(Legend)

Generic Name

• Lithium
  T½ = 20–27 h
  Pregnancy category D

Trade Name

• Eskalith
• Eskalith CR
• Lithobid
• Lithonate
• Lithotabs
• Carbolith
• Lithane
• Lithmax

Dose Range/Adult Daily Dose

• Acute mania: 1800–2400 mg/d; Maintenance: 300–1200 mg/d. Start: 300–600 mg po 3 × daily; usual maintenance: 300 mg 3–4 × daily. Slow release: 200–300 mg po 3 × daily to start, up to 1800 mg/d (divided doses); Extended release: 300–600 mg po 3 × daily to start

Use/Common Side Effects (CSE)

• Use: Bipolar disorder: Acute manic episodes; prophylaxis against recurrence
  CSE: Fatigue, headache, impaired memory, ECG changes, bloating, diarrhea, nausea, abdominal pain, leukocytosis, polyuria, acne, hypothyroidism, tremors, weight gain, SEIZURES, ARRHYTHMIAS

Geriatric & Dose Considerations

• Initial dose reduction recommended; caution w CV/renal/thyroid disease, diabetes mellitus

Classification

• Antimanic/mood stabilizer

Assessment Cautions

• Serum lithium levels: Acute mania: 1.0–1.5 mEq/L; Maintenance: 0.6–1.2 mEq/L. Narrow therapeutic range; Signs of toxicity: vomiting, diarrhea, slurred speech, drowsiness, ↓ coordination. Li ↓ thyroid function (hypothyroidism)/renal changes. Monitor thyroid/kidney function, WBC w diff, electrolytes, glucose, ECG, weight (also BMI). Caution: Toxic encephalopathy w haloperidol + lithium