Indications for: LITHOBID
Mania in bipolar disorder.
Swallow whole. Acute mania: 1800mg/day in 2–3 divided doses. Usual maintenance: 900–1200mg daily in 2–3 divided doses.
Risk of lithium toxicity (esp. recent febrile illness, acute ingestion, volume depletion/dehydration, impaired renal function, cardiovascular disease, changes in electrolytes). Avoid in Brugada syndrome. Seizure disorders. Organic brain syndrome or other CNS impairment: monitor for neurologic toxicity. Dehydration. Maintain adequate fluid and salt intake esp. with fever, sweating, diarrhea, or infection. Monitor serum lithium levels frequently (toxic and therapeutic levels are close); draw blood for serum tests 8–12hrs after previous dose. Monitor thyroid, renal function, and for serotonin syndrome. Discontinue if diarrhea, vomiting, tremor, ataxia, drowsiness or weakness occur. Elderly. Pregnancy, nursing mothers: not recommended.
Lithium toxicity potentiated by diuretics, ACE inhibitors, angiotensin II receptor blockers, indomethacin, piroxicam (possibly other NSAIDs, including COX-2 inhibitors), metronidazole, calcium channel blockers: monitor and adjust lithium dose, if needed. Discontinue if signs of neurologic toxicity occur with antipsychotics. Xanthines, acetazolamide, urea, alkalinizing agents may reduce serum lithium levels. May potentiate adverse reactions of methyldopa, phenytoin, carbamazepine. Prolongs effects of neuromuscular blockers. Hypothyroidism with chronic iodide administration. Increased risk of serotonin syndrome with concomitant SSRIs, SNRIs, MAOIs; discontinue if occurs. Fluoxetine has variable effects on serum lithium levels. May be antagonized by SGLT2 inhibitors; monitor for frequently.
Polyuria, polydipsia, drowsiness, tremor, hypothyroidism, extrapyramidal symptoms, nausea, renal toxicity, seizures, arrhythmias, hypotension, lethargy, metallic taste, dry mouth, blurred vision, pseudotumor cerebri (discontinue if occurs), encephalopathic syndrome.