lithium, Lithobid

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Pharmacy Author:

Omudhome Ogbru, PharmD

Omudhome Ogbru, PharmD

Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

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Medical and Pharmacy Editor:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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GENERIC NAME: lithium

BRAND NAME: Lithobid

DRUG CLASS AND MECHANISM: Lithium is used for the treatment of manic/depressive (bipolar) and depressive disorders. Lithium is a positively charged element or particle that is similar to sodium and potassium. It interferes at several places inside cells and on the cell surface with other positively charged atoms such as sodium, potassium, calcium, and magnesium which are important in many cellular functions.

Lithium interferes with the production and uptake of chemical messengers by which nerves communicate with each other (neurotransmitters). Lithium also affects the concentrations of tryptophan and serotonin in the brain. In addition, lithium increases the production of white blood cells in the bone marrow. Lithium's effects usually begin within 1 week of starting treatment, and the full effect is seen by 2 to 3 weeks.

Lithium has been used since the 1950's. The FDA approved lithium carbonate, the most common lithium preparation in 1970.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS:

• Tablets: 300 mg.
• Tablets (extended release): 300 and 450 mg.
• Capsules: 150, 300 and 600 mg.
• Syrup: 300 mg/5 ml

STORAGE: All formulations should be kept at room temperature, 15 C to 30 C (59 F to 86 F).

PRESCRIBED FOR: Lithium is used for treating manic episodes due to bipolar disorder (manic-depressive illness). It also is combined with antidepressants to treat depression.

DOSING: Doses vary widely and are adjusted based on measurements of the levels of lithium in the blood. Recommended blood levels are 0.6-1.2 mEq/L. Early in therapy, dose adjustments are made as often as every 5 to 7 days to establish the correct dose. Most patients require 900-2400 mg daily in 2-4 divided doses depending on the formulation being used. Patients with kidney disease excrete less lithium from the body and, therefore, require lower doses.

DRUG INTERACTIONS: Nonsteroidal anti-inflammatory drugs (NSAIDs), (for example, ibuprofen [Motrin, Advil], naproxen [Naprosyn, Aleve], indomethacin [Indocin], nabumetone [Relafen], diclofenac [Voltaren, Cataflam, Arthrotec], ketorolac [Toradol]), reduce the kidney's ability to eliminate lithium and lead to elevated levels of lithium in the blood andside effects from lithium. Blood concentrations of lithium may need to be measured for 4 to 7 days after an NSAID is either added or stopped during lithium therapy. Aspirin and sulindac (Clinoril) do not appear to affect lithium concentrations in the blood.

Diuretics (water pills) should be used cautiously in patients receiving lithium. Diuretics that act at the distal renal tubule, (for example, hydrochlorothiazide [Hydrodiuril], spironolactone [Aldactone], triamterene [Dyrenium; Dyazide, Maxzide]), can increase blood concentrations of lithium. Diuretics that act at the proximal tubule, (for example, acetazolamide [Diamox]), are more likely to reduce blood concentrations of lithium. Diuretics such as furosemide (Lasix) and bumetanide (Bumex) may have no affect on lithium concentrations in blood.

ACE inhibitors, (for example, enalapril [Vasotec], lisinopril [Zestril, Prinivil], benazepril [Lotensin], quinapril [Accupril], moexipril [Univasc], captopril [Capoten], ramipril [Altace]), may increase the risk of developing lithium toxicity by increasing the amount of lithium that is reabsorbed into the body in the tubules of the kidney and thereby reducing the excretion of lithium.

Report Problems to the Food and Drug Administration You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088. Need help identifying pills and medications? Use the pill identifier tool on RxList.