Lithium Carbonate

Registered South African indications:

• Bipolar affective disorder

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Renal disease
• Cardiac disease
• Addison’s disease
• Renal or cardiac failure
• Evidence of brain damage or a low sodium intake
• Pregnancy
• Breastfeeding
• Congenital long QT syndrome
• Concomitant medicines known to prolong QT interval

Cautions

• Elderly 
• Fluid/electrolyte imbalance
• Seizure disorders
• Infectious diseases
• QT prolongation or risk factors thereof
• Family history of cardiac arrest or sudden death
• Depression
• Suicidal ideation
• Thyroid disease

Forms avail. in SA and covered in this monograph: tab

Acute episodes of mania and hypomania
Prophylaxis of recurrent bipolar affective disorder

• Oral (tab): 500-1800mg/day, in 2 divided doses; Adjust dose according to serum levels and clinical response

Serum concentrations should be determined once or twice a week during the acute phase, then monthly for the 1st 3 months and every 6 months once levels have stabilised

Desired serum lithium concentration for acute episodes of mania and hypomania: 0.8-1.0mmol/L

Desired serum lithium concentration for prophylaxis of recurrent bipolar affective disorder: 0.4-0.8mmol/L

Refractory Depression

• Oral (tab): Initial: 300mg, 12-24hrly; Adjust dose according to serum levels and clinical response; Maintenance: 600-1200mg/day, in divided doses

Desired serum lithium concentration for refractory depression: 0.6-1mmol/l

A double dose to make up for a dose that has been missed should not be taken

Take with food to reduce gastrointestinal side-effects

Tablets should not be chewed or crushed

Gradual withdrawal of lithium over a period of at least 2 weeks is recommended, unless drug needs to be withdrawn due to toxicity in which case it should be withdrawn immediately

Not established for use in children

Pregnancy

• Contraindicated

Breastfeeding

• Contraindicated

Fertility

• Studies in animals have shown adverse effects on male fertility

Renal Impairment

• Contraindicated

Hepatic Impairment

• No dose adjustment recommended

Elderly

• Caution; dose adjustment recommended
• Initial: 200-400mg, dly; Titrate by 200-400mg at intervals of  3-5 days as needed

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

•  Permitted - No warnings

Central Nervous System Disorders

• Delirium
• Ataxia
• Hyperactive deep tendon reflexes
• Slurred speech
• Dizziness
• Coma
• Myasthenia gravis
• Giddiness
• Memory impairment
• Tremor
• Dysarthria
• Myoclonus
• Benign intracranial hypertension 
• Vertigo
• Seizures
• Extrapyramidal disorders
• Encephalopathy
• Cerebellar syndrome
• Nystagmus
• Peripheral neuropathy

Cardiovascular Disorders

• Cardiac arrhythmia
• Bradycardia
• Sinus node dysfunction 
• Peripheral circulatory collapse
• Hypotension
• ECG changes 
• Atrioventricular block
• Cardiomyopathy
• Peripheral edema

 Gastrointestinal Disorders

• Abdominal discomfort
• Nausea and vomiting
• Diarrhoea
• Gastritis
• Salivary hypersecretion
• Dry mouth 
• Anorexia

Genitourinary Disorders

• Polydipsia 
• Polyuria 
• Nephrogenic diabetes insipidus
• Histological renal changes with interstitial fibrosis 
• Impaired renal function
• Nephrotic syndrome 
• Microcysts
• Oncocytoma 
• Collecting duct renal carcinoma
• Sexual dysfunction

Endocrine and Metabolic Disorders

• Thyroid function disturbances 
• Hypercalcaemia
• Hypermagnesaemia
• Hyperparathyroidism 
• Increased weight 
• Hyperglycaemia

Musculoskeletal Disorders

• Muscle weakness
• Rhabdomyolysis

Skin and Subcutaneous Tissue Disorders

• Folliculitis
• Pruritus
• Papular skin disorders
• Acne or acneform eruptions
• Aggravation or occurrence of psoriasis
• Allergic rashes
• Alopecia
• Cutaneous ulcers
• Urticaria

Immune, Blood and Lymphatic System Disorders

• Leucocytosis
• Angioedema

Sensory Disorders

• Dysgeusia
• Blurred vision
• Scotomata
• Taste disorder

• Metronidazole 
• Non-steroidal anti-inflammatory drugs
• Angiotensin-converting enzyme inhibitors
• Angiotensin II antagonists
• Diuretics 
• Corticosteroids
• Tetracyclines
• Xanthines 
• Sodium bicarbonate containing products
• Urea
• Calcitonin
• Antipsychotics 
• Methyldopa
• Triptan derivatives
• Serotonergic agents
• Calcium channel blockers 
• Carbamazepine 
• QT prolonging agents
• Agents that decrease the seizure threshold 
• Neuromuscular blocking agents
• Phenytoin
• Indomethacin 
• Prostaglandin synthetase inhibitors

• Serum lithium levels (see additional prescribing points)
• Renal function
• Cardiac function
• Thyroid function
• Serum electrolytes

Drug levels

• Blood samples for serum lithium concentrations should be drawn 12 hours after the last dose, immediately prior to next dose

Patients should be advised to report signs and symptoms of lithium toxicity, hypothyroidism, renal dysfunction (including polyuria and polydipsia), and benign intracranial hypertension (a persistent headache and visual disturbance).

• Maintain adequate fluid intake and avoid dietary changes which reduce or increase sodium intake

Serum lithium levels

• Serum-lithium therapeutic concentrations ranges can be different from one laboratory to another (always confirm therapeutic ranges per laboratory service provider)
• Routine serum-lithium monitoring should be performed weekly after initiation and after each dose change until concentrations are stable, then every 3 months thereafter

Lithium is an alkali metal. The exact mechanism of action is not known. It modifies the production and turnover of certain neurotransmitters, particularly serotonin, and it may also block dopamine receptors.  

Tablet 250mg

• Camcolit (Pharmacare) originator

Tablet 400mg

• Camcolit (Pharmacare) originator

Tablet 450mg

• Quilonum (GSK) originator