LITHIUM CARBONATE

Indications & Dose:

Manic episodes of bipolar affective disorder; prophylaxis of cluster headache, premenstrual syndrome, bulimia;alcoholism’, SIADH, tardive dyskinesia,hyperthyroidism,postpartum affective psychosis

•  BY MOUTH

Adult

• Initially:  400mg-1200mg daily as a single dose, maintain serum lithium level in range 0.7-1.0 mmol/ lit 12 hours after previous dose

• Maintenance: PO 300 mg tid-qid; adjust to maintain therapeutic serum lithium concentration

Child:• Not recommended

Contraindications:

Severe cardiovascular or renal disease. 

Side Effects:

Cautions:

Precautions:

Toxicity closely related to serum levels (facilities for serum lithium determinations required to monitor therapy); dehydration,sodium depletion, elderly, children < 12 yr, concomitant infection, thyroid disease, tartrazine sensitivity, diabetes mellitus 

Interaction:

Drugs

ACE inhibitors, methyldopa: Increased risk of lithium toxicity

Diltiazem, verapamil, amitriptyline, carzepine, fuoxetine, fuvoxamine: Neurotoxicity, including seizures

MAOIs: Malignant hyperpyrexia

Neuroleptics: Reduced neuroleptic response; severe neurotoxicity possible in acute manic patients receiving lithium and neuroleptics

NSAIDs: Increased lithium concentrations

Phenytoin: Development of lithium toxicity has been reported

Potassium iodide: Increased risk for hypothyroidism

Sodium bicarbonate: Decreased plasma lithium concentrations

Sodium chloride: High sodium intake may reduce serum lithium concentrations; sodium restriction may increase serum lithium

Theophylline: Increased lithium renal clearance, decreased lithium efficacy Thiazide diuretics: Increased lithium concentrations

Warnings:

Adverse Effects:

Lactations:

Avoid use in pregnancy if possible, especially during the 1st trimester; contraindicated in nursing mothers 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Ataxia, clonic movements, confusion, dizziness, drowsiness, fine hand tremor, headache, memory loss, pseudotumor cerebri, restlessness, seizures, slurred speech, stupor, twitching

CV: Bradycardia, circulatory collapse, dysrhythmias, ECG changes, edema, hypotension

EENT: Blurred vision, tinnitus

GI: Abdominal pain, anorexia, diarrhea, dry, mouth, excessive salivation, flatulence, gastritis, metallic taste, nausea, vomiting

GU: Albuminuria, decreased creatinine clearance, glycosuria, polydipsia, polyuria, proteinuria, sexual dysfunction, symptoms of nephrogenic diabetes, urinary incontinence

METAB: Euthyroid goiter, hyperthyroidism (rare), hyponatremia, hypothyroidism, transient hyperglycemia

MS: Arthralgia

SKIN: Acne, anesthesia of skin, angioedema, chronic folliculitis, drying and thinning of hair, exacerbation of psoriasis, generalized pruritis

MISC: Excessive weight gain, thirst 

Patient And Carer Advice: