Lithium Carbonate 150mg Capsules

The precise mechanism of action of lithium in treating bipolar disorder is not fully understood, but it is thought to involve multiple neurotransmitter systems and intracellular signaling pathways. It affects ion transport across cell membranes, alters the metabolism of neurotransmitters (e.g., serotonin, norepinephrine, dopamine), and modulates second messenger systems (e.g., inositol monophosphatase, glycogen synthase kinase-3 (GSK-3)). These actions contribute to its mood-stabilizing effects.

Serious Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you experience any of the following symptoms, contact your doctor or seek medical attention immediately:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of too much acid in the blood (acidosis), such as:
+ Confusion
+ Fast breathing
+ Fast heartbeat
+ Irregular heartbeat
+ Severe stomach pain, nausea, or vomiting
+ Excessive sleepiness
+ Shortness of breath
+ Feeling extremely tired or weak
Signs of thyroid problems, such as:
+ Weight changes
+ Feeling nervous, excitable, restless, or weak
+ Hair thinning
+ Depression
+ Eye or neck swelling
+ Difficulty concentrating
+ Sensitivity to heat or cold
+ Menstrual changes
+ Shakiness
+ Excessive sweating
Signs of fluid and electrolyte problems, such as:
+ Mood changes
+ Confusion
+ Muscle pain or weakness
+ Abnormal heartbeat
+ Severe dizziness or fainting
+ Increased thirst
+ Seizures
+ Feeling extremely tired or weak
+ Decreased appetite
+ Urination problems (difficulty starting or stopping urine flow, or changes in urine output)
+ Dry mouth
+ Dry eyes
+ Severe nausea or vomiting
Other serious side effects, such as:
+ Bloating
+ Diarrhea
+ Dizziness or lightheadedness
+ Difficulty walking
+ Trouble controlling body movements, twitching, or balance problems
+ Swallowing or speaking difficulties
+ Muscle weakness
+ Feeling sluggish
+ Uncontrolled eye movements
+ Mood changes
+ Fever
+ Hallucinations (seeing or hearing things that are not there)
+ Memory problems or loss
+ Restlessness
+ Shortness of breath
+ Sudden weight gain or swelling in the arms or legs
+ Unexplained weight changes
+ Loss of bladder or bowel control
+ Sexual problems

Other Side Effects

Like all medications, this drug can cause side effects. However, many people experience no side effects or only mild ones. If you experience any of the following side effects, or if they bother you or do not go away, contact your doctor:

Feeling dizzy, sleepy, tired, or weak
Upset stomach
Decreased appetite
Stomach pain
Excessive saliva production
Gas
Dry mouth
Headache
Dry or thin hair
Hair loss
Changes in taste
* Joint pain

Reporting Side Effects

This is not a complete list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction and its symptoms.
Certain health conditions, including:
+ Dehydration (fluid loss)
+ Heart disease
+ Kidney disease
+ Low sodium levels in your blood
+ Severe illness or weakness
Specific heart conditions, such as Brugada syndrome, or if you have ever fainted without knowing the reason.
A family history of Brugada syndrome or sudden death before the age of 45.
* If you are taking medications for blood pressure or heart problems, as you may require more frequent blood tests to monitor your condition.

This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions. Never start, stop, or change the dose of any medication without consulting your doctor first.

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Regular blood tests will be necessary, as directed by your doctor, to monitor your condition. Be sure to discuss any concerns or questions with your doctor.

Until you understand how this medication affects you, avoid driving and other activities that require alertness. If you are placed on a low-salt diet, notify your doctor, as this can impact how your body processes lithium. Additionally, consult your doctor before consuming alcohol.

Certain conditions, such as fever, infection, vomiting, diarrhea, or excessive sweating, can alter the levels of this medication in your blood. If you experience any of these conditions, inform your doctor promptly. It is also crucial to be cautious in hot weather or during physical activity, drinking plenty of fluids to prevent dehydration.

Monitor your body for signs of high blood sugar, including confusion, drowsiness, unusual thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath. If you notice any of these symptoms, report them to your doctor.

There is a risk of a specific heart condition, known as Brugada Syndrome, which may be associated with this medication. Although rare, this condition can lead to abnormal heart rhythms and increase the risk of sudden death. Discuss this potential risk with your doctor. In some cases, brain problems have occurred in individuals taking this medication in combination with other drugs, such as haloperidol. These brain problems can be severe and potentially lead to long-lasting damage. Consult your doctor about this potential risk.

A severe and potentially life-threatening condition called serotonin syndrome can occur, particularly if you are taking certain other medications. Seek immediate medical attention if you experience agitation, balance problems, confusion, hallucinations, fever, rapid or irregular heartbeat, flushing, muscle twitching or stiffness, seizures, shivering or shaking, excessive sweating, severe diarrhea, nausea or vomiting, or a severe headache.

This medication can also cause increased pressure in the brain and swelling in the eyes, leading to vision problems, including loss of vision. If you experience a severe headache, ringing in the ears, or vision problems such as blurred vision, double vision, or loss of vision, contact your doctor immediately.

If you notice signs of kidney problems, such as difficulty urinating, changes in urine output, bloody, brown, or foamy urine, shortness of breath, coughing, or swelling in the face, feet, or hands, seek medical attention promptly.

If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects. This medication can harm an unborn baby, so a pregnancy test may be required before starting treatment to confirm that you are not pregnant. If you become pregnant while taking this medication, notify your doctor immediately. Additionally, if you are breastfeeding or plan to breastfeed, inform your doctor, as this medication can pass into breast milk and potentially harm your baby.

• Diuretics (thiazide, loop): Increased lithium reabsorption, leading to increased lithium levels and toxicity.
• NSAIDs (e.g., ibuprofen, naproxen, celecoxib): Decrease renal lithium clearance, leading to increased lithium levels and toxicity.
• ACE Inhibitors (e.g., lisinopril, enalapril) & ARBs (e.g., losartan, valsartan): Decrease renal lithium clearance, leading to increased lithium levels and toxicity.
• Metronidazole: Can increase lithium levels.
• Serotonergic agents (e.g., SSRIs, SNRIs, triptans, tramadol): Increased risk of serotonin syndrome.
• Calcium Channel Blockers (e.g., verapamil, diltiazem): Increased risk of neurotoxicity (ataxia, tremor, nausea, vomiting).
• Antipsychotics (e.g., haloperidol, chlorpromazine): Increased risk of neurotoxicity, including encephalopathic syndrome (fever, rigidity, confusion, extrapyramidal symptoms).

• Sodium-depleting agents (e.g., excessive sweating, diarrhea, vomiting): Can increase lithium levels due to increased renal reabsorption.
• Caffeine: May increase lithium excretion, potentially lowering levels.
• Theophylline: May increase lithium excretion, potentially lowering levels.
• Phenytoin: May increase lithium levels or cause neurotoxicity.
• Carbamazepine: Increased risk of neurotoxicity (ataxia, tremor, nausea, vomiting) even at therapeutic levels of both drugs.

• Sodium intake changes: Significant changes in dietary sodium can affect lithium levels (high sodium -> lower lithium; low sodium -> higher lithium).

• Signs of lithium toxicity (tremor, nausea, vomiting, diarrhea, ataxia, slurred speech, confusion, muscle weakness, drowsiness, polyuria, polydipsia)
• Signs of hypothyroidism (fatigue, weight gain, constipation, cold intolerance, dry skin)
• Signs of renal dysfunction (changes in urination, edema)
• Changes in mood or behavior (return of manic or depressive symptoms)

Lithium is classified as Pregnancy Category D due to potential risks to the fetus, particularly during the first trimester. Use should be carefully weighed against the benefits, and alternative treatments should be considered.

Lithium is excreted into breast milk in significant amounts (Lactation Risk L4 - possibly hazardous). Breastfeeding is generally not recommended due to the risk of toxicity in the infant. If breastfeeding is chosen, close monitoring of infant for signs of toxicity (lethargy, hypotonia, poor feeding, cyanosis) and regular infant serum lithium levels are crucial.

Not routinely recommended for children under 12 years due to limited safety and efficacy data. If used, dosing must be highly individualized based on weight and close monitoring of serum levels, renal function, and thyroid function is essential. Children may be more susceptible to adverse effects.

Elderly patients may have reduced renal clearance, leading to higher lithium levels and increased risk of toxicity at lower doses. Start with lower doses and titrate slowly. More frequent monitoring of serum lithium levels, renal function, and thyroid function is recommended. They may also be more susceptible to neurotoxic effects.

• Lithium has a narrow therapeutic index; small changes in dose or fluid/sodium balance can lead to toxicity.
• Consistency is key: Advise patients to maintain consistent fluid and sodium intake.
• Always obtain trough lithium levels (12 hours post-dose) for accurate interpretation.
• Educate patients thoroughly on early signs of toxicity and when to seek medical attention.
• Long-term lithium use can cause nephrogenic diabetes insipidus (polyuria, polydipsia) and hypothyroidism; monitor for these conditions.
• Avoid concomitant use with NSAIDs, ACE inhibitors, ARBs, and thiazide diuretics unless absolutely necessary and with very close monitoring of lithium levels.
• Consider extended-release formulations for better tolerability and once-daily dosing, which may improve adherence.

• Valproate (Divalproex sodium)
• Carbamazepine
• Lamotrigine
• Atypical antipsychotics (e.g., olanzapine, quetiapine, risperidone, aripiprazole)
• Electroconvulsive Therapy (ECT) for severe or refractory cases.

If your symptoms or health issues persist or worsen, contact your doctor immediately. It's essential to use your medication responsibly: do not share it with others, and never take someone else's medication. This medication is accompanied by a Medication Guide, which provides crucial information. Please read it carefully and review it again whenever you refill your prescription. If you have any questions or concerns about this medication, consult your doctor, pharmacist, or healthcare provider. In the event of a suspected overdose, promptly call your local poison control center or seek immediate medical attention. Be prepared to provide details about the overdose, including the substance taken, the amount, and the time it occurred.