BMA Concise Guide to Medicine & Drugs

Lithium

Brand names Camcolit, Li-liquid, Liskonum, Priadel

Used in the following combined preparations None

QUICK REFERENCE

Drug group Antimanic drug

Overdose danger rating High

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Lithium, the lightest known metal, has been used since the 1940s to treat manic depression (bipolar affective disorder). Lithium decreases the intensity and frequency of the swings from extreme excitement to deep depression that characterize the disorder.

It is sometimes used along with an antidepressant for depression that has not responded to an antidepressant alone. Lithium is also sometimes used for aggressive or self-harming behaviour. Careful monitoring with blood tests is required because high levels of lithium can cause serious adverse effects. Any apparent benefit may take two to three weeks; an antipsychotic drug is often given with lithium until it becomes effective. Lithium cards, with details of side effects, are available from pharmacies.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, SR tablets, liquid.

Frequency and timing of doses 1–2 x daily with meals. Always take the same brand of lithium to ensure a consistent effect; change of brand must be closely supervised.

Adult dosage range 0.3–1.6g daily. Dosage may vary according to individual response and blood levels.

Onset of effect Effects may be noticed in 3–5 days, but the full preventative effect may take 6–12 months.

Duration of action 18–36 hours. Some effects may last for several days.

Diet advice Lithium levels in the blood are affected by the amount of salt in the body, so do not suddenly alter the amount of salt in your diet. Be sure to drink plenty of fluids, especially in hot weather.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due within 4 hours, take a single dose now and skip the next.

Stopping the drug Do not stop the drug without consulting your doctor; symptoms may recur.

OVERDOSE ACTION

Seek immediate medical advice in all cases. Take emergency action if seizures or loss of consciousness occur.

POSSIBLE ADVERSE EFFECTS

Many adverse effects are signs of a high level of lithium in the blood. They include increased urine productiion, thirst, nausea, vomiting, diarrhoea, tremor, weight gain, drowsiness, lethargy, blurred vision, unsteadiness, and slurred speech. You should seek prompt medical advice if you notice any of these symptoms. If drowsiness, lethargy, blurred vison, unsteadiness, or slurred speech occur, you should also stop taking the drug.

INTERACTIONS

General note Many drugs interact with lithium. Do not take any over-the-counter or prescription drugs without consulting your doctor or pharmacist. Paracetamol should be used in preference to other analgesics for everyday pain relief.

Diuretics, aspirin, and NSAIDs can increase lithium to a dangerous level. Blood levels of lithium should be monitored closely.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have long-term liver or kidney problems.

· You have heart or circulation problems.

· You have an overactive thyroid gland.

· You have Addison’s disease.

· You are taking other medicines.

Pregnancy Not usually prescribed. May cause defects in the unborn baby. Discuss with your doctor.

Breast-feeding The drug passes into the breast milk and may affect the baby. Discuss with your doctor.

Infants and children Not recommended.

Over 60 Increased likelihood of adverse effects. Reduced dose may therefore be necessary.

Driving and hazardous work Avoid such activities until you have learned how lithium affects you because the drug can cause reduced alertness.

Alcohol Avoid. Alcohol may increase the sedative effects of this drug.

PROLONGED USE

Prolonged lithium use may lead to kidney and thyroid problems. Treatment for periods of longer than 5 years is not normally advised unless the benefits are significant and tests show no sign of reduced kidney function. When the decision is taken to stop lithium, it should be reduced gradually over a few weeks.

Monitoring Once stabilized, lithium levels should be checked every 3 months. Thyroid function should be checked every 6–12 months. Kidney function should also be monitored regularly.