Litiam ER

Indications

Lithium Carbonate is a mood stabiliser used to treat and prevent episodes of mania and depression in bipolar disorder. It is also used to prevent recurrent depression, sometimes added to an antidepressant when depression has not responded well, and to reduce aggressive or self-harming behaviour in some people, as decided by a psychiatrist.

How It Works

The exact way lithium works is not fully known. It affects several chemical signalling pathways inside nerve cells, including those using inositol and an enzyme called GSK-3, and it alters the balance of messengers such as serotonin and noradrenaline. Over weeks this steadies mood and reduces the frequency and severity of manic and depressive episodes. It also appears to lower the risk of suicide.

Dosage and Administration

Lithium is taken by mouth exactly as prescribed. The dose is started low and adjusted by the doctor according to regular blood tests of lithium level, usually taken 12 hours after the last dose. Different brands and forms (standard or slow-release) release lithium differently, so do not switch brands without your doctor. Take at the same time each day with water, and keep salt and fluid intake steady. Do not stop suddenly unless told to.

Interactions

• Diuretics (especially thiazides such as Hydrochlorothiazide), ACE inhibitors (such as Enalapril), angiotensin receptor blockers (such as Losartan) and NSAIDs (such as Ibuprofen, Diclofenac) can raise lithium levels to toxic amounts.
• Metronidazole and some other antibiotics may raise levels.
• Theophylline, caffeine and sodium-containing antacids can lower levels.
• SSRIs, Tramadol and Triptans can cause serotonin syndrome; antipsychotics such as Haloperidol may increase nerve side effects.

Contraindications

• Allergy to lithium.
• Severe kidney disease.
• Untreated underactive thyroid (hypothyroidism).
• Significant heart disease or heart rhythm disorders, Brugada syndrome.
• Addison's disease or conditions with low sodium, severe dehydration.

Side Effects

Common: fine hand tremor, thirst, passing more urine, mild nausea, loose stools, weight gain and a metallic taste, especially early in treatment. Long-term use can cause underactive thyroid, raised calcium and reduced kidney function, so blood tests are done regularly.

Get urgent medical help for signs of lithium toxicity: severe or coarse shaking, vomiting, diarrhoea, unsteady walking, slurred speech, muscle twitching, drowsiness or confusion, blurred vision, fits, or fainting and irregular heartbeat. Also seek help for severe dehydration from vomiting, diarrhoea, fever or heavy sweating.

Pregnancy and Lactation

Lithium can affect the baby's heart development, especially in early pregnancy, and doses need careful adjustment later in pregnancy and after delivery. Plan pregnancy with your psychiatrist; do not stop suddenly. Lithium passes into breast milk and can affect the baby, so breastfeeding is usually not advised, or only with close monitoring.

Precautions and Warnings

• Regular blood tests for lithium level, kidney and thyroid function and calcium are essential.
• Avoid dehydration: drink enough fluids in hot weather, during exercise or illness, and avoid sudden changes in salt intake.
• Tell every doctor and pharmacist you take lithium before starting new medicines, including pain relievers.
• It may impair driving at first; use care.

Overdose

Lithium has a narrow safe range. Overdose causes vomiting, diarrhoea, tremor, confusion, seizures, irregular heartbeat, kidney failure and coma. Seek emergency medical help at once; hospital treatment may include fluids and dialysis.

Therapeutic Class

Mood stabiliser (antimanic agent).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.