Lithium

Question 1

Drug Class

Answer 1

Antimanic agents

Question 2

Active

Answer 2

Lithium

Question 3

Indications

Answer 3

Prevention of manic or depressive episodes in bipolar disorder.

Treatment of acute mania

Schizoaffective disorder and chronic schizophrenia

Question 4

Dose Range

Answer 4

Initially 250 - 1000 mg daily in divided doses

up to 2.5g daily (same max as valproate)

Question 5

SE’s

Answer 5

• metallic taste
• acne
• hair loss
• weight gain
• psoriasis
• hypothyroidism
• diarrhoea
• nausea

Question 6

Counselling

Answer 6

Labels: B, 5, 13

• Take with food.
• Do not break, crush or chew controlled release lithium tablets, and avoid taking with hot drinks.
• Maintain a normal diet with regular salt and fluid intake.
• Drink more non-alcoholic fluid during hot weather to avoid toxicity.
• Be alert for signs of lithium toxicity (eg. extreme thirst and frequent urination, nausea and vomiting), especially during illness, excessive sweating or low fluid intake; if these occur, stop taking the tablets and seek medical attention immediately.
• Regular blood tests are important during treatment.
• Avoid sodium bicarbonate (found in products such as indigestion medicines and urinary alkalinisers, e.g. Ural®) as they make lithium less effective.

Question 7

Monitoring

Answer 7

• lithium concentration
• compliance
• Serum calcium concentration
• renal function and thyroid function (every 3-6 months)
• ECG (for patients with cardiac disease)