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.
Labeled use. Bipolar I: acute manic or mixed episodes and maintenance, as monotherapy, from age 7.
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Lithium is a first-line mood stabilizer for bipolar I disorder, especially classic euphoric mania and maintenance, and it lowers suicide risk. Valproate or an atypical antipsychotic may be preferred for mixed states or rapid cycling, or when renal disease, poor adherence to level checks, or pregnancy make lithium hard to use safely.
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.
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.
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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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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May cause fetal harm. First-trimester use has been linked to cardiac malformations such as Ebstein's anomaly, though the added risk is likely small; consider fetal echocardiography at 16 to 20 weeks. Clearance rises in pregnancy, so monitor levels; cut or stop the dose 2 to 3 days before delivery. Exposed newborns can show floppy baby syndrome.
Not recommended. Lithium enters breast milk, and breastfed infants can reach 30 to 40% of maternal plasma levels, with reported toxicity. If the mother breastfeeds anyway, monitor the infant closely, consider checking infant lithium and thyroid levels, and stop breastfeeding if toxicity appears.
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Approved from age 7. Children over 30 kg use adult dosing. Children 20 to 30 kg: start 300 mg twice daily and increase by 300 mg weekly; usual dose 600 to 1500 mg/day for mania and 600 to 1200 mg/day for maintenance, in divided doses. Not established below age 7.