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Indication & Dosage |
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| Oral |
| BIPOLAR MANIA, ACUTE MANIA AND MIXED EPISODES |
| Adult:
Acute episode: Serum concentrations of 1-1.2 mEq/l. Max dose: 1.5 mEq/l. Initially, 1.8 g lithium carbonate daily as conventional capsules/tablets in 3-4 divided doses, or 30 ml (approx 48 mEq) lithium citrate oral solution daily in 3-4 divided doses. Alternatively, initially 1.8 g lithium carbonate daily as extended-release tablets in 2-3 divided doses. Maintenance: 900 mg to 1.2 g lithium carbonate daily as conventional tablets/capsules in 3-4 divided doses, or 15-20 ml lithium citrate oral solution (approx 24-32 mEq) daily in 3-4 divided doses. Alternatively, 900 mg to 1.2 g lithium carbonate daily as extended-release tablets in 2-3 divided doses. Maintain steady-state concentrations at 0.6-1.2 mEq/l using the min effective dose and while avoiding adverse effects. Max maintenance dose: 2.4 g lithium carbonate (65 mEq) daily. |
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| Oral |
| BIPOLAR MANIA, ACUTE MANIA AND MIXED EPISODES |
| Child:
≥12 yr: Acute phase: Serum concentrations of 1-1.2 mEq/l. Max dose: 1.5 mEq/l. Initially, 1.8 g lithium carbonate daily as conventional capsules/tablets in 3-4 divided doses, or 30 ml (approx 48 mEq) lithium citrate oral solution daily in 3-4 divided doses. Alternatively, initially 1.8 g lithium carbonate daily as extended-release tablets in 2-3 divided doses. Maintenance: Not established.
Elderly: ≤900 mg lithium carbonate daily. Titrate dose slowly to achieve therapeutic serum concentrations. Maintenance: Maintain serum concentrations at the lower end of 0.6-1.2 mEq/l. |
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| Oral |
| BIPOLAR DISORDER |
| Adult:
Acute episode: Serum concentrations of 1-1.2 mEq/l. Max dose: 1.5 mEq/l. Initially, 1.8 g lithium carbonate daily as conventional capsules/tablets in 3-4 divided doses, or 30 ml (approx 48 mEq) lithium citrate oral solution daily in 3-4 divided doses. Alternatively, initially 1.8 g lithium carbonate daily as extended-release tablets in 2-3 divided doses. Maintenance: 900 mg to 1.2 g lithium carbonate daily as conventional tablets/capsules in 3-4 divided doses, or 15-20 ml lithium citrate oral solution (approx 24-32 mEq) daily in 3-4 divided doses. Alternatively, 900 mg to 1.2 g lithium carbonate daily as extended-release tablets in 2-3 divided doses. Maintain steady-state concentrations at 0.6-1.2 mEq/l using the min effective dose and while avoiding adverse effects. Max maintenance dose: 2.4 g lithium carbonate (65 mEq) daily.
Child: ≥12 yr: Acute phase: Serum concentrations of 1-1.2 mEq/l. Max dose: 1.5 mEq/l. Initially, 1.8 g lithium carbonate daily as conventional capsules/tablets in 3-4 divided doses, or 30 ml (approx 48 mEq) lithium citrate oral solution daily in 3-4 divided doses. Alternatively, initially 1.8 g lithium carbonate daily as extended-release tablets in 2-3 divided doses. Maintenance: Not established.
Elderly: ≤900 mg lithium carbonate daily. Titrate dose slowly to achieve therapeutic serum concentrations. Maintenance: Maintain serum concentrations at the lower end of 0.6-1.2 mEq/l. |
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| Oral |
| PROPHYLAXIS AND TREATMENT OF UNIPOLAR DEPRESSION |
| Adult:
Acute episode: Serum concentrations of 1-1.2 mEq/l. Max dose: 1.5 mEq/l. Initially, 1.8 g lithium carbonate daily as conventional capsules/tablets in 3-4 divided doses, or 30 ml (approx 48 mEq) lithium citrate oral solution daily in 3-4 divided doses. Alternatively, initially 1.8 g lithium carbonate daily as extended-release tablets in 2-3 divided doses. Maintenance: 900 mg to 1.2 g lithium carbonate daily as conventional tablets/capsules in 3-4 divided doses, or 15-20 ml lithium citrate oral solution (approx 24-32 mEq) daily in 3-4 divided doses. Alternatively, 900 mg to 1.2 g lithium carbonate daily as extended-release tablets in 2-3 divided doses. Maintain steady-state concentrations at 0.6-1.2 mEq/l using the min effective dose and while avoiding adverse effects. Max maintenance dose: 2.4 g lithium carbonate (65 mEq) daily.
Child: ≥12 yr: Acute phase: Serum concentrations of 1-1.2 mEq/l. Max dose: 1.5 mEq/l. Initially, 1.8 g lithium carbonate daily as conventional capsules/tablets in 3-4 divided doses, or 30 ml (approx 48 mEq) lithium citrate oral solution daily in 3-4 divided doses. Alternatively, initially 1.8 g lithium carbonate daily as extended-release tablets in 2-3 divided doses. Maintenance: Not established.
Elderly: ≤900 mg lithium carbonate daily. Titrate dose slowly to achieve therapeutic serum concentrations. Maintenance: Maintain serum concentrations at the lower end of 0.6-1.2 mEq/l. |
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| Administration |
Should be taken with food. |
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| Precautions |
Monitor serum lithium levels (twice wkly or more frequently in acute phase; at least every 2 mth during maintenance). Thyroid disorders, mild to moderate renal or cardiac impairment. Marked fluid loss (protracted sweating, diarrhoea or prolonged fever). Maintain normal fluid and salt intake. Elderly. Monitor changes in renal function. Patients with suicidal tendency. May impair ability to drive or operate machinery. Children <12 yr. Pregnancy and lactation. |
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Potentially Life-threatening
Adverse Drug Reactions |
Exacerbation of psoriasis, acne, rash; nausea, diarrhoea, vertigo, muscle weakness, dazed feeling; loss of concentration; tremors; hypothyroidism; wt gain, oedema; cardiac arrhythmias; exophthalmos; restlessness; electrolyte disturbances. |
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| Adverse Drug Reactions |
Severe neurotoxicity, leucopenia. |
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| Interactions |
Reduced serum levels with carbonic anhydrase inhibitors, chlorpromazine, sodium-containing preparations, theophylline, urea. Enhanced hypothyroid effects with iodine salts. Enhanced effects of neuromuscular-blocking agents. Reduced pressor response to sympathomimetics. |
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