PREGNANCY AND BREASTFEEDING SAFETY:
- Lithium crosses the placenta and has been associated with toxicity in the fetus. Children born to women taking lithium during pregnancy have an increased risk of goiter and cardiac anomalies. If possible, lithium should be withheld during the first trimester. Women of childbearing age who may require lithium should be counseled about becoming pregnant.
- Lithium is secreted into breast milk. Symptoms of lithium toxicity, including changes in the electrocardiogram, have been seen in some breastfed infants, whose mothers were taking lithium. If possible, women taking lithium should not breastfeed their infants.
STORAGE: All formulations should be kept at room temperature, 15 C to 30 C (59 F to 86 F).
- 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 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.
Reference: FDA Prescribing Information
Quick GuideBipolar Disorder: Symptoms, Testing for Bipolar Depression
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