lithium citrate
Pregnancy Risk Category D
How supplied
lithium carbonate
Tablets: 250 mg‡, 300 mg (300 mg equals 8.12 mEq lithium)
Tablets (controlled-release): 300 mg, 400 mg‡, 450 mg
Capsules: 150 mg, 300 mg, 600 mg
lithium citrate
Syrup (sugarless): 8 mEq (lithium)/5 ml
Note: 5 ml of lithium citrate (liquid) contains 8 mEq lithium, equal to 300 mg lithium carbonate.
Action
Unknown. Probably alters chemical transmitters in the CNS, possibly by interfering with ionic pump mechanisms in brain cells, and may compete with or replace sodium ions.
Indications & dosage
Prevention or control of mania--
Adults: 300 to 600 mg P.O. up to q.i.d. or 900 mg P.O. q 12 hours of controlled-release tablets; increase based on blood levels to achieve optimal dosage. Recommended therapeutic lithium blood levels are 1.5 mEq/L for acute mania, 0.6 to
1.2 mEq/L for maintenance therapy, and
2 mEq/L as maximum level.
Adverse reactions
CNS: tremors, drowsiness, headache, confusion, restlessness, dizziness, psychomotor retardation, lethargy, coma, blackouts, epileptiform seizures, EEG changes, worsened organic mental syndrome, impaired speech, ataxia, muscle weakness, incoordination.
CV: reversible ECG changes, arrhythmias, hypotension, bradycardia, peripheral vascular collapse (rare).
EENT: tinnitus, blurred vision.
GI: dry mouth, metallic taste, nausea, vomiting, anorexia, diarrhea, thirst, abdominal pain, flatulence, indigestion.
GU: polyuria, glycosuria, decreased creatinine clearance, albuminuria; renal toxicity (with long-term use).
Hematologic: leukocytosis with leukocyte count of 14,000 to 18,000/mm3 (reversible); elevated neutrophil count.
Metabolic: transient hyperglycemia, goiter, hypothyroidism (lowered T3, T4, and protein-bound iodine, but elevated 131I uptake), hyponatremia.
Skin: pruritus, rash, diminished or absent sensation, drying and thinning of hair, psoriasis, acne, alopecia.
Other: ankle and wrist edema.
Interactions
Drug-drug. Aminophylline, sodium bicarbonate, urine alkalinizers: increased lithium excretion. Avoid excessive salt and monitor lithium levels.
Carbamazepine, fluoxetine, methyldopa, NSAIDs, probenecid: increased effect of lithium. Monitor for lithium toxicity.
Diuretics: increased reabsorption of lithium by kidneys, with possible toxic effect. Use with extreme caution and monitor lithium and electrolyte levels (especially sodium).
Neuroleptics: may cause encephalopathy. Watch for signs and symptoms (lethargy, tremor, extrapyramidal symptoms), and stop drug if encephalopathy occurs.
Neuromuscular blockers: may cause prolonged paralysis or weakness. Monitor patient closely.
Thyroid hormones: may induce hypothyroidism. Monitor thyroid function.
Drug-herb. Parsley: may promote or produce serotonin syndrome. Avoid concomitant use.
Plantains: psyllium seed has been known to inhibit GI absorption. Avoid concomitant use.
Effects on diagnostic tests
Lithium causes false-positive test results on thyroid function tests.
Contraindications
Contraindicated if therapy can't be closely monitored.
Nursing considerations
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING