát
Finnish Litiumkarbonaatti
German Dilithium-Carbonat, Lithiumcarbonat
Italian Dilitio carbonato, Carbonato di litio
Russian LITIIA KARBONAT, ЛИТИЯ КАРБОНАТ
Japanese 炭酸リチウム, リチオマール, リーマス
Polish Węglan litowy
Norwegian Litiumkarbonat
Spanish carbonato de litio (producto), carbonato de litio (sustancia), carbonato de litio, preparado de carbonato de litio, Carbonato de Litio
Portuguese Carbonato de Lítio
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Lithium Compounds (C0206486)

Definition (MSH) Inorganic compounds that contain lithium as an integral part of the molecule.
Concepts Inorganic Chemical (T197)
MSH D018020
SnomedCT 36378007
English Lithium Compounds, Compounds, Lithium, LITHIUM CPDS, Lithium Compounds [Chemical/Ingredient], Lithium compounds, Lithium compound (substance), Lithium compound, Lithium compound, NOS
French Composés du lithium
Swedish Litiumföreningar
Czech lithium - sloučeniny
Finnish Litumyhdisteetltj
Russian LITIIA SOEDINENIIA, ЛИТИЯ СОЕДИНЕНИЯ
Polish Litu związki
Norwegian Litiumforbindelser
Spanish compuesto de litio (sustancia), compuesto de litio, Compuestos de Litio
German Lithiumverbindungen
Italian Composti del litio
Portuguese Compostos de Lítio
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Lithium salt (C0302213)

Concepts Pharmacologic Substance (T121) , Inorganic Chemical (T197)
SnomedCT 9765000
English LITHIUM SALTS, [CN750] LITHIUM SALTS, Lithium salt, Lithium salt (substance), Lithium salt, NOS
Spanish sal de litio (sustancia), sal de litio
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Lithobid (C0700751)

Concepts Pharmacologic Substance (T121) , Inorganic Chemical (T197)
MSH D016651
English lithobid, Lithobid
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Eskalith (C0700753)

Concepts Pharmacologic Substance (T121)
MSH D016651
English eskalith, Escalith, Eskalith
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Pharmacology

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