lithium carbonate (Eskalith, Lithane, Lithobid, Lithonate)

From Aaushi
Jump to navigation Jump to search

Introduction

Tradenames: Eskalith, Lithane, Lithobid, Lithonate.

Indications

Contraindications

Caution:

pregnancy category = d

safety in lactation = -

Dosage

  • start 300 mg PO BID
  • average effective dose 900-1800 mg/day divided TID-QID
  • average maximum dose: 2.4 g/day divided TID-QID
  • children: 15-60 mg/kg/day divided TID-QID (do NOT exceed adult dosage)
  • take with meals to reduce GI upset

300 mg = 60 mg Li+, 8 meq or mmol

Tabs: 150, 300, 600 mg.

Slow-release: 300, 450 mg.

Syrup: 300 mg/5 mL.

Pharmacokinetics

elimination via kidney

1/2life = 15-30 hours

protein binding = <5 %

elimination by hemodialysis = -

elimination by hemoperfusion = -

elimination by peritoneal dialysis = -

Monitor

* Lithium toxicity is closely related to serum levels & can occur with therapeutic levels.[21]

* Serial serum lithium levels should be monitored during therapy

* During pregnancy, monitor monthly & weekly near delivery[8]

Therapeutic range:

Adverse effects

(may not be dose-related)

* women at greater risk of renal & thyroid disorders than men

* younger women at higher risk than older women

* adverse effects generally occur early in treatment[21]

Toxicity:

Drug interactions

* aspirin & sulindac OK

Laboratory

Mechanism of action

Comparative biology

More general terms

Additional terms

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996.
  2. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 134
  3. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  4. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 714-715
  5. 5.0 5.1 5.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 16. American College of Physicians, Philadelphia 1998, 2006, 2012
  6. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  7. Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995
  8. 8.0 8.1 8.2 Prescriber's Letter 7(11):65 2000
  9. 9.0 9.1 Principles of Ambulatory Medicine, 4th edition, Barker et al (eds), Williams & Wilkins, Baltimore, 1995, pg 104
  10. 10.0 10.1 Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 470
  11. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1039
  12. 12.0 12.1 Prescriber's Letter 10(12):70 2003 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=191211&pb=PRL (subscription needed) http://www.prescribersletter.com
  13. 13.0 13.1 deprecated reference
  14. 14.0 14.1 Kessing LV et al. Does lithium protect against dementia? Bipolar Disord 2010 Feb; 12:87. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20148870
  15. 15.0 15.1 15.2 McKnight RF et al Lithium toxicity profile: a systematic review and meta-analysis Lancet. 2012 Jan 19. [Epub ahead of print] <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22265699 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61516-X/abstract
    Malhi GS and Berk M Is the safety of lithium no longer in the balance? Lancet. 2012 Jan 19. [Epub ahead of print] <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22265701 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961703-0/fulltext
  16. 16.0 16.1 Grunfeld JP, Rossier BC. Lithium nephrotoxicity revisited. Nat Rev Nephrol. 2009 May;5(5):270-6 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19384328
  17. Bendz H, Schon S, Attman PO et al Renal failure occurs in chronic lithium treatment but is uncommon. Kidney Int. 2010 Feb;77(3):219-24. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19940841
  18. 18.0 18.1 Cipriani A et al Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. BMJ 2013;346:f3646 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23814104 <Internet> http://www.bmj.com/content/346/bmj.f3646
  19. 19.0 19.1 Deprecated Reference
  20. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  21. 21.0 21.1 21.2 21.3 21.4 Shine B, McKnight RF, Leaver L, Geddes JR Long-term effects of lithium on renal, thyroid, and parathyroid function: a retrospective analysis of laboratory data. Lancet. 2015 May 20. pii: S0140-6736(14)61842-0 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26003379
  22. Juurlink DN, Mamdani MM, Kopp A et al Drug-induced lithium toxicity in the elderly: a population- based study. J Am Geriatr Soc. 2004 May;52(5):794-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15086664
  23. 23.0 23.1 23.2 Geller B A Likely Cause of Lithium-Associated Parkinsonian Tremor. NEJM Journal Watch. July 25 2016 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
    Lei P et al. Lithium suppression of tau induces brain iron accumulation and neurodegeneration. Mol Psychiatry 2016 Jul 12; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27400857
  24. 24.0 24.1 Pawar AS, Kattah AG Lithium-Induced Nephropathy N Engl J Med 2018; 378:1042. March 15, 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29539276 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1709438
  25. 25.0 25.1 25.2 NEJM Knowledge+ Psychiatry

Database