Lithium Carbonate

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

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II. Indication

  1. Bipolar Disorder

III. History

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

IV. Contraindications

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

V. Mechanism

  1. 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
  3. Therapeutic Trough levels
    1. Acute mania: 1.0 to 1.2 meq/L
    2. Maintenance Bipolar Disorder: 0.8 to 1.0 meq/liter
    3. Increasing dose 300 mg/day raises level 0.2 meq/L
  4. Excretion
    1. Renal excretion (and 60% reabsorbed at proximal tubules)

VII. Preparations

  1. Lithium Carbonate (immediate release)
  2. Lithobid (sustained release)
  3. Eskalith (sustained release)

VIII. Dosing

  1. Blood levels peak 1-2 hours after immediate release products at therapeutic dose (4-6 hours after sustained release)
  2. Effective dose: 900 to 1800 mg per day divided twice daily (or 3-4 times daily)
  3. Start: 300 mg orally twice daily
    1. May adjust dose every 2-3 days as tolerated

IX. Adverse Effects

  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

X. Adverse Effects: Toxicity

  1. Nausea and Vomiting
  2. Diarrhea
  3. Ataxia
  4. Coma
  5. Death

XI. Toxicity

  1. See Lithium Toxicity
  2. Precaution
    1. Toxicity is dose dependent and Overdose can be lethal
  3. Pregnancy
    1. Highly Teratogenic
  4. Cerebellar Signs or symptoms
  5. Mechanism
    1. Poor therapeutic window
    2. Renal excretion

XII. Drug Interactions

  1. Diuretics
  2. NSAIDs
  3. ACE Inhibitors

XIII. 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

XIV. References

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

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Cost: Medications

Lithium Carbonate (on 6/18/2017 at Walmart.com)
Lithium Carbonate 300mg #90 capsules for $4.00 $0.04 each
Lithium Carbonate 300mg #270 capsules for $10.00 $0.04 each
lithium carbonate (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
LITHIUM CARBONATE 150 MG CAP Generic $0.06 each
LITHIUM CARBONATE 300 MG CAP Generic $0.03 each
LITHIUM CARBONATE 300 MG TAB Generic $0.14 each
LITHIUM CARBONATE 600 MG CAP Generic $0.09 each
LITHIUM CARBONATE ER 300 MG TB Generic $0.17 each
LITHIUM CARBONATE ER 450 MG TB Generic $0.26 each
lithium (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
LITHIUM 8 MEQ/5 ML SOLUTION Generic $0.04 per ml
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.

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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