Lithium

Administration

• Type: Antimanic agent
• Dosage Forms:
• Routes of Administration: oral
• Common Trade Names:

Adult Dosing

• Maintenance: 300mg PO 3 to 4 times daily; desired serum lithium level 0.6 to 1.2 mEq/L
• Acute manic episode: 600mg PO 3 times daily; desired serum lithium level 1 to 1.5 mEq/L

Pediatric Dosing

Safety/efficacy not established in children <12yo

Special Populations

• Pregnancy Rating: D
• Lactation risk: infant risk cannot be ruled out

Renal Dosing

• Adult: Contraindicated if renal function unstable

Hepatic Dosing

• Adult: Not established

Contraindications

• Allergy to class/drug
• Unstable renal function
• Severe dehydration
• Sodium depletion
• Severe debilitation
• Concurrent diuretics
• Severe cardiovascular disease
• 1st trimester pregnancy

Adverse Reactions

Serious

• Toxicity (see Lithium toxicity)
• Seizure, ataxia, raised ICP
• Angioedema
• Erythema multiforme

Common

• Hypothyroidism, weight gain
• Nephrotoxicity
• Fine tremor, hyperreflexia
• Leukocytosis
• Nausea, gastritis
• Acne

Pharmacology

• Half-life: 14-50hr
• Metabolism: Renal
• Excretion: Renal

Mechanism of Action

• Exact mechanism unclear; inhibits postsynaptic D2 receptor supersensitivity, alters cation transport in nerve cells, influences serotonin/norepinephrine reuptake, inhibits phosphatidylinositol cycle second messenger systems

Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

Indication	Dose	Context	Route	Population
Thyroid storm	300 mg PO q8h	Block hormone release (if iodine allergic)	PO	Adult

See Also

• Lithium toxicity