Formulary
Lithium citrate: Indications, Dosing, Side Effects and Interactions
Lithium citrate clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Lithium citrate: Indications, Dosing, Side Effects and Interactions
Lithium citrate 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 0.52-1.56 g daily in 1-2 divided doses, dose adjusted according to serum-lithium concentration.
- **Elderly** (By Mouth): Initially 260-645 mg daily in 1-2 divided doses, 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 Li-Liquid**
- **Child 12-17 years** (By mouth): Initially 509 mg daily in 1-2 divided doses, 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 Priadel liquid**
- **Child 12-17 years** (By mouth): Initially 520 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 citrate Frequency not known Thirst
Interactions
**Severe interactions:**
- Co-administration of lithium with neuroleptics increases the risk of Neuroleptic Malignant Syndrome (NMS), which may be fatal.
**Other interactions (18):**
- If one of the following drugs is initiated, lithium dosage should either be adjusted or concomitant treatment stopped, as appropriate.
- Interactions which increase lithium concentrations Metronidazole may reduce lithium renal clearance.
- Note that thiazides show a paradoxical antidiuretic effect resulting in possible water retention and lithium intoxication.
- If a thiazide diuretic has to be prescribed for a lithium-treated patient, lithium dosage should first be reduced and the patient re-stabilised with frequent monitoring.
- Loop diuretics seem less likely to increase lithium levels.
- Interactions which decrease serum lithium concentrations Serum lithium levels may be decreased due to an increase in lithium renal clearance in case of concomitant administration of one of the...
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
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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