Adult Dosing
Acute mania
- Extended Release TABS
- 900 mg PO bid
- Max: 1800 mg/day
- SYRUP
- 10 ml (2 teaspoonfull) PO tid
Maintenance treatment of manic-depressive illness
- 900-1200 mg/day PO divided tid-qid
- Maintain serum lithium level to 0.6 to 1.2 mEq/L
Note:
- Elderly patients may need lower doses
- Do not cut/crush/chew extended release form
Pediatric Dosing
- Safety and effectiveness <12 yrs have not been established
Acute mania (>12 yrs)
- Extended Release TABS
- 900 mg PO bid
- Max: 1800 mg/day
- SYRUP
- 10 ml (2 teaspoonfull) PO tid
Maintenance treatment of manic-depressive illness (>12 yrs)
- 900-1200 mg/day PO divided tid-qid
- Maintain serum lithium level to 0.6 to 1.2 mEq/L
Note:
- Do not cut/crush/chew extended release form
[Outline]
See Supplemental Patient Information
- Lithium toxicity is closely related to serum lithium levels, and can occur at doses close to therapeutic levels. Discontinue the treatment if any sign of toxicity such as diarrhea, vomiting, tremor, mild ataxia, drowsiness or muscular weakness occurs [US Black Box Warning]
- Lithium is generally contraindicated in patients with significant renal or cardiovascular disease, severe debilitation or dehydration, or sodium depletion, since the risk of lithium toxicity is very high in such patients. However if the psychiatric indication is life-threatening and if patient fails to respond to other measures, hospitalize the patient and start with lithium treatment with extreme caution, including daily determination of serum lithium levels and use the lowest possible dose [Extended Release TABS]
- Diminution of renal concentrating ability, occasionally presenting as nephrogenic diabetes insipidus, with polyuria and polydipsia has been reported with chronic lithium therapy. Manage these patients carefully to avoid dehydration resulting in lithium retention and toxicity. Discontinuation of therapy can reverse the condition
- Monitor kidney function, routine urinalysis and other tests prior to starting lithium therapy or thereafter to evaluate tubular function and glomerular function. Reevaluate the therapy if there is progressive or sudden changes in renal function, even within the normal range
- An encephalopathic syndrome (characterized by weakness, lethargy, fever, tremulousness and confusion, extrapyramidal symptoms, leukocytosis, elevated serum enzymes, BUN and FBS), followed by irreversible brain damage, has been observed with lithium anlog with neuroleptic agent. Closely monitor patients receiving such combined therapy for early sign of neurologic toxicity and discontinue the treatment if such sign occurs
- Lithium can cause fetal harm when administered to a pregnant woman. Ebstein's anomaly has been reported. Patients should be advised to avoid pregnancy during the therapy. If patient becomes pregnant or if drug is used during pregnancy the patient should be apprised of the potential hazard to the fetus
- The ability to tolerate lithium is greater during the acute manic phase and decreases when manic symptoms subside
- Lithium decreases sodium reabsorption by the renal tubules leading to sodium depletion, hence the patients should be advised to maintain normal diet, including salt, and an adequate fluid intake
- Protracted sweating or diarrhea, concomitant infection with elevated temperatures can occur with decreased tolerance to lithium, reduce the dose or temporary suspend the drug if such condition occurs and administer supplemental fluid and salt
- Monitor thyroid function in preexisting hypothyroidism, during lithium stabilization and maintenance. Adjust the lithium dose and administer supplemental thyroid treatment if hypothyroism occurs
- Avoid concomitant use of lithium and diuretics or angiotensin converting enzyme (ACE) inhibitors. If concomitant use is necessary, use with extreme caution with lowest possible dose of lithium and more frequent monitoring of lithium serum concentrations, as sodium loss from these drugs may reduce the renal clearance of lithium resulting in increased serum lithium concentrations with the risk of lithium toxicity
Cautions: Use cautiously in
- Renal impairment
- Diabetes mellitus
- Febrile illness
- Thyroid disorder
- Volume depletion
- Elderly patients
Supplemental Patient Information
- Patients should be advised to contact their physician , if any sign of lithium toxicity such as diarrhea, vomiting, tremor, mild ataxia, drowsiness, or muscular weakness occurs
- Patients should be cautioned about activities requiring alertness such as operating vehicles or machinery as lithium may impair mental and/or physical abilities
Pregnancy Category:D
Breastfeeding: As per limited data lithium in milk can adversely affect the infant when its elimination is impaired, as in dehydration or in newborn or premature infants. The long-term effects of lithium on infants are not known, but limited data indicate no obvious problems in growth and development. Although lithium contraindicated during breastfeeding, some resourcese consider that lithium can be used in mothers of full-term infants who are willing and able to monitor their infants. Monitor infant serum lithium, serum creatinine, BUN, and TSH every 4 to 12 wks during breastfeeding and maternal lithium therapy. Discontinue breastfeeding if the infant appears restless or looks ill. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 31 March 2011). As per manufacturer's data signs of lithium toxicity such as hypertonia, hypothermia, cyanosis and ECG changes have been reported in some infants and neonates. Hence manufacturer recommends not to breastfed during lithium therapy except in rare and unusual circumstances where, the potential benefits to the mother outweigh possible hazard to the infant or neonate.
Pricing data from www.DrugStore.com in U.S.A.
- Lithium Carbonate 300 MG CAPS [Bottle] (ROXANE)
90 mg = $25.99
180 mg = $42.97 - Lithobid 300 MG TBCR [Bottle] (NOVEN THERAPEUTICS)
90 mg = $222
270 mg = $625.95 - Lithium Citrate 8 MEQ/5ML SYRP [Bottle] (ROXANE)
500 5ml = $59.99
1500 5ml = $150.96
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
Drug Name: Lithane 300 MG Oral Tablet
Ingredient(s): Lithium Carbonate
Imprint: Miles;951
Color(s): Green
Shape: Round
Size (mm): 10.00
Score: 2
Inactive Ingredient(s): blue 1 lake / dibasic calcium phosphate / magnesium stearate / polyethylene glycol / sodium lauryl sulfate / starch / yellow 5 lake
Drug Label Author:
Miles Pharmaceuticals
DEA Schedule:
Non-Scheduled
Drug Name: Lithobid 300 MG Extended Release Tablet
Ingredient(s): Lithium Carbonate
Imprint: LITHOBID;300
Color(s): Pink
Shape: Round
Size (mm): 10.00
Score: 1
Inactive Ingredient(s): calcium stearate / carnauba wax / hypromellose 2910 (50 cps) / fd&c blue no. 2 / fd&c red no. 40 / fd&c yellow no. 6 / povidone / propylene glycol / sodium chloride / sodium lauryl sulfate / sodium starch glycolate type a potato / sorbitol / titanium dioxide
Drug Label Author:
NOVEN THERAPEUTICS, LLC
DEA Schedule:
Non-Scheduled
