Lithium Oral Solution Rx
Generic Name and Formulations:
Lithium ion 8mEq/5mL (equivalent to 300mg lithium carbonate); contains alcohol.
Various generic manufacturers
Indications for Lithium Oral Solution:
Monotherapy for bipolar I disorder.
Adults and Children:
<7yrs: not established. Individualize. ≥7yrs (>30kg): Initially 300mg 3 times daily; titrate by 300mg every 3 days. Usual acute goal: 600mg 2–3 times daily. Usual maintenance goal: 300–600mg 2–3 times daily. (20–30kg): Initially 300mg twice daily; titrate by 300mg weekly. Usual acute goal: usually 600–1500mg in divided doses daily. Usual maintenance goal: 600–1200mg in divided doses daily. Mild–to–moderate renal impairment: use lower initial dose; titrate slowly and monitor.
Risk of lithium toxicity. Cardiovascular disease, sodium depletion, severely debilitated or dehydrated (use lower initial doses, monitor serum lithium levels daily, hospitalize). Maintain adequate fluid and salt intake, esp. with sweating, diarrhea, infection, or fever. Monitor serum lithium levels frequently (toxic and therapeutic levels are close); draw blood for serum tests 12hrs after previous dose. Monitor serum electrolytes, thyroid, renal function. Discontinue if diarrhea, vomiting, tremor, ataxia, drowsiness or weakness occur. Avoid in Brugada Syndrome. Severe renal impairment: not recommended. Elderly. Neonates. Pregnancy: monitor and adjust dose. Nursing mothers: not recommended.
Lithium toxicity potentiated by diuretics, ACE inhibitors, angiotensin II receptor blockers, indomethacin, ibuprofen, naproxen (possibly other NSAIDs, including COX-2 inhibitors), metronidazole, calcium channel blockers: monitor and adjust lithium dose, if needed. Discontinue if signs of neurologic toxicity occur with antipsychotics (eg, haloperidol, risperidone, thioridazine). Xanthines, acetazolamide, urea, alkalinizing agents may reduce serum lithium levels. May potentiate adverse reactions of methyldopa, phenytoin, carbamazepine. Prolongs effects of neuromuscular blockers (eg, succinylcholine, pancuronium). Hypothyroidism with chronic iodide administration. Serotonin syndrome with concomitant SSRIs, SNRIs, MAOIs; discontinue if occurs.
Fine hand tremor, polyuria, thirst/polydipsia, nausea, vomiting, general discomfort, thyroid abnormalities, dizziness, rash/dermatitis, ataxia/gait disturbance, decreased appetite, blurry vision; extrapyramidal symptoms, renal toxicity, seizures, lethargy, metallic taste, dry mouth, pseudotumor cerebri (discontinue if occurs).