Lithium is a foundational mood-stabilizing agent primarily indicated for the management of bipolar disorder. Its therapeutic use is well-established in psychiatric medicine, offering significant control over manic episodes and reducing the risk of suicide. Proper administration requires careful medical supervision due to its narrow therapeutic index. This product card provides a comprehensive overview for healthcare professionals to ensure safe and effective patient use.

Features

• Active ingredient: Lithium carbonate or lithium citrate
• Available in immediate-release and extended-release tablet formulations, as well as oral solution
• Standard strengths: 150 mg, 300 mg, 450 mg lithium carbonate equivalents
• Requires precise dosing based on serum lithium levels
• Not metabolized; excreted unchanged by the kidneys
• Known for its long-term prophylactic efficacy in bipolar disorder

Benefits

• Effectively reduces the severity and frequency of manic episodes in bipolar I disorder
• Demonstrates significant anti-suicidal properties, lowering mortality risk
• Provides long-term mood stabilization and relapse prevention
• Augments the effects of antidepressants in treatment-resistant unipolar depression
• May improve impulsive aggression in certain personality disorders
• Offers a cost-effective treatment option with decades of clinical validation

Common use

Lithium is primarily prescribed for the treatment and maintenance therapy of bipolar disorder, particularly for managing acute mania and preventing recurrent manic and depressive episodes. It is also used as an adjunctive treatment for major depressive disorder when there is inadequate response to antidepressants alone. Off-label applications may include schizoaffective disorder and cluster headache prophylaxis. Its use is always predicated on confirmed diagnosis and ongoing therapeutic monitoring.

Dosage and direction

Dosage must be individualized based on patient response, tolerance, and serum lithium concentrations. The typical starting dose for adults is 300 mg two to three times daily, with gradual titration to achieve a target serum level of 0.6–1.2 mEq/L for acute mania and 0.6–0.8 mEq/L for maintenance therapy. Serum levels should be checked 5–7 days after initiation or dose adjustment, then regularly every 2–3 months once stable. Administration with meals can minimize gastrointestinal upset. Extended-release formulations should be swallowed whole and not crushed.

Precautions

Regular monitoring of renal function, thyroid function, and electrolytes is essential due to lithium’s potential effects on these systems. Patients should maintain adequate and consistent fluid intake (2–3 L daily) and sodium intake to avoid dehydration or toxicity. Caution is advised in elderly patients, those with renal impairment, and individuals with cardiovascular disease. Lithium may cause drowsiness; patients should avoid driving or operating machinery until they know how the medication affects them. Pregnancy and breastfeeding require careful risk-benefit assessment.

Contraindications

Lithium is contraindicated in patients with severe renal impairment, significant cardiovascular disease, severe debilitation or dehydration, sodium depletion, and in those with known hypersensitivity to lithium or formulation ingredients. It should not be used during pregnancy unless clearly necessary and under strict specialist supervision, due to potential fetal risks, including cardiac anomalies.

Possible side effect

Common side effects include fine hand tremor, polyuria, polydipsia, and mild gastrointestinal discomfort (nausea, diarrhea). Weight gain and acne or psoriasis exacerbation may occur. Long-term use can lead to nephrogenic diabetes insipidus, hypothyroidism, or benign leukocytosis. Rare but serious adverse effects include lithium toxicity (see Overdose), renal impairment, and cardiac arrhythmias. Any signs of confusion, coordination difficulties, or severe tremor warrant immediate medical evaluation.

Drug interaction

Lithium interacts significantly with several medication classes. Diuretics (especially thiazides), NSAIDs, ACE inhibitors, and ARBs can increase lithium levels and risk of toxicity. Concomitant use with antipsychotics may increase the risk of extrapyramidal symptoms or neurotoxicity. Drugs that promote sodium loss (e.g., methylxanthines, carbonic anhydrase inhibitors) may also elevate lithium concentrations. Always review the full medication list, including over-the-counter products, before prescribing or adjusting lithium therapy.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling doses to make up for a missed one is not recommended, as it may increase the risk of toxicity. Patients should be educated on the importance of consistent dosing and advised to contact their healthcare provider if multiple doses are missed.

Overdose

Lithium overdose is a medical emergency, with symptoms including severe diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination, giddiness, tinnitus, and blurred vision. Severe toxicity can lead to seizures, coma, permanent neurological damage, or death. Serum lithium levels above 1.5 mEq/L indicate toxicity, and levels above 2.5 mEq/L are life-threatening. Treatment involves discontinuation of lithium, aggressive hydration with saline infusion, and supportive care. Hemodialysis may be necessary in severe cases.

Storage

Store at controlled room temperature (20–25°C or 68–77°F), in a tightly closed container, away from light, moisture, and heat. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Oral solutions should not be frozen and must be used within a specified period after opening—consult the product leaflet for details.

Disclaimer

This information is intended for educational purposes and professional reference only. It is not a substitute for clinical judgment, individualized patient assessment, or formal medical advice. Prescribing and monitoring lithium therapy must be conducted by a qualified healthcare provider familiar with the patient’s full medical history, current medications, and therapeutic goals. Always refer to the latest official prescribing information and clinical guidelines.

Reviews

“Lithium remains the gold standard for bipolar disorder prophylaxis. Its anti-suicidal effect is unparalleled among mood stabilizers.” – Dr. Elena Rostova, Psychopharmacologist
“While monitoring is intensive, the long-term benefits for appropriate patients justify the required vigilance.” – Clinical Psychiatry Today
“Decades of use confirm its efficacy, though it demands respect for its narrow therapeutic window.” – Journal of Affective Disorders
“Patients who respond well to lithium often achieve stability that other agents cannot provide.” – Bipolar Treatment Network
“A cornerstone of psychiatric therapy, but not without its management challenges.” – Modern Psychiatrist Monthly