lithium carbonate

lithium carbonate

n.

A lithium salt used in the treatment of depression and mania associated with bipolar disorder.

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lithium carbonate,

an antimanic agent.

indication It is prescribed in the treatment of manic episodes of manic-depressive disorder.

contraindications It is used with caution in the presence of renal or cardiovascular disease and is not recommended for children under 12 years of age. Known hypersensitivity to this drug and pregnancy prohibit its use.

adverse effects Among the most serious adverse effects are renal damage, polydipsia and polyuria, and impairment of mental and physical abilities. Retention of sodium and fluid may occur.

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lithium

a chemical element, atomic number 3, atomic weight 6.939, symbol Li. See Table 6.

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lithium carbonate

used in the treatment of canine cyclic hematopoiesis to stabilize numbers of neutrophils.

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lithium carbonate

Apo-Lithium Carbonate (CA), Apo-Lithium Camcolit (UK), Carbolith (CA), Carbonate SR (CA), Liskonum (UK), Lithane, Lithobid, Lithonate (UK), PMS-Lithium Carbonate (CA), Priadel (UK)

Pharmacologic class: Miscellaneous CNS drug

Therapeutic class: Antimanic drug

Pregnancy risk category D

FDA Boxed Warning

• Lithium toxicity is closely related to lithium blood level and can occur at doses close to therapeutic levels. Before starting therapy, ensure that resources for prompt, accurate blood lithium testing are available.

Action

Unknown. Thought to disrupt sodium exchange and transport in nerves and muscles and control reuptake of neurotransmitters.

Availability

Capsules: 150 mg, 300 mg, 600 mg

Capsules (slow-release): 150 mg, 300 mg

Syrup (citrate): 300 mg (8 mEq lithium)/5 ml

Tablets: 300 mg

Tablets (controlled-release): 450 mg

Tablets (extended-release): 300 mg, 450 mg

Tablets (slow-release): 300 mg

⊘Indications and dosages

➣ Manic episodes of bipolar disorder

Adults and children ages 12 and older: 900 to 1,800 mg P.O. daily in divided doses (for example, 300 to 600 mg t.i.d. or 450 to 900 mg b.i.d. of controlled- or slow-release form) to achieve blood level of 1 to 1.5 mEq/L; measure blood level twice weekly until patient stabilizes. Maintenance dosage is 900 to 1,200 mg/day in divided doses (for example, 300 to 400 mg t.i.d. or 450 to 600 mg b.i.d. of controlled- or slow-release form) to maintain blood level of 0.6 to 1.2 mEq/L. Monitor blood level at least q 2 months.

Dosage adjustment

• Impaired renal function
• Elderly patients

Off-label uses

• Acute manic episodes in children
• Corticosteroid-induced psychosis
• Neutropenia secondary to antineoplastic therapy
• Tardive dyskinesia
• Alcoholism
• Bulimia

Contraindications

None

Precautions

Use cautiously in:
• hepatic or thyroid disease, severe cardiovascular or renal disease, diabetes mellitus, seizure disorders, systemic infections, brain trauma, organic brain syndrome, urinary retention, severe sodium depletion
• elderly patients
• pregnant or breastfeeding patients
• children (safety not established).

Administration

☞ Be aware that dosages are individualized according to lithium blood level and response.
• Give with food or milk to minimize GI upset.
• Make sure patient swallows slow-release tablet whole without chewing or crushing.
• When switching patient from immediate-release to controlled- or slow-release form, give same total daily dosage.
• Know that immediate-release tablets typically are given three or four times daily, whereas controlled-release forms usually are given twice daily, roughly 12 hours apart.

Route	Onset	Peak	Duration
P.O.	Unknown	0.5-3 hr	Unknown
P.O.(controlled, slow-release)	Unknown	3-12 hr	Unknown

Adverse reactions

CNS: dizziness, drowsiness, headache, tremor, tics, EEG changes, ataxia, choreoathetotic movements, abnormal tongue movements, extrapyramidal reactions, cogwheel rigidity, blackout spells, psychomotor retardation, slow mental functioning, slurred speech, startled response, restlessness, agitation, confusion, hallucinations, poor memory, worsening of organic brain syndrome, stupor, coma, epileptiform seizures

CV: bradycardia, ECG changes, hypotension, sinus node dysfunction with severe bradycardia and syncope, arrhythmias, peripheral circulatory collapse

EENT: blurred vision, nystagmus, tinnitus

GI: nausea, vomiting, diarrhea, abdominal pain, fecal incontinence, gastritis, flatulence, dyspepsia, anorexia, increased salivation, salivary gland swelling, dry mouth

GU: urinary incontinence, glycosuria, albuminuria, erectile or other sexual dysfunction, polyuria or other signs of nephrogenic diabetes insipidus, oliguria

Hematologic: leukocytosis

Metabolic: hypothyroidism or hyperthyroidism, goiter, hyperglycemia, hypercalcemia, hyponatremia, hyperparathyroidism

Musculoskeletal: swollen or painful joints, muscle weakness, muscle fasciculations and twitching, clonic arm or leg movements, hypertonicity, hyperactive deep tendon reflexes, polyarthralgia

Skin: dry thin hair, alopecia, diminished or absent skin sensations, chronic folliculitis, eczema with dry skin, new onset or exacerbation of psoriasis, pruritus (with or without rash), cutaneous ulcers, angioedema

Other: altered, metallic, or salty taste; dental caries; weight gain; excessive thirst; polydipsia; fever; edema of lips, ankles, and wrists

Interactions

Drug-drug. Acetazolamide, alkalinizing agents (such as sodium bicarbonate), urea, verapamil, xanthines: decreased lithium blood level

Calcium channel blockers, carbamazepine, haloperidol, methyldopa: increased risk of neurotoxicity

Diuretics: increased sodium loss, increased risk of lithium toxicity

Fluoxetine, loop diuretics, metronidazole, nonsteroidal anti-inflammatory drugs: increased risk of lithium toxicity

Iodide salts: synergistic effects, increased risk of hypothyroidism

Neuromuscular blockers: prolonged neuromuscular blockade, severe respiratory depression

Phenothiazines: decreased phenothiazine blood level or increased lithium blood level, greater risk of neurotoxicity

Selective serotonin reuptake inhibitors: increased risk of tremor, confusion, dizziness, agitation, and diarrhea

Sympathomimetics: decreased pressor sensitivity

Tricyclic antidepressants: increased antidepressant effects

Drug-diagnostic tests. Albumin, creatinine, sodium, thyroxine, triiodothyronine: decreased levels

Calcium, glucose, ¹³¹I uptake, white blood cells (WBCs): increased levels

Drug-food. Caffeine-containing foods and beverages: decreased lithium blood level and efficacy

Drug-herbs. Caffeine-containing herbs (cola nut, guarana, yerba maté): decreased lithium blood level and efficacy

Patient monitoring

• Obtain baseline ECG and electrolyte levels before and periodically during therapy.
• Assess neurologic and psychiatric status. Institute safety measures as needed to prevent injury.
• Monitor lithium blood level, WBC count, and thyroid and kidney function tests.
• Assess cardiovascular status regularly.
• Monitor fluid intake and output. Watch for edema and weight gain.

Patient teaching

• Advise patient to take with food or milk to minimize GI upset.
• Instruct patient to swallow slow-release tablet whole without chewing or crushing.
• Tell patient that beneficial effects may take 1 to 3 weeks to appear.
• Advise patient to limit foods and beverages containing caffeine, because they may interfere with drug action.
• Tell patient to maintain adequate fluid intake.
• Explain that drug may cause adverse CNS effects. Advise patient to avoid activities requiring mental alertness until effects are known.
☞ Emphasize importance of having regular blood tests, to help detect and prevent serious adverse reactions.
• Instruct patient to carry appropriate medical identification at all times.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.

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lithium carbonate

LiCO₃ Pharmacology An alkali used to treat bipolar I disorder, which blocks neurotransmission at the 'second messenger' phosphoinositide-mediated cholinergic neurons in the hippocampus , inhibiting release and uptake of norepinephrine at nerve endings by inhibiting receptor-mediated synthesis of cAMP Neuropharmacologic effects-antimanic Blocks development of dopamine receptor supersensitivity, ↑ GABA function, ↑ acetylcholine function Antidepressant ↑ 5-HT function, ↓ β-adrenoceptor stimulation of adenylate cyclase, ↓ α₂-adrenoceptor function Thymoleptic ↓ Neurotransmitter-coupled adenylate cyclase activity and cAMP formation, ↓ receptor-G protein coupling, ↓ phosphoinositide metabolism, alters kinetics of alkali cations–Na+, K+, Ca2+, Mg2+  Side effects Hyperirritability, hyperpyrexia, stupor, coma, gastroenteritis, cardiovascular disease–eg, arrhythmia, hypotension, ↓ ST wave, T inversion, osteoporosis Teratogenesis Cardiac malformations in 10% of infants born to lithium-treated ♀ Toxicity Overdose causes death in¹⁄₄ of Pts Treatment K⁺-sparing drugs

Lithium toxicity

< 1.5 mmol/L Nausea, tremor, mild polyuria

1.5–2.5 mmol/L Diarrhea, vomiting, polyuria, coarse tremor, muscle fasciculation, ataxia, weakness, sedation

2.5–4.0 mmol/L Muscle hypertonia, choreiform movement, ↑ deep muscle reflexes, seizures, focal neurologic signs, impaired consciousness, confusion, stupor

> 4.0 mmol/L Coma, death