Lithium Carbonate (7 brand names, 3 dosage forms, 1 route)
Available dosage forms: TABLET, EXTENDED RELEASE, CAPSULE, TABLET.
Routes of administration: ORAL.
Brand Names
- ESKALITH
- ESKALITH CR
- LITHANE
- LITHIUM CARBONATE
- LITHOBID
- LITHONATE
- LITHOTABS
Boxed Warning
Lithium toxicity is closely related to serum lithium concentrations, and can occur at doses close to therapeutic concentrations. Facilities for prompt and accurate serum lithium determinations should be available before initiating treatment [see Dosage and Administration ( 2.3), Warnings and Precautions ( 5.1)] .
Indications and Usage
Lithium is a mood-stabilizing agent indicated as monotherapy for the treatment of bipolar I disorder: Treatment of acute manic and mixed episodes in patients 7 years and older [see Clinical Studies ( 14 )] Maintenance treatment in patients 7 years and older [see Clinical Studies ( 14 )]
Contraindications
Lithium is contraindicated in patients with known hypersensitivity to any inactive ingredient in the lithium carbonate tablet or capsule or lithium citrate products [see Adverse Reactions ( 6)].
Adverse Reactions
The following adverse reactions are described in greater detail in other sections: Acute Lithium Toxicity [see Warnings and Precautions ( 5.1)] Lithium-Induced Polyuria [see Warnings and Precautions ( 5.2)] Hyponatremia [see Warnings and Precautions ( 5.3)] Lithium-Induced Chronic Kidney Disease [see Warnings and Precautions ( 5.4)] Encephalopathic Syndrome [see Warnings and Precautions ( 5.5)] Serotonin Syndrome [see Warnings and Precautions ( 5.6)] Hypothyroidism or Hyperthyroidism [see Warnings and Precautions ( 5.7)] Hypercalcemia and Hyperparathyroidism [see Warnings and Precautions ( 5.8)] Unmasking of Brugada Syndrome [see Warnings and Precautions ( 5.9)] Pseudotumor Cerebri [see Warnings and Precautions ( 5.10)]
Mechanism of Action
The mechanism of action of lithium as a mood stabilizing agent is unknown.
Overdosage
The toxic concentrations for lithium (≥ 1.5 mEq/L) are close to the therapeutic concentrations [see Warnings and Precautions ( 5.1)] . At lithium concentrations greater than 3 mEq/L, patients may progress to seizures, coma, and irreversible brain damage. Treatment: For current information on the management of poisoning or overdosage, contact the National Poison Control Center at 1-800-222-1222 or www.poison.org. No specific antidote for lithium poisoning is known. Mild symptoms of lithium toxicity can usually be treated by reduction in dose or cessation of the drug. In severe cases of lithium poisoning, the goal of treatment is elimination of this ion from the patient. Administration of gastric lavage should be performed, but use of activated charcoal is not recommended as it does not significantly absorb lithium ions. Hemodialysis is the treatment of choice as it is an effective and rapid means of removing lithium in patients with severe toxicity. As an alternative option, urea, mannitol and aminophylline can induce a significant increase in lithium excretion. Appropriate supportive care for the patient should be undertaken. Patients with impaired consciousness should have their airway protected and it is critical to correct any volume depletion or electrolyte imbalance. Patients should be monitored to prevent hypernatremia while receiving normal saline and careful regulation of kidney function is of utmost importance. Serum lithium concentrations should be closely monitored as there may be a rebound in serum lithium concentrations as a result of delayed diffusion from the body tissues. Likewise, during the late recovery phase, lithium should be re-administered with caution taking into account the possible release of significant lithium stores in body tissues.