Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
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 preparation, in 1970.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 300, and 450mg. Capsules: 150, 300, and 600 mg.
Syrup: 300 mg/5 ml
STORAGE: Tablets and capsules should be kept at room temperature,
15-30°C (59-86°F).
PRESCRIBED FOR: Lithium is used for treating manic episodes due to
bipolar disorder (manic-depressive illness). It is also 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 06-1.2 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 900-1200 mg daily in 2-3
divided doses. Patients with kidney diseases excrete less lithium from the body
and, therefore, require lower doses.
DRUG INTERACTIONS: Non-steroidal 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 and lithium side effects. 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 in the tubules
of the kidney and thereby reducing the excretion of lithium.
When carbamazepine (Tegretol) and lithium are used together, some patients
may experience side effects, including dizziness, lethargy, and tremor. Central
nervous system side effects also may occur when lithium is used with
antidepressants, [for example, fluoxetine (Prozac) sertraline (Zoloft), and
paroxetine (Paxil), fluvoxamine (Luvox), amitriptyline (Elavil), imipramine
(Tofranil), desipramine (Norpramin)].
Medications which cause the urine to become alkaline (the opposite of acidic)
can increase the amount of lithium that is lost into the urine. This results in
lower blood concentrations of lithium and reduces the effects of lithium. Such
drugs include potassium acetate, potassium citrate
(Urocit-K), sodium bicarbonate, and
sodium citrate (Bicitra, Cytra-2, Liqui-Citra, Oracit, Shohl's).
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.
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