Generic Lithium

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Lithium is a mood stabilizer used to treat manic episodes in bipolar disorder and to reduce the frequency of future relapses in people with a history of mania. It is one of the oldest and most studied psychiatric medications, and it remains the gold standard for long-term mood stabilization in bipolar illness. The medication works by calming overactive signalling in the brain, though the exact mechanism is still not fully understood.
The usual starting dose for an acute manic episode is 900 mg to 1,800 mg daily, divided into three doses. Once the acute episode is controlled, the daily dose is often reduced to 500 mg to 1,200 mg, sometimes taken as a single dose. The dose is always guided by regular blood tests, because lithium has a narrow therapeutic window.
The administration form is capsules containing 300 mg of lithium carbonate. A 150 mg and 600 mg capsule are also available, along with a sustained-release 300 mg tablet.
Lithium does not work overnight. It takes about one to three weeks before it has a noticeable effect on manic symptoms. For maintenance, the benefit builds over months of steady use.
Alcohol should be avoided during treatment. Drinking can cause dehydration, which raises lithium levels and increases the risk of toxicity. It also adds to the drowsiness and dizziness that lithium can cause.
The most common side effects are fine hand tremor, increased thirst, frequent urination, and mild nausea.
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Common Use Lithium

Lithium is a mood stabilizer with a unique place in psychiatry. It is approved in Canada for the treatment of manic episodes of manic-depressive illness, and for maintenance therapy to prevent or reduce the frequency of future relapses in patients with a history of mania. At the cellular level, lithium affects several signalling pathways. It inhibits glycogen synthase kinase-3 (GSK-3), an enzyme involved in mood regulation and neuroprotection. It also depletes inositol, which dampens overactive signalling in neurons. These actions are thought to stabilize the electrical and chemical activity in the brain that goes out of balance during manic and depressive episodes. Lithium is not a sedative and it does not work by simply slowing you down. It helps regulate the swings themselves.

Basic Lithium Information

• INN (International Nonproprietary Name): Lithium carbonate
• Brand names available in Canada: Carbolith® (Bausch Health); generic lithium carbonate is sold under names including Apo-Lithium Carbonate, pms-Lithium Carbonate, Lithmax, and DOM-Lithium Carbonate. Duralith, a sustained-release tablet, has been discontinued.
• ATC Code: N05AN01
• Forms and dosages: Capsules – 150 mg, 300 mg, and 600 mg. A sustained-release tablet was previously available in 300 mg.
• Manufacturers in Canada: Bausch Health, Canada Inc. (Carbolith), Apotex Inc. (Apo-Lithium Carbonate), Pharmascience Inc. (pms-Lithium Carbonate), AA Pharma Inc. (Lithmax), and Dominion Pharmacal (DOM-Lithium Carbonate).
• Registration status in Canada: Approved by Health Canada. Carbolith 300 mg is listed under DIN 00236683. Apo-Lithium Carbonate 300 mg is listed under DIN 02216140, and pms-Lithium Carbonate 300 mg under DIN 02216140. Lithmax 300 mg is listed under DIN 02266695.
• OTC / Rx classification: Prescription only (Rx) – not legally sold over-the-counter in Canadian pharmacies

Dosage & Direction

Lithium dosing is always individualized. The dose is not fixed; it is adjusted until your blood level falls within a target range. For an acute manic episode, the usual starting dose is 900 mg to 1,800 mg daily, divided into three equal doses. Your doctor will check your serum lithium level about five days after starting, drawn 12 hours after your last dose. The therapeutic range for adults is generally 0.6 to 1.2 mmol/L, though the exact target depends on your age and the indication. For maintenance, the level is often kept between 0.6 and 0.8 mmol/L. Once your dose is stable, you may be able to take the whole daily dose at bedtime instead of three times a day. Take lithium with food to reduce stomach upset. Swallow the capsules whole with water. Do not crush or chew them. Drink plenty of fluids throughout the day, especially in hot weather or during exercise. A sudden drop in salt intake, heavy sweating, vomiting, or diarrhea can all raise lithium levels and push you toward toxicity. If any of these happen, contact your doctor. Do not stop lithium suddenly. Stopping abruptly can trigger a relapse of mania or depression. If you need to stop, your doctor will taper the dose slowly.

Precautions

Lithium has a narrow therapeutic index. That means the difference between a helpful dose and a toxic dose is small. Regular blood tests are not optional; they are essential. Your doctor will check your serum lithium level, kidney function, thyroid function, and electrolyte levels before you start and at regular intervals during treatment. Even at therapeutic levels, some people develop toxicity if they become dehydrated or lose too much sodium. Early signs of toxicity include coarse hand tremor, vomiting, diarrhea, drowsiness, and unsteadiness. If you notice these, stop the medication and contact your doctor right away. Lithium can affect the kidneys over time. It can cause a condition called nephrogenic diabetes insipidus, which makes you urinate large volumes and feel constantly thirsty. It can also reduce kidney function with long-term use. Lithium can cause hypothyroidism by interfering with thyroid hormone production. Your doctor will monitor your thyroid function and may prescribe thyroid hormone replacement if needed. Lithium can raise calcium levels and affect the parathyroid glands. It can also cause weight gain and mild swelling in the ankles and hands. Tell your doctor if you have heart disease, kidney disease, thyroid disease, or a history of seizures. Lithium can cause a rare but serious skin reaction called DRESS syndrome, which involves a rash, fever, swollen lymph nodes, and organ inflammation. If you develop a rash with fever, stop the medication and seek medical attention. Lithium is not recommended during pregnancy unless the benefit clearly outweighs the risk. It crosses the placenta and has been associated with an increased risk of congenital heart defects, especially when taken in the first trimester. If you are pregnant or planning pregnancy, talk to your doctor before making any changes. Lithium passes into breast milk. Breastfeeding is not recommended during treatment because of the risk of toxicity in the infant. Women who could become pregnant should use effective contraception. Older adults are more sensitive to lithium's effects and usually need lower doses.

Contraindications

Do not take lithium if you have had an allergic reaction to lithium carbonate or any of the inactive ingredients in the capsule. Lithium is contraindicated in patients with severe kidney disease, because the drug is cleared by the kidneys and impaired function leads to toxic accumulation. It should not be used in patients with severe heart disease, especially those with sick sinus syndrome or recent myocardial infarction, because lithium can affect cardiac conduction. Lithium is contraindicated in patients with severe dehydration or sodium depletion, as these conditions dramatically increase the risk of toxicity. It should not be used during pregnancy unless the potential benefit clearly outweighs the risk to the fetus. Lithium is contraindicated during breastfeeding, because it passes into breast milk and can cause toxicity in the infant. Do not take lithium if you have untreated hypothyroidism or hyperthyroidism. It should not be used in patients with a history of severe neurological disorders, including epilepsy, without careful evaluation. Lithium is not approved for use in children under 12 years of age, because safety and efficacy have not been established.

Possible Side Effects

More than 1 in 10 people experience a fine tremor of the hands, increased thirst, and frequent urination. These effects are often the first sign that lithium is working, but they can also be a sign that the level is creeping too high. Mild nausea, diarrhea, and abdominal discomfort are also common, especially at the start of treatment. Taking the capsules with food can help. Weight gain and mild swelling of the hands and feet are possible. Some people notice a metallic taste, dry mouth, or mild fatigue. These effects often settle as your body adjusts. Serious side effects require immediate medical attention. Coarse hand tremor, vomiting, diarrhea, drowsiness, and unsteadiness are early signs of lithium toxicity and mean you should stop the medication and call your doctor. Severe toxicity can cause confusion, slurred speech, blurred vision, muscle twitching, seizures, and coma. Lithium can cause hypothyroidism, with symptoms like fatigue, weight gain, cold intolerance, and dry skin. Kidney problems, including nephrogenic diabetes insipidus, cause excessive urination and thirst. Rarely, lithium can cause a serious skin reaction with rash, fever, and swollen lymph nodes. If you notice any of these, contact your doctor right away. Lithium can also affect the heart and cause changes in the electrocardiogram.

Drug Interaction

Lithium interacts with a long list of medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, naproxen, and prescription NSAIDs, reduce blood flow to the kidneys and decrease lithium clearance. This can raise lithium levels into the toxic range. If you need an NSAID, your doctor may need to check your lithium level more often and adjust your dose. Thiazide diuretics, such as hydrochlorothiazide, and loop diuretics, such as furosemide, reduce lithium excretion and can cause toxicity. Potassium-sparing diuretics may have a similar effect. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), used for high blood pressure and heart failure, can also raise lithium levels. If any of these are essential, your doctor will monitor your lithium level closely. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, paroxetine, and sertraline, can increase the risk of serotonin syndrome when combined with lithium. Metronidazole and tetracycline antibiotics have been reported to raise lithium levels to toxic values. Topiramate can increase lithium exposure at higher doses and has been associated with toxicity. Sodium-containing medications, including some antacids, can lower lithium levels by increasing its elimination. Caffeine can affect lithium levels, and stopping caffeine suddenly may cause levels to rise. Tell your doctor and pharmacist about every medication you take, including over-the-counter products, vitamins, and herbal supplements.

Missed Dose

If you miss a dose of lithium, take it as soon as you remember. If it is almost time for your next dose, skip the missed one and continue with your regular schedule. Do not take two doses at once to make up for a missed one. If you miss several doses in a row, contact your doctor before restarting. Missing doses can cause your mood to destabilize, and restarting at the full dose after a gap can push your lithium level too high. Consistency matters more than catching up.

Overdose

Lithium overdose is a medical emergency. Symptoms depend on the level and how quickly it rose. Early signs include nausea, vomiting, diarrhea, coarse tremor, and unsteadiness. As toxicity progresses, you may develop confusion, slurred speech, blurred vision, muscle twitching, and seizures. Severe overdose can lead to coma and irreversible brain damage. There is no specific antidote. Treatment is supportive and focuses on removing lithium from the body. If the overdose was recent, a doctor may perform gastric lavage or give activated charcoal. Intravenous fluids with sodium are used to help the kidneys excrete lithium. Hemodialysis is the treatment of choice for severe lithium intoxication, especially when neurological symptoms are present or when kidney function is impaired. Contact a poison control centre or go to an emergency department immediately if you suspect an overdose. Do not wait for symptoms to appear.

Storage

Store lithium capsules at room temperature between 15 and 30 degrees Celsius (59 and 86 degrees Fahrenheit). Keep the container tightly closed and protect it from light and moisture. Do not store the capsules in the bathroom or near a sink. Keep out of reach of children and pets. Do not use after the expiry date on the label. Dispose of unused medication according to local guidelines. Do not flush lithium down the toilet or pour it down the sink.

Disclaimer

We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information at the site cannot be used for self-treatment and self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care adviser or doctor in charge of the case. We disclaim reliability of this information and mistakes it could contain. We are not responsible for any direct, indirect, special or other indirect damage as a result of any use of the information on this site and also for consequences of self-treatment.

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