Formulary
Lithium carbonate: Indications, Dosing, Side Effects and Interactions
Lithium carbonate clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Lithium carbonate: Indications, Dosing, Side Effects and Interactions
Lithium carbonate clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Treatment and prophylaxis of mania (initiated by a specialist),Treatment and prophylaxis of bipolar disorder (initiated by a specialist),Treatment and prophylaxis of recurrent major depressive disorder [unipolar depression] (initiated by a specialist),Treatment and prophylaxis of aggressive or self-harming behaviour (initiated by a specialist)**
- **Adult** (By Mouth): Initially 200-600 mg once daily, to be taken at night, dose adjusted according to serum-lithium concentration.
- **Elderly** (By Mouth): Initially 100-250 mg once daily, to be taken at night, dose adjusted according to serum-lithium concentration.
**Treatment and prophylaxis of mania (initiated by a specialist), Treatment and prophylaxis of bipolar disorder (initiated by a specialist), Treatment and prophylaxis of recurrent major depressive disorder [unipolar depression] (initiated by a specialist), Treatment and prophylaxis of aggressive or self-harming behaviour (initiated by a specialist) for lithium carbonate**
- **Child 12-17 years** (By mouth): Initially 200-250 mg daily in 1-2 divided doses, dose adjusted according to serum-lithium concentration.
Cautions
For all lithium salts Avoid abrupt withdrawal; cardiac disease; concurrent ECT (may lower seizure threshold); diuretic treatment (risk of toxicity); elderly (reduce dose); epilepsy (may lower seizure threshold); myasthenia gravis; psoriasis (risk of exacerbation); QT interval prolongation; review dose as necessary in diarrhoea; review dose as necessary in intercurrent infection (especially if sweating profusely); review dose as necessary in vomiting; surgery
Contraindications
For all lithium salts Addison's disease; cardiac disease associated with rhythm disorder; cardiac insufficiency; dehydration; family history of Brugada syndrome; low sodium diets; personal history of Brugada syndrome; untreated hypothyroidism
Side effects
For all lithium salts Common or very common Electrolyte imbalance Rare or very rare Nephrotic syndrome Frequency not known Abdominal discomfort; alopecia; angioedema; appetite decreased; arrhythmias; atrioventricular block; cardiomyopathy; cerebellar syndrome; circulatory collapse; coma; confusion; consciousness impaired; delirium; diarrhoea; dizziness; drug reaction with eosinophilia and systemic symptoms (DRESS); dry mouth; encephalopathy; feeling dazed; folliculitis; gastritis; goitre; hyperglycaemia; hyperparathyroidism; hypersalivation; hypotension; hypothyroidism; idiopathic intracranial hypertension; leucocytosis; memory impairment; movement disorders; muscle weakness; myasthenia gravis; nausea; neoplasms; nephrogenic diabetes insipidus; neuroleptic malignant syndrome (discontinue-potentially fatal); nystagmus; parathyroid hyperplasia; peripheral neuropathy; peripheral oedema; polydipsia; polyuria; QT interval prolongation; reflexes abnormal; renal disorders; renal impairment; rhabdomyolysis; seizure; serotonin syndrome; sexual dysfunction; skin reactions; skin ulcer; speech impairment; taste altered; thyrotoxicosis; tremor; vertigo; vision disorders; vomiting; weight increased Side-effects, further information Overdose Signs of intoxication require withdrawal of treatment and include increasing gastro-intestinal disturbances (vomiting, diarrhoea), visual disturbances, polyuria, muscle weakness, fine tremor increasing to coarse tremor, CNS disturbances (confusion and drowsiness increasing to lack of coordination, restlessness, stupor); abnormal reflexes, myoclonus, incontinence, hypernatraemia. With severe overdosage seizures, cardiac arrhythmias (including sino-atrial block, bradycardia and first-degree heart block), blood pressure changes, circulatory failure, renal failure, coma and sudden death reported. For details on the management of poisoning, see Lithium, under Emergency treatment of poisoning . Side-effects For lithium carbonate Frequency not known Cardiac arrest; hyperthyroidism; parkinsonism
Interactions
**Other interactions (21):**
- Interactions may occur as a result of increased or decreased lithium levels, or may act through other mechanisms, the most important being neurotoxicity which may occur at therapeutic levels when...
- Interactions which increase lithium concentrations Co-administration of the following drugs with lithium may lead to increased lithium concentrations and a risk of toxicity: Any drug which may...
- If the use of the drug is unavoidable, carefully monitor lithium blood level and adapt dosage as necessary.
- Toxic symptoms may also occur at low or normal levels when used in conjunction with co-trimoxazole or trimethoprim.
- Lithium toxicity has been reported on isolated occasions in patients receiving spectinomycin.
- In addition to the effects noted above, thiazide diuretics show a paradoxical antidiuretic effect resulting in possible water retention and lithium intoxication.
Pregnancy
For all lithium salts Avoid if possible, particularly in the first trimester (risk of teratogenicity, including cardiac abnormalities). Close monitoring of serum-lithium concentration advised in pregnancy (risk of toxicity in neonate). Dose requirements increased during the second and third trimesters (but on delivery return abruptly to normal).
Breast feeding
For all lithium salts Present in milk and risk of toxicity in infant-avoid.
Renal impairment
For all lithium salts See Prescribing in renal impairment . Caution in mild to moderate impairment; avoid in severe impairment. M
Medicinal forms
Suspension,Tablet,Tablet
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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