Lithium
Administration
- Type: Antimanic agent
- Dosage Forms:
- Routes of Administration: oral
- Common Trade Names:
Adult Dosing
- Maintenance: 300mg PO 3 to 4 times daily; desired serum lithium level 0.6 to 1.2 mEq/L
- Acute manic episode: 600mg PO 3 times daily; desired serum lithium level 1 to 1.5 mEq/L
Pediatric Dosing
Safety/efficacy not established in children <12yo
Special Populations
- Pregnancy Rating: D
- Lactation risk: infant risk cannot be ruled out
Renal Dosing
- Adult: Contraindicated if renal function unstable[1]
Hepatic Dosing
- Adult: Not established
Contraindications
- Allergy to class/drug
- Unstable renal function
- Severe dehydration
- Sodium depletion
- Severe debilitation
- Concurrent diuretics
- Severe cardiovascular disease
- 1st trimester pregnancy
Adverse Reactions
Serious
- Toxicity (see Lithium toxicity)
- Seizure, ataxia, raised ICP
- Angioedema
- Erythema multiforme
Common
- Hypothyroidism, weight gain
- Nephrotoxicity
- Fine tremor, hyperreflexia
- Leukocytosis
- Nausea, gastritis
- Acne
Pharmacology
- Half-life: 14-50hr
- Metabolism: Renal
- Excretion: Renal
Mechanism of Action
- Exact mechanism unclear; inhibits postsynaptic D2 receptor supersensitivity, alters cation transport in nerve cells, influences serotonin/norepinephrine reuptake, inhibits phosphatidylinositol cycle second messenger systems[2]