Lithium (Oral Route)

Drug Information provided by: Micromedex

ARTICLE SECTIONS

US Brand Names

Eskalith
Eskalith-CR
Lithobid

Description

Lithium is used to treat the manic stage of bipolar disorder (manic-depressive illness). Manic-depressive patients experience severe mood changes, ranging from an excited or manic state (for example, unusual anger or irritability or a false sense of well-being) to depression or sadness. Lithium is used to reduce the frequency and severity of manic states. Lithium may also reduce the frequency and severity of depression in bipolar disorder.

It is not known how lithium works to stabilize a person's mood. However, it does act on the central nervous system. It helps you to have more control over your emotions and helps you cope better with the problems of living.

It is important that you and your family understand all the effects of lithium. These effects depend on your individual condition and response and the amount of lithium you use. You also must know when to contact your doctor if there are problems with the medicine's use. Lithium may also be used for other conditions as determined by your doctor.

This medicine is available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, lithium is used in certain patients with the following medical conditions:

Cluster headaches
Mental depression
Neutropenia (a blood condition in which there is a decreased number of a certain type of white blood cells)

This product is available in the following dosage forms:

Solution
Syrup
Capsule
Tablet, Extended Release
Tablet

Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Lithium may cause weakened bones in children during treatment.

Geriatric

Unusual thirst, an increase in amount of urine, diarrhea, drowsiness, loss of appetite, muscle weakness, trembling, slurred speech, nausea or vomiting, goiter, or symptoms of underactive thyroid are especially likely to occur in elderly patients, who are often more sensitive than younger adults to the effects of lithium.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	D	Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acetophenazine
Azosemide
Bemetizide
Bendroflumethiazide
Benzthiazide
Bromperidol
Bumetanide
Buthiazide
Candesartan Cilexetil
Canrenoate
Chlorothiazide
Chlorpromazine
Chlorprothixene
Chlorthalidone
Clozapine
Cyclothiazide
Domperidone
Droperidol
Duloxetine
Ethacrynic Acid
Ethopropazine
Flupenthixol
Fluphenazine
Furosemide
Haloperidol
Hydrochlorothiazide
Hydroflumethiazide
Indapamide
Linezolid
Losartan
Loxapine
Melperone
Mesoridazine
Methotrimeprazine
Methyclothiazide
Metolazone
Molindone
Olanzapine
Penfluridol
Periciazine
Perphenazine
Phenelzine
Pimozide
Pipamperone
Pipotiazine
Piretanide
Polythiazide
Prochlorperazine
Promazine
Promethazine
Quinethazone
Remoxipride
Risperidone
Sertindole
Sibutramine
Spironolactone
Sulpiride
Thiopropazate
Thioproperazine
Thioridazine
Thiothixene
Tiapride
Torsemide
Trichlormethiazide
Trifluoperazine
Triflupromazine
Trimeprazine
Valsartan
Xipamide
Zotepine
Zuclopenthixol

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

Brain disease or
Schizophrenia—You may be especially sensitive to lithium, and mental effects (such as increased confusion) may occur

Diabetes mellitus (sugar diabetes)—Lithium may increase the blood levels of insulin; the dose of insulin you need to take may change

Difficult urination or
Infection (severe, occurring with fever, prolonged sweating, diarrhea, or vomiting) or
Kidney disease—Higher blood levels of lithium may occur, increasing the chance of serious side effects

Epilepsy or
Goiter or other thyroid disease, or
Heart disease or
Parkinson's disease or
Psoriasis—Lithium may make the condition worse

Leukemia (history of)—Lithium may cause the leukemia to occur again

Proper Use

Make certain your health care professional knows if you are on a low-sodium or low-salt diet. Too little salt in your diet could lead to serious side effects.

Take this medicine after a meal or snack. Doing so will reduce stomach upset, tremors, or weakness and may also prevent a laxative effect.

For patients taking the long-acting or slow-release form of lithium:

Swallow the tablet or capsule whole.
Do not break, crush, or chew before swallowing.

For patients taking the syrup form of lithium:

Dilute the syrup in fruit juice or another flavored beverage before taking.

During treatment with lithium, drink 2 or 3 quarts of water or other fluids each day, and use a normal amount of salt in your food, unless otherwise directed by your doctor.

Take this medicine exactly as directed. Do not take more or less of it, do not take it more or less often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of unwanted effects.

Sometimes lithium must be taken for 1 to several weeks before you begin to feel better.

In order for lithium to work properly, it must be taken every day in regularly spaced doses as ordered by your doctor. This is necessary to keep a constant amount of lithium in your blood. To help keep the amount constant, do not miss any doses and do not stop taking the medicine even if you feel better.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For short-acting oral dosage forms (capsules, tablets, syrup):
- Adults and adolescents: To start, 300 to 600 milligrams three times a day.
- Children up to 12 years of age: The dose is based on body weight. To start, the usual dose is 15 to 20 milligrams per kilogram of body weight (6.8 to 9 milligrams per pound) a day, given in smaller doses two or three times during the day.
For long-acting oral dosage forms (slow-release capsules, extended-release tablets):
- Adults and adolescents: 300 to 600 milligrams three times a day, or 450 to 900 milligrams two times a day.
- Children up to 12 years of age: Dose must be determined by the doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions

Your doctor should check your progress at regular visits to make sure that the medicine is working properly and that possible side effects are avoided. Laboratory tests may be necessary.

Lithium may not work properly if you drink large amounts of caffeine-containing coffee, tea, or colas.

This medicine may cause some people to become dizzy, drowsy, or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert.

Use extra care in hot weather and during activities that cause you to sweat heavily, such as hot baths, saunas, or exercising . The loss of too much water and salt from your body could lead to serious side effects from this medicine.

If you have an infection or illness that causes heavy sweating, vomiting, or diarrhea, check with your doctor. The loss of too much water and salt from your body could lead to serious side effects from lithium.

Do not go on a diet to lose weight and do not make a major change in your diet without first checking with your doctor. Improper dieting could cause the loss of too much water and salt from your body and could lead to serious side effects from this medicine.

For patients taking the slow-release capsules or the extended-release tablets:

Do not use this medicine interchangeably with other lithium products.

It is important that you and your family know the early symptoms of lithium overdose or toxicity and when to call the doctor.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Early symptoms of overdose or toxicity

Diarrhea
Drowsiness
Lack of coordination
Loss of appetite
Muscle weakness
Nausea or vomiting
Slurred speech
Trembling

Late symptoms of overdose or toxicity

Blurred vision
Clumsiness or unsteadiness
Confusion
Convulsions (seizures)
Dizziness
Increase in amount of urine
Ringing in the ears
Trembling (severe)

Check with your doctor as soon as possible if any of the following side effects occur:

Less common

Confusion, poor memory or lack of awareness
Fainting
Fast or slow heartbeat
Frequent urination
Irregular pulse
Increased thirst
Stiffness of arms or legs
Troubled breathing (especially during hard work or exercise)
Slurred speech
Unusual tiredness or weakness
Weight gain

Rare

Blue color and pain in fingers and toes
Coldness of arms and legs
Dizziness
Eye pain
Headache
Noises in the ears
Vision problems

Signs of low thyroid function

Dry, rough skin
Hair loss
Hoarseness
Mental depression
Sensitivity to cold
Swelling of feet or lower legs
Swelling of neck
Unusual excitement

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Increased frequency of urination or loss of bladder control—more common in women than in men, usually beginning 2 to 7 years after start of treatment
Increased thirst
Nausea (mild)
Trembling of hands (slight)

Less common