Lithium

Lithium usually given as carbonate or citrate, provides lithium ions which substitute for sodium in excitable tissues and reduce brain catecholamine levels. Lithium used in the prophylactic treatment of mania and depression it stabilizes the mood and reduces extremes in behavior. Caution in cardiac and renal disease. Needs careful control of plasma levels.

Brands
NEUROLITH NEUROLITH URODONAL NORMALITH SR LITH CAMCOLIT-400 PRIADEL LITHOTROPE CARLIT NEUROGLIT THICAR SR
Adult Dose
Dose: 1.5 to 2 mg
Single Dose: 1.8 (1.75)
Frequency: 24 hourly
Route: PO
Instructions: For first 5-7 days.
Neonatal
Paedriatic
Dose:
Single Dose:
Frequency:
Route:
Instructions: Not recommended in this age group
Characteristics
Lithium citrate, Lithium citrate are the derivatives of Lithium. It is of Natural origin and belongs to Alkaline Metal. It belongs to Psychotropic Drugs pharmacological group on the basis of mechanism of action. The Molecular Weight of Lithium is 73.90.
Contraindications
Lithium is contraindicated in conditions like Heart failure,Psoriasis,Salt depletion,Cardiovascular disease,Heart disease,Kidney infection,Electrolyte disturbance,Acneiform eruption,Hypothyroidism,Breast feeding.
Effects
The severe or irreversible adverse effects of Lithium, which give rise to further complications include Convulsions, Cardiac arrhythmias, Cardiac arrhythmias, Dehydration, Hypercalcemia, Sinus bradycardia, Hyperthyroidism, Leucocytosis, Dysarthria.Lithium produces potentially life-threatening effects which include Coma, Acute Renal Failure, Acute renal failure. which are responsible for the discontinuation of Lithium therapy.The signs and symptoms that are produced after the acute overdosage of Lithium include Bradycardia, Cardiac arrhythmias, Polyuria, Ataxia, Glycosuria, Tinnitus, Permanent disability, Abdominal discomfort.The symptomatic adverse reactions produced by Lithium are more or less tolerable and if they become severe, they can be treated symptomatically, these include Vertigo, Drowsiness, Ataxia, Anorexia, Diarrhea, Confusion, Weight gain, Polyuria, Muscle weakness, Tremor, Nausea and vomiting, ECG changes, Psoriasis, Vison disturbance, Xerostomia, Goiter, Acneform eruptions, Polydipsia, Confusion, Ataxia.
Indications
Lithium is primarily indicated in conditions like Bipolar disorders, Depression, Mania, Mood disorder prophylaxis, Psychosis, Schizo-affective psychosis prophylaxis, and can also be given in adjunctive therapy as an alternative drug of choice in Aggression, Chemotherapy induced neutropenia.
Interactions
Lithium is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAescinAlcoholCoadministration result in additive central nervous system and impairment, thinking and psychomotor skills.ModeratePatient should be warned of interaction and advised to limit alcohol cosumption.Amiloride (HCl)Renal clearance of lithium is reduced by amiloride due to oncrease in serum lithium levels which leads to lithium toxicity.MajorThis combination should be avoided or used with extreme caution include reduce dose of lithium.ithium levels should be monitor.AzapropazoneBaclofenEffects of muscle relaxants (e.g Baclofen) enhanced by Lithium; Baclofen possibly aggravates hyperkinesis caused by lithium. BendrofluazideBumetanideBupropion (HCl)CaptoprilCaptopril may increase the serum concentration of LithiumModerateDelayedMonitor for increased serum concentrations/toxic effects of lithium if Captopril is initiated/dose increased, or decreased effects if Captopril is discontinued/dose decreased. Lithium dosage reductions will likely be needed following the addition of Captopril.CarbamazepineNeurotoxicity,lethargy,muscular weakness,ataxia,dystonia,tremor and sinus node dysfunction may occur when Carbamazepine given with Lithium.ModerateAdverse neurologic and cardiac effects,lithium toxicity and altered thyroxine levels must be monitor.CelecoxibChlorocarbacholChlorothiazideChlorpromazine (HCl)Chlortetracycline (HCl)ChlorthalidoneCilazaprilClopamideClozapineBoth agents act as additive serotonergic result in the development of neurologic toxicity.ModerateClosely monitor for neurologic symptoms and check the level of blood glucose regularly.CyclopenthiazideDapoxetine HClmay lead to an incidence of serotonin associated effects. Dapoxetine should not be used in combination with other SSRIs, MAOIs or other serotonergic medicinal/herbal products Demeclocycline (HCl)Desipramine (HCl)Desmopressin (Acetate)Dexamphetamine (Sulphate)DexibuprofenNSAIDs can increase the plasma levels of lithium, by reducing its renal clearance. The combination is not recommended. Frequent lithium monitoring should be performed. The possibility of reducing the dose of lithium should be considered.DexketoprofenDiazepamWhen both drugs given in combination cause HypothermiaDiclofenac (Na)decrease in plasma concentration of diclofenac by sucralfateDiltiazem (HCl)Distigmine (Br)DoxacuriumLlithium potentiate the pharmacological effect of doxacurium.Prolong apnea and delayed recovery from anesthesia occurs when they administered in combination.ModerateClose monitoring for the development of respiratory depression.Doxepin (HCl)DroperidolEnalapril (Maleate)coadministration may increase lithium plasma level and lithium toxcity occurlithium levels should be monitoredEplerenoneCause lithium toxicity.MajorMonitor serum lithium levels frequently.Ethacrynic AcidFluoxetine (HCl)co administration may lead to lithium toxicity, symptomps include agitation, restlessness, GI distresslithium level should be monitoredFluphenazineFosinopril (Na)Frusemide or FurosemideFurosemide may decrease the excretion of Lithium. MinorNo action required.GallopamilHaloperidolBoth of them have been use together safely.Fewer patients may observe encephalopathic syndrome consisting of neurotoxic effect and extra pyramidal symptoms followed by irreversible brain damage.Moderate. Larger doses should be avoided. Mainly reduce the haloperidol dose.During the first week of treatment careful observation should be done and if any sign of encephalopathic syndrome occurs discontinued the treatment.Human InsulinHydrochlorothiazideVolume depletion by Hydrochlorothiazide increases lithium absorption and causes Lithium toxicityHydroflumethiazideImidaprilIndomethacinIndomethacin increases the serum concentration of lithium results in increased toxicity.ModerateClosely monitor the serum level of lithium.Insulin LisproIodideIodineKetoprofenKetorolac (Tromethamine)LisinoprilLornoxicamMight lead to an increase of the lithium peak concentration and thus to a possible increase in adverse events.Monitor lithium serum levels.Losartan (K)Losartan increases the plasma level of lithium by inhibiting secretion of aldosterone result in increased toxicity.ModerateClosely monitor the patient for lithium toxicity.LypressinMannitolMefrusideMethyclothiazideMethyldopaMetoclopramide (HCl)MetronidazoleLithium toxicity occurs when lithium is used with metronidazole.Minocycline (HCl)MoexiprilMolindoneThe risk of certain serious side effects is increased when taken with Molindone.NabumetoneNabumetone has produced an elevation of plasma lithium levels and a reduction in renal lithium clearance. NaproxenNeostigmineOxtriphylline (Choline Theophyllinate)OxyphenbutazoneThese drugs should not be taken concurrently with out doctor and pharmacist approval.Pancuronium (Br)ParoxetinePerindoprilPiretanidePiroxicam-beta-cyclodextrinPiroxicam decreases renal excretion of lithiumPolythiazidePotassium Iodide Pyridostigmine (Br)lithium interfere with neuromuscular conductionRamiprilRivastigmineRofecoxibRofecoxib have produced an elevation of plasma lithium levels and a reduction in renal lithium clearance resulting in lithium toxcity.Rubidium IodideSalsalateSalsalate may increase the blood levels of lithium by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity. SecnidazoleSibutramineSodium BicarbonateSodium IodideSpectinomycin (HCl)Suxamethonium (Cl)TelmisartanReversible increases in serum lithium concentrations and toxicity have been reported during concomitant administration of lithium with Telmisartan.TenoxicamLithium toxicity may result due to decreased elimination of lithium. TetrabenazineTetracycline (HCl)TheophyllineThioridazine (HCl)Coadministration may initiate the number of neurologic and psychiatric symptoms such as extrapyramidal effects, seizures, change in mental status, delirium, fever etcModerateClosely monitor the patient for changed efficacy and safety. Discontinue one or both agents if necessary.Tiaprofenic AcidLithium levels can be increased.Avoid concurrent use if possible or monitor lithium levels and adjust dose.Ticarcillin (di Na)Tienilic AcidTramadol (HCl)Tubocurarine (Cl) Lithium exacerbate the pharmacological effects of tubocurarineresults in prolonged apnea and delayed recovery from anesthesia.ModerateClosely monitor for respiratory depression and life support should be readily available in case of emergencyVasopressinVerapamil (HCl)Vortioxetineincreases the level of vortioxetinemonitor closely ,use alternative These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.
Interfrence
Risks
Drug should not be given to Pregnant Mothers, Cardiac / Hypertensive Patients, patients suffering from Kidney dysfunction, and Neonates.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.
Storage
Tab Store in a well closed container, Below 40°C.
Warnings
'It is important that the kidney, thyroid gland and heart function are checked regularly while taking this medicine. It is important to maintain a normal diet while taking lithium so that the level of salts in blood remains stable and patient don''t become dehydrated. Consult doctor if patient need to pass urine more often or experience excessive thirst while taking this medicine. This medicine is not recommended for use in children and adolescents. If the level of lithium in your blood gets too high it can cause some unpleasant side effects and can be potentially dangerous. This is often referred to as lithium toxicity, and patient should be aware of the warning signs of this. These include: loss of appetite, diarrhoea, vomiting, blurred vision, muscle weakness, lack of co-ordination, drowsiness, tremor, unsteadiness, muscle twitching, ringing in the ears, confusion, seizures and unconsciousness. If patient experience any of these symptoms he should consult doctor immediately so that lithium level can be checked.'
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