Known brand names include No current brand name for immediate-release lithium carbonate; marketed as generic capsules and tablets. Lithobid is the extended-release brand, which is not covered here..
A mood stabilizer taken by mouth for bipolar I disorder, both to treat manic or mixed episodes and to prevent new ones. It has a narrow margin between helpful and toxic levels, so blood levels are checked regularly.
Narrow therapeutic index. The label sets a target serum lithium range of 0.8 to 1.2 mEq/L and warns that toxic levels (1.5 mEq/L and up) sit close to it.
Lithium toxicity. Toxicity tracks closely with serum levels and can occur at doses near the therapeutic range. Do not start treatment unless prompt, accurate serum lithium testing is available.
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No specific antidote. Mild toxicity: lower or stop the dose. Severe toxicity: hemodialysis is the treatment of choice; activated charcoal does not bind lithium. Protect the airway, correct volume and electrolyte problems, and recheck levels because they can rebound as lithium leaves the tissues. Levels above 3 mEq/L can lead to seizures, coma, and brain damage.
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Doses come from the FDA label. Study tool, not for clinical decisions.
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Creatinine clearance 30 to 89 mL/min: start below usual doses and titrate slowly with frequent level checks. Below 30 mL/min: not recommended, especially if a low-sodium diet is needed.
No specific adjustment. Lithium is not metabolized and is cleared by the kidneys.
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How lithium stabilizes mood is unknown. It is fully absorbed, not metabolized, and not protein bound. The kidneys filter it, and 80% is reabsorbed in the proximal tubule along with sodium, so sodium and fluid status strongly affect its level. Half-life is about 18 to 36 hours.