Lithium

A to Z Drug Facts

Lithium

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(LITH-ee-uhm)

Eskalith, Eskalith CR, Lithobid, Lithonate, Lithotabs, Carbolith, Duralith, PMS-Lithium Carbonate, PMS-Lithium Citrate

Class: Antipsychotic/antimanic

Action Specific mechanism unknown; alters sodium transport in nerve and muscle cells and effects shift toward intraneuronal metabolism of catecholamines.

Indications Management of bipolar disorder and manic episodes of manic-depressive illness. Unlabeled use(s): Treatment of neutropenia; unipolar depression; schizoaffective disorder; prophylaxis of cluster headaches; premenstrual tension; tardive dyskinesia; hyperthyroidism; syndrome of inappropriate secretion of antidiuretic hormone, postpartum affective psychosis; corticosteroid-induced psychosis.

Contraindications History of leukemia.

Route/Dosage

ADULTS: PO 900 to 1800 mg/day in 2 to 4 divided doses. Give regular capsules tid or qid; slow-release tablets bid or tid. Maximum dose: 2400 mg/day. CHILDREN ³ 12 YR: 15 to 20 mg/kg/day in 2 to 3 divided doses.

Interactions

Acetazolamide, osmotic diuretics, theophyllines, urinary alkalinizers: Increased renal excretion of lithium. ACE inhibitors, fluoxetine, loop diuretics, NSAIDs, thiazide diuretics: Increased lithium serum levels. Carbamazepine, haloperidol, methyldopa: Increased neurotoxic effects despite therapeutic serum levels and normal dosage range. Iodide salts: Increased risk of hypothyroidism. Neuromuscular blocking agents, tricyclic antidepressants: Increased pharmacological effects of additive drug. Phenothiazines: Neurotoxicity; decreased phenothiazine concentrations or increased lithium concentrations may occur. Verapamil: Reductions in lithium levels and lithium toxicity have occurred.

Lab Test Interferences None well documented.

Adverse Reactions

CV: Arrhythmias; hypotension; bradycardia; peripheral circulatory collapse. CNS: Tremor; muscle hyperirritability; headache; fatigue; ataxia; dizziness; pychomotor retardation; confusion; dystonia; hallucinations; blackouts; seizures; pseudotumor cerebri; drowsiness; poor memory and intellectual function; muscular weakness; slurred speech. DERM: Drying or thinning hair; dry skin; pruritis; exacerbation of psoriasis; acne. EENT: Blurred vision; tinnitus. GI: Anorexia; nausea; vomiting; diarrhea; sialorrhea; dry mouth; parotitis. GU: Urinary urgency; stress incontinence; polyuria; albuminuria; sexual dysfunction; symptoms of nephrogenic diabetes; decreased creatinine clearance. HEMA: Leukocytosis; leukemia. META: Hypothyroidism; hypercalcemia; hyperparathyroidism; hyponatremia; dehydration; weight gain. OTHER: Taste distortion; thirst; fever; swollen joints.

Precautions

Pregnancy: Category D. Lactation: Excreted in breast milk. Children: Safety and efficacy not established in children < 12 yr. Encephalopathic syndrome: Has occurred in patients also taking neuroleptic, and may cause irreversible brain damage. Characterized by weakness, lethargy, fever, tremors, confusion, extrapyramidal symptoms, leukocytosis, and elevated serum enzymes, BUN and fasting blood sugar. Hypothyroidism: Has occurred with chronic use. Thyroid hormone replacement therapy may be required. Infections: Reduction in dose or discontinuation may be required if patient has infection with fever, especially if accompanied by protracted sweating, vomiting or diarrhea. Renal function: Chronic use may lead to nephrogenic diabetes insipidus. Patients, including elderly, who have reduced renal function, should take lower doses. Sodium/volume depletion: Because drug decreases renal sodium absorption, patients must maintain adequate salt and fluid intake. Tartrazine sensitivity: Some products contain tartrazine, which may cause allergic-type reactions in susceptible individuals. Toxicity: Toxicity can occur even at therapeutic doses. Toxicity risk is greater in patients with renal or cardiovascular disease, debilitation, dehydration or sodium depletion.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Administer with meals to minimize GI upset.
Do not crush, chew or break extended release capsules or coated tablets.
Observe carefully during administration to make such patient swallows medication.
Store at room temperature. Protect capsules from moisture.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies.
Ensure that baseline renal and thyroid function studies and ECG have been obtained before beginning therapy.
Assess mood and behavior before beginning medication and frequently, thereafter. Note particularly: flight of ideas, elation, grandiosity, aggressiveness and hyperactivity.
Assess for lithium toxicity: Persistent nausea/vomiting, diarrhea, ataxia, blurred vision, tinnitus.
Periodically assess thyroid and renal function.
Ensure that weekly lithium blood levels are obtained until therapeutic level has been reached; monthly levels should be obtained thereafter.
Monitor lithium level frequently while titrating, then periodically once dose is stable. Therapeutic doses are 1 to 1.5 mEq/L during acute manic attacks and 0.6 to 1.2 mEq/L for maintenance. Lithium serum testing should be performed as close as possible to 12 hr after last dose. Withhold dose and consult physician if blood level is > 1.5 mEq/L.
Record I&O and weight daily. Report sudden changes to physician.
Provide diet matching patient's normal sodium intake. Do not dramatically alter sodium intake from patient's usual amount.
Encourage intake of 2500 to 3000 mL of fluids daily.
If signs of neurological toxicity occur, withhold drug and notify physician.

OVERDOSAGE: SIGNS & SYMPTOMS
	ECG changes, slurred speech, seizures, acute renal failure, coma, diarrhea, vomiting, drowsiness, muscle weakness, ataxia

Patient/Family Education

Explain that therapeutic improvement will be noted in 1 to 3 wk.
Instruct patient to take medication regularly even if feeling well. Symptoms may return if medication is discontinued.
Advise patient not to decrease or increase dietary sodium intake.
Tell patient to drink 8 to 10 glasses of water or other caffeine-free liquids daily.
Caution patient to avoid excessive caffeine intake, as caffeine may increase urinary excretion of drug.
Advise patient that thirst, frequent polyuria, taste distortion and fine hand tremors are common side effects.
Instruct patient to report the following symptoms to physician immediately: Nausea, vomiting, diarrhea, muscular weakness, ataxia, blurred vision or tinnitus.
Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
Emphasize need for serum lithium level monitoring every 1 or 2 mo or as advised by physician.
Encourage patient to wear a Medi-Alert tag at all times stating medication name and dosage.