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Mood Stabilizer

Lithium Carbonate | Eskalith

Clinical Overview

Lithium carbonate is the gold standard mood stabilizer for bipolar disorder, indicated for acute manic episodes and maintenance therapy to prevent mood episodes. It remains one of the most effective treatments for bipolar disorder with extensive evidence supporting its efficacy in reducing suicide risk.

Primary Clinical Applications

Lithium is first-line treatment for bipolar I disorder maintenance therapy and is effective for acute mania treatment. It has unique anti-suicidal properties and may be used augmentation in treatment-resistant depression. Long-term lithium therapy significantly reduces hospitalization rates and suicide risk in bipolar patients.

Mechanism and Therapeutic Monitoring

Lithium’s exact mechanism is complex, involving modulation of neurotransmitter systems and neuroprotective effects. Therapeutic drug monitoring is essential due to narrow therapeutic index, with target serum levels of 0.6-1.2 mEq/L for maintenance therapy.

Long-term Considerations

Lithium requires regular monitoring of serum levels, kidney function, and thyroid function. While highly effective, long-term use may affect renal and thyroid function, necessitating ongoing surveillance and patient education.

Prescribing Information

Dosing & Administration

Acute Mania:

  • Initial: 300 mg 3 times daily or 600 mg twice daily
  • Target level: 1.0-1.5 mEq/L
  • Adjust based on serum levels and clinical response

Maintenance Therapy:

  • Typical dose: 900-1200 mg daily in divided doses
  • Target level: 0.6-1.2 mEq/L
  • Extended release: May allow twice daily dosing

Elderly:

  • Initial: 150-300 mg daily
  • Target level: 0.6-0.8 mEq/L

Indications

  • Acute manic episodes of bipolar disorder
  • Maintenance treatment of bipolar I disorder
  • Off-label: Augmentation in treatment-resistant depression

Contraindications

  • Severe renal disease
  • Severe cardiovascular disease
  • Severe dehydration or sodium depletion
  • Hypersensitivity to lithium

Warnings & Precautions

  • Narrow therapeutic index: Regular serum level monitoring required
  • Lithium toxicity: Monitor for tremor, confusion, ataxia
  • Renal function: Monitor creatinine and BUN regularly
  • Thyroid function: Monitor TSH every 6-12 months
  • Dehydration and sodium depletion increase toxicity risk
  • Drug interactions affecting lithium clearance

Drug Interactions

  • ACE inhibitors/ARBs: Increase lithium levels
  • Thiazide diuretics: Increase lithium levels
  • NSAIDs: Increase lithium levels
  • Sodium-depleting drugs: Increase toxicity risk
  • Neuromuscular blocking agents: Prolonged paralysis

Adverse Reactions

Common:

  • Fine hand tremor, polyuria, polydipsia, weight gain

GI:

  • Nausea, diarrhea, abdominal pain

Long-term:

  • Hypothyroidism, nephrogenic diabetes insipidus, renal impairment

Toxicity Signs:

  • Coarse tremor, confusion, ataxia, seizures, coma

Special Populations

  • Pregnancy: Category D – risk of Ebstein’s anomaly, use only if essential
  • Renal Impairment: Dose reduction required, frequent monitoring
  • Elderly: Lower doses, more frequent monitoring
  • Monitoring: Serum levels, creatinine, TSH, CBC, urinalysis
Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. Always consult with qualified healthcare professionals before making any treatment decisions. Individual patient circumstances may vary significantly.