Lithium Citrate 8meq/5ml Solution
WARNING: This drug may cause severe side effects at doses that are close to the normal dose. Rarely, this may include death. Do not take more of this drug than you are told. You will have blood tests to check the level of this drug in your blood. There are many signs of too much lithium in the blood. Closely read the part in this leaflet which lists when to call your doctor. @ COMMON USES: It is used to treat bipolar disorder. It may be given to you for other reasons. Talk with the doctor.
Drug Class
Antimanic agent; Mood stabilizer
Pharmacologic Class
Alkali metal
Pregnancy Category
Category D
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
Lithium citrate is a liquid medication used to treat bipolar disorder, a condition that causes extreme mood swings, including periods of high energy (mania) and low energy (depression). It helps to stabilize your mood and reduce the intensity of these swings.
How to Use This Medicine
Taking Your Medication Correctly
To ensure you get the most benefit from your medication, follow these steps:
Take your medication exactly as directed by your doctor.
Read all the information provided with your medication and follow the instructions carefully.
You can take your medication with or without food. If it causes stomach upset, take it with food to help minimize this side effect.
Maintain a consistent salt intake from day to day.
Follow your doctor's advice on the types of liquids to drink and the amount of liquid to consume while taking this medication.
When measuring liquid doses, use the measuring device that comes with your medication. If one is not provided, ask your pharmacist for a suitable measuring device.
Storing and Disposing of Your Medication
To keep your medication safe and effective:
Store your medication at room temperature in a dry place, avoiding the bathroom.
Keep all medications in a secure location, out of the reach of children and pets.
Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your pharmacist.
If you have questions about disposing of your medication, consult your pharmacist. You may also have access to drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose of your medication:
Take the missed dose as soon as you remember.
If it is close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule.
Do not take two doses at the same time or take extra doses.
If you are unsure about what to do if you miss a dose, contact your doctor for guidance.
To ensure you get the most benefit from your medication, follow these steps:
Take your medication exactly as directed by your doctor.
Read all the information provided with your medication and follow the instructions carefully.
You can take your medication with or without food. If it causes stomach upset, take it with food to help minimize this side effect.
Maintain a consistent salt intake from day to day.
Follow your doctor's advice on the types of liquids to drink and the amount of liquid to consume while taking this medication.
When measuring liquid doses, use the measuring device that comes with your medication. If one is not provided, ask your pharmacist for a suitable measuring device.
Storing and Disposing of Your Medication
To keep your medication safe and effective:
Store your medication at room temperature in a dry place, avoiding the bathroom.
Keep all medications in a secure location, out of the reach of children and pets.
Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your pharmacist.
If you have questions about disposing of your medication, consult your pharmacist. You may also have access to drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose of your medication:
Take the missed dose as soon as you remember.
If it is close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule.
Do not take two doses at the same time or take extra doses.
If you are unsure about what to do if you miss a dose, contact your doctor for guidance.
Lifestyle & Tips
- Maintain consistent fluid intake (drink 8-12 glasses of water daily) to prevent dehydration, which can increase lithium levels and lead to toxicity.
- Maintain a consistent sodium intake in your diet. Significant changes in sodium intake (e.g., very low sodium diet, excessive sodium intake) can affect lithium levels.
- Avoid excessive caffeine intake, as it can affect lithium levels.
- Avoid alcohol, as it can worsen mood symptoms and contribute to dehydration.
- Be aware of conditions that can cause dehydration (e.g., fever, vomiting, diarrhea, heavy sweating from exercise or hot weather) and increase fluid intake if these occur.
- Do not change your dose or stop taking lithium without consulting your doctor.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
Acute Mania: Initial 10-15 mL (16-24 mEq) BID or TID, titrated to achieve serum lithium levels of 0.8-1.2 mEq/L. Maintenance: 5 mL (8 mEq) to 10 mL (16 mEq) BID or TID, titrated to achieve serum lithium levels of 0.6-1.0 mEq/L.
Dose Range:
8 - 48 mg
Condition-Specific Dosing:
acuteMania:
Initial 10-15 mL (16-24 mEq) BID or TID, target serum levels 0.8-1.2 mEq/L.
maintenance:
5-10 mL (8-16 mEq) BID or TID, target serum levels 0.6-1.0 mEq/L.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not routinely recommended for children under 12 years; if used, dose based on weight and titrated to serum levels (e.g., 15-60 mg/kg/day in divided doses, equivalent to 0.4-1.6 mEq/kg/day). Careful monitoring required.
Adolescent:
Similar to adult dosing, but start low and titrate carefully based on weight and serum levels. Target serum levels 0.6-1.2 mEq/L.
Dose Adjustments
Renal Impairment:
Mild:
Reduce dose by 25-50% or extend dosing interval. Monitor serum levels closely.
Moderate:
Reduce dose by 50-75% or extend dosing interval significantly. Monitor serum levels closely. Use with extreme caution.
Severe:
Contraindicated due to high risk of toxicity. If absolutely necessary, use with extreme caution and frequent monitoring, often in a hospital setting.
Dialysis:
Lithium is dialyzable. Dosing adjustments required post-dialysis. Typically, a supplemental dose is given after each dialysis session.
Hepatic Impairment:
Mild:
No specific adjustment needed, as lithium is not hepatically metabolized.
Moderate:
No specific adjustment needed.
Severe:
No specific adjustment needed.
Pharmacology
Mechanism of Action
The precise mechanism of action of lithium in bipolar disorder is not fully understood but is thought to involve multiple pathways. It modulates neurotransmitter systems (e.g., serotonin, norepinephrine, dopamine), inhibits inositol monophosphatase (leading to depletion of inositol), inhibits glycogen synthase kinase-3 (GSK-3), and may exert neuroprotective effects by increasing levels of brain-derived neurotrophic factor (BDNF). These actions collectively contribute to its mood-stabilizing effects.
Pharmacokinetics
Absorption:
Bioavailability:
Approximately 100%
Tmax:
0.5-3 hours (for solution/syrup formulations)
FoodEffect:
Food may delay absorption but does not significantly affect the extent of absorption.
Distribution:
Vd:
0.7-0.9 L/kg (initial), 0.7-1.0 L/kg (steady-state)
ProteinBinding:
None (0%)
CnssPenetration:
Limited (crosses blood-brain barrier slowly; CNS levels are approximately 40-50% of plasma levels at steady state)
Elimination:
HalfLife:
18-36 hours (longer in elderly and renal impairment)
Clearance:
Primarily renal clearance, proportional to creatinine clearance.
ExcretionRoute:
Renal (urine)
Unchanged:
95-100%
Pharmacodynamics
OnsetOfAction:
Mood-stabilizing effects typically begin within 1-3 weeks, with full therapeutic effect often taking several weeks.
PeakEffect:
Corresponds to steady-state serum concentrations, usually achieved within 5-7 days of consistent dosing.
DurationOfAction:
Related to its half-life; requires twice or thrice daily dosing for sustained therapeutic levels.
Safety & Warnings
Side Effects
Serious Side Effects: Seek Medical Help Immediately
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention right away:
Allergic Reaction: 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, or swelling of the mouth, face, lips, tongue, or throat.
Acidosis (Too Much Acid in the Blood): Confusion, fast breathing, fast heartbeat, irregular heartbeat, severe stomach pain, upset stomach, vomiting, excessive sleepiness, shortness of breath, or feeling extremely tired or weak.
Thyroid Problems: Weight changes, nervousness, excitability, restlessness, weakness, hair thinning, depression, eye or neck swelling, difficulty focusing, sensitivity to heat or cold, menstrual changes, shakiness, or excessive sweating.
Fluid and Electrolyte Imbalance: Mood changes, confusion, muscle pain or weakness, abnormal heartbeat, severe dizziness or fainting, increased thirst, seizures, excessive tiredness or weakness, decreased appetite, urinary retention or changes in urine output, dry mouth, dry eyes, or severe stomach upset or vomiting.
Other serious side effects may include:
+ Bloating
+ Diarrhea
+ Dizziness or lightheadedness
+ Difficulty walking
+ Trouble controlling body movements, twitching, balance problems, or difficulty swallowing or speaking
+ 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, significant weight gain, or swelling in the arms or legs
+ Unintentional weight changes
+ Loss of bladder or bowel control
+ Sexual problems
Common Side Effects
Most people do not experience serious side effects, and some may only have mild side effects. If you notice any of the following side effects and they bother you or do not go away, contact your doctor:
Dizziness, drowsiness, tiredness, or weakness
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 comprehensive list of all 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.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention right away:
Allergic Reaction: 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, or swelling of the mouth, face, lips, tongue, or throat.
Acidosis (Too Much Acid in the Blood): Confusion, fast breathing, fast heartbeat, irregular heartbeat, severe stomach pain, upset stomach, vomiting, excessive sleepiness, shortness of breath, or feeling extremely tired or weak.
Thyroid Problems: Weight changes, nervousness, excitability, restlessness, weakness, hair thinning, depression, eye or neck swelling, difficulty focusing, sensitivity to heat or cold, menstrual changes, shakiness, or excessive sweating.
Fluid and Electrolyte Imbalance: Mood changes, confusion, muscle pain or weakness, abnormal heartbeat, severe dizziness or fainting, increased thirst, seizures, excessive tiredness or weakness, decreased appetite, urinary retention or changes in urine output, dry mouth, dry eyes, or severe stomach upset or vomiting.
Other serious side effects may include:
+ Bloating
+ Diarrhea
+ Dizziness or lightheadedness
+ Difficulty walking
+ Trouble controlling body movements, twitching, balance problems, or difficulty swallowing or speaking
+ 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, significant weight gain, or swelling in the arms or legs
+ Unintentional weight changes
+ Loss of bladder or bowel control
+ Sexual problems
Common Side Effects
Most people do not experience serious side effects, and some may only have mild side effects. If you notice any of the following side effects and they bother you or do not go away, contact your doctor:
Dizziness, drowsiness, tiredness, or weakness
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 comprehensive list of all 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.
Seek Immediate Medical Attention If You Experience:
- Early signs of lithium toxicity: Nausea, vomiting, diarrhea, fine tremor (shaking), muscle weakness, feeling tired or sluggish, increased thirst, increased urination.
- More severe signs of toxicity: Coarse tremor, difficulty walking (ataxia), slurred speech, confusion, blurred vision, muscle twitching, seizures, irregular heartbeat, fainting.
Before Using This Medicine
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. 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
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 your doctor may need to monitor your blood work more closely
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. Do not start, stop, or change the dose of any medication without consulting your doctor first.
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. 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
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 your doctor may need to monitor your blood work more closely
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. Do not start, stop, or change the dose of any medication without consulting your doctor first.
Precautions & Cautions
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 advised to follow 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.
In hot weather or during physical activity, be cautious and drink plenty of fluids to prevent dehydration. If you notice signs of high blood sugar, such as confusion, drowsiness, unusual thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath, report them to your doctor.
A rare heart condition called Brugada Syndrome has been associated with this medication in some individuals who were previously unaware of their condition. This condition can lead to abnormal heart rhythms and increase the risk of sudden death. Discuss this with your doctor. In rare cases, brain problems have occurred in people taking this medication in combination with certain other drugs, such as haloperidol, which can result in long-term brain damage. Consult your doctor about this potential risk.
There is a risk of a severe and potentially life-threatening condition called serotonin syndrome, which may be increased if you are taking certain other medications. Seek immediate medical attention if you experience symptoms such as 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 has been linked to increased pressure in the brain and swelling in the eyes, which can lead 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, cough, 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, and a pregnancy test may be required before starting treatment to confirm that you are not pregnant. If you become pregnant while taking this medication, inform your doctor immediately. Additionally, if you are breastfeeding or plan to breastfeed, consult your doctor, as this medication can pass into breast milk and potentially harm your baby.
Until you understand how this medication affects you, avoid driving and other activities that require alertness. If you are advised to follow 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.
In hot weather or during physical activity, be cautious and drink plenty of fluids to prevent dehydration. If you notice signs of high blood sugar, such as confusion, drowsiness, unusual thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath, report them to your doctor.
A rare heart condition called Brugada Syndrome has been associated with this medication in some individuals who were previously unaware of their condition. This condition can lead to abnormal heart rhythms and increase the risk of sudden death. Discuss this with your doctor. In rare cases, brain problems have occurred in people taking this medication in combination with certain other drugs, such as haloperidol, which can result in long-term brain damage. Consult your doctor about this potential risk.
There is a risk of a severe and potentially life-threatening condition called serotonin syndrome, which may be increased if you are taking certain other medications. Seek immediate medical attention if you experience symptoms such as 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 has been linked to increased pressure in the brain and swelling in the eyes, which can lead 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, cough, 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, and a pregnancy test may be required before starting treatment to confirm that you are not pregnant. If you become pregnant while taking this medication, inform your doctor immediately. Additionally, if you are breastfeeding or plan to breastfeed, consult your doctor, as this medication can pass into breast milk and potentially harm your baby.
Overdose Information
Overdose Symptoms:
- Severe nausea, vomiting, and diarrhea
- Severe tremor, muscle weakness, and lack of coordination
- Drowsiness, confusion, and disorientation
- Slurred speech
- Blurred vision or nystagmus (involuntary eye movements)
- Seizures
- Cardiac arrhythmias
- Coma
- Kidney failure
What to Do:
If you suspect an overdose, seek immediate medical attention. Call 911 or your local emergency number. For poison control, call 1-800-222-1222. Treatment may involve gastric lavage, whole bowel irrigation, fluid and electrolyte correction, and in severe cases, hemodialysis to remove lithium from the body.
Drug Interactions
Major Interactions
- Thiazide diuretics (e.g., hydrochlorothiazide): Significantly increase lithium reabsorption in the renal tubules, leading to increased lithium levels and toxicity.
- NSAIDs (e.g., ibuprofen, naproxen, celecoxib): Can decrease renal lithium clearance, leading to increased lithium levels and toxicity. Aspirin and sulindac may have less effect.
- ACE inhibitors (e.g., lisinopril, enalapril) and ARBs (e.g., losartan, valsartan): Can decrease renal lithium clearance, leading to increased lithium levels and toxicity.
- Metronidazole: Can increase lithium levels and risk of toxicity.
- Calcium channel blockers (e.g., verapamil, diltiazem): May increase risk of neurotoxicity (ataxia, tremor, nausea, vomiting) even at therapeutic lithium levels.
- Antipsychotics (especially haloperidol, chlorpromazine): Increased risk of neurotoxicity, severe extrapyramidal symptoms, and irreversible brain damage (rare).
- SSRIs/SNRIs (e.g., fluoxetine, sertraline, venlafaxine): Increased risk of serotonin syndrome.
- Neuromuscular blocking agents: Lithium may prolong the effects of depolarizing and non-depolarizing neuromuscular blockers.
Moderate Interactions
- Loop diuretics (e.g., furosemide): Variable effect on lithium levels; can increase or decrease depending on hydration and sodium status. Monitor closely.
- Sodium-depleting agents (e.g., excessive sweating, low sodium diet, severe diarrhea/vomiting): Can increase lithium levels due to increased renal reabsorption.
- Caffeine: May increase renal lithium excretion, potentially lowering lithium levels.
- Theophylline: May increase renal lithium excretion, potentially lowering lithium levels.
- Acetazolamide, osmotic diuretics, urea: May increase lithium excretion, potentially lowering lithium levels.
- Phenytoin, carbamazepine: May increase risk of neurotoxicity without significant changes in lithium levels.
Minor Interactions
- Not available
Monitoring
Baseline Monitoring
Renal function (BUN, serum creatinine, eGFR, urinalysis with specific gravity)
Rationale: Lithium is primarily renally excreted; renal impairment increases toxicity risk. Long-term use can cause nephrogenic diabetes insipidus.
Timing: Prior to initiation
Thyroid function (TSH, free T4)
Rationale: Lithium can cause hypothyroidism.
Timing: Prior to initiation
Electrolytes (Sodium, Potassium, Calcium)
Rationale: Electrolyte imbalances, especially sodium, can affect lithium levels and toxicity.
Timing: Prior to initiation
Electrocardiogram (ECG)
Rationale: Lithium can cause T-wave flattening or inversion; caution in patients with cardiac disease.
Timing: Prior to initiation, especially in patients with cardiac risk factors or over 50 years old
Pregnancy test (for females of childbearing potential)
Rationale: Lithium is Category D in pregnancy.
Timing: Prior to initiation
Weight/BMI
Rationale: Lithium can cause weight gain.
Timing: Prior to initiation
Routine Monitoring
Serum Lithium Levels
Frequency: 5-7 days after initiation or dose change, then weekly until stable, then every 1-3 months (or more frequently if clinically indicated, e.g., illness, new medications). Levels should be drawn 10-12 hours post-dose (trough level).
Target: Acute Mania: 0.8-1.2 mEq/L; Maintenance: 0.6-1.0 mEq/L
Action Threshold: >1.5 mEq/L (mild toxicity), >2.0 mEq/L (moderate-severe toxicity), >2.5 mEq/L (severe toxicity, medical emergency)
Renal function (BUN, serum creatinine, eGFR)
Frequency: Every 6-12 months, or more frequently if clinically indicated (e.g., signs of renal dysfunction, new nephrotoxic medications).
Target: Within normal limits for age
Action Threshold: Significant decline in GFR, increase in creatinine, or signs of renal impairment warrant dose adjustment or discontinuation.
Thyroid function (TSH, free T4)
Frequency: Every 6-12 months, or more frequently if symptoms of hypothyroidism develop.
Target: Within normal limits
Action Threshold: Elevated TSH or low free T4 warrants thyroid hormone replacement or lithium dose adjustment/discontinuation.
Electrolytes (Sodium, Potassium)
Frequency: Periodically, especially if patient is ill, dehydrated, or on interacting medications.
Target: Within normal limits
Action Threshold: Significant abnormalities may require intervention or lithium dose adjustment.
Weight/BMI
Frequency: Annually or as clinically indicated.
Target: Stable
Action Threshold: Significant weight gain may warrant lifestyle intervention or consideration of alternative therapy.
Symptom Monitoring
- Early signs of toxicity: Nausea, vomiting, diarrhea, fine tremor, muscle weakness, lethargy, thirst, polyuria.
- Moderate to severe toxicity: Coarse tremor, ataxia, slurred speech, confusion, nystagmus, muscle fasciculations, hyperreflexia, blurred vision, seizures, cardiac arrhythmias, coma.
Special Patient Groups
Pregnancy
Lithium is classified as Pregnancy Category D, meaning there is positive evidence of human fetal risk. However, the benefits of use in pregnant women may be acceptable despite the risk in certain situations (e.g., severe, uncontrolled bipolar disorder). Decision to use should be made after careful consideration of risks vs. benefits and discussion with the patient.
Trimester-Specific Risks:
First Trimester:
Increased risk of cardiac malformations, particularly Ebstein's anomaly (a rare heart defect), if exposed during the first trimester (especially weeks 4-8 of gestation). The absolute risk is low but higher than the general population.
Second Trimester:
Less risk of major malformations than the first trimester. Risk of neonatal toxicity (e.g., hypotonia, lethargy, cyanosis, poor feeding) if exposed late in pregnancy.
Third Trimester:
Risk of neonatal toxicity (e.g., hypotonia, lethargy, cyanosis, poor feeding, goiter, diabetes insipidus-like syndrome) due to accumulation of lithium in the fetus. Close monitoring of maternal lithium levels and fetal well-being is crucial.
Lactation
Lithium is excreted into breast milk in significant amounts. The American Academy of Pediatrics considers lithium to be a drug for which the effect on a nursing infant is unknown but may be of concern. The risk of infant toxicity (e.g., lethargy, hypotonia, cyanosis, ECG changes) is present. Breastfeeding is generally not recommended, or if continued, requires close monitoring of infant serum lithium levels and clinical status.
Infant Risk:
L4 (Possibly Hazardous)
Pediatric Use
Lithium is generally not recommended for children under 12 years of age due to limited safety and efficacy data. If used in severe cases, it requires careful titration, frequent monitoring of serum levels, renal function, and thyroid function due to increased susceptibility to side effects and toxicity.
Geriatric Use
Elderly patients are at increased risk of lithium toxicity due to age-related decline in renal function, reduced total body water, and potential for polypharmacy. Start with lower doses and titrate slowly. Monitor serum lithium levels, renal function, and thyroid function more frequently. They may also be more susceptible to neurotoxic side effects.
Clinical Information
Clinical Pearls
- Lithium has a narrow therapeutic index; small changes in dose or patient status can lead to toxicity. Consistent monitoring of serum levels is paramount.
- Maintain consistent hydration and sodium intake. Dehydration or sodium depletion can rapidly increase lithium levels.
- Onset of action is slow (1-3 weeks); patients should be educated on this to manage expectations and ensure adherence.
- Many common medications (e.g., NSAIDs, thiazide diuretics, ACE inhibitors) can significantly increase lithium levels; always review concomitant medications.
- Lithium can cause long-term renal and thyroid dysfunction; regular monitoring of these systems is essential.
- Patients should be educated on the signs and symptoms of lithium toxicity and instructed to seek immediate medical attention if they occur.
Alternative Therapies
- Valproate (divalproex sodium)
- Lamotrigine
- Carbamazepine
- Atypical antipsychotics (e.g., olanzapine, quetiapine, risperidone, aripiprazole, lurasidone, cariprazine) - often used in combination with mood stabilizers or as monotherapy for acute mania/depression in bipolar disorder.
Cost & Coverage
Average Cost:
Variable, generally low per 480 mL bottle
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure your safety, never share your medication with others or take someone else's medication. This medication is accompanied by a Medication Guide, which provides crucial information. Please read this guide carefully and review it again whenever you receive a refill. If you have any questions or concerns about this medication, we encourage you to discuss them with your doctor, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide details about the overdose, including the substance taken, the amount, and the time it occurred.