Lithium Fact Sheet

Medication Name (brand):

Lithium

Medication Name (clinical):

lithium

Manufacturer:

Various, depending on formulation; most are available as generics.

Indications:

Acute Mania
Prevention of Depression and Mania in Bipolar Disorder
Off-label use for augmentation of antidepressants

Mechanism:

Unclear; may work by affecting G-proteins and 2nd messengers.

Dosing:

Most clinicians dose lithium at bedtime, whether using the immediate release or slow release versions.
Start at 300-600 mg QHS, gradually increasing to a target blood lithium level of 0.8 meq/L, which will often be in the 900-1200 mg QHS range.
With Eskalith CR, start with 450 mg QHS, and increase gradually from there.
When converting from IR lithium to Eskalith CR or Lithobid, prescribe as close to the identical dose as possible (only a potential problem with Eskalith CR).
No dosing adjustment required in liver disease; if you dare to use it in a patient with chronic renal impairment, decrease the dose substantially, using the patient’s GFR as your guide.

Side Effects:

Nausea/diarrhea (strategies: split dosing, take with meals, switch to Li Citrate or slow release formulations).
Fine tremor (treat with Inderal LA 60 mg QAM or regular Inderal 20 mg BID-TID).
Polyuria/excessive thirst (dose at night, try low dose hydrochlorthiazide).
Memory problems (minimize dose, try cholinesterase inhibitors).
Weight gain.
Renal impairment (usual problem is benign, reversible decrease in concentrating ability; true kidney damage is very rare, but check yearly BUN/Cr just in case).
Cardiac (rare sinus node dysfunction causing bradycardia; baseline EKG only required in patients with documented cardiac disease).

Drug-drug Interactions:

Mnemonic for drugs that increase Li levels: “No ACE in the Hole” (NSAIDS, Ace Inhibitors, and Hydrochlorothiazide); excess sweating can increase levels.
Caffeine may decrease levels.

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