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Back to Psychiatry Drug Index
Name: Lithium carbonate
Pregnancy Category D
Drug classes
Mechanism of actions
Mechanism of action is not known; alters sodium transport in nerve and
muscle cells; inhibits release of norepinephrine and dopamine, but not
serotonin, from stimulated neurons; slightly increases intraneuronal
stores of catecholamines; decreases intraneuronal content of second
messengers and may thereby selectively modulate the responsiveness of
hyperactive neurons that might contribute to the manic state.
Indications
The main indication is treatment of bipolar disorder. Other
indications includes augmenting antidepressants, treatment of
aggression, PTSD and conduction defects in children.
Contraindications/cautions
Contraindicated in the presence of hypersensitivity to tartrazine (in
tablets marketed as Lithane); significant renal or cardiovascular
disease; severe debilitation, dehydration; sodium depletion, patients
on
diuretics (lithium decreases sodium reabsorption, and hyponatremia
increases lithium retention); pregnancy; lactation.
Use caution in the presence of protracted sweating and diarrhea;
suicidal
or impulsive patients; infection with fever.
Adverse effects Reactions are related to serum lithium levels (toxic lithium levels
are
close to therapeutic levels:
- Therapeutic levels in acute mania range
between 1 and 1.5 mEq/L;
- Therapeutic levels for maintenance are 0.6 to
1.2 mEq/L).
- 2.5 mEq/L (life-threatening toxicity)
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General: Complex involvement of multiple organ systems
- Reactions unrelated to serum levels
- CNS: Headache, worsening of organic brain syndromes, fever, reversible
short-term memory impairment, dyspraxia
- Neuromuscular: peripheral neuropathy, myopathy
- GI: Dysgeusia/taste distortion, salty taste; swollen lips; dental
caries
- CV: ECG changes; hyperkalemia associated with ECG changes; syncope;
tachycardia-bradycardia syndrome; rarely, arrhythmias, CHF, diffuse
myocarditis, death
- Dermatologic: Pruritus with or without rash; dermatitis, maculopapular, acneiform,
and follicular eruptions; cutaneous ulcers; edema of ankles or wrists
- Endocrine: Hypothyroidism, diffuse nontoxic goiter; hypercalcemia associated with
hyperparathyroidism; transient hyperglycemia; irreversible nephrogenic
diabetes insipidus, which improves with diuretic therapy; impotence or
sexual dysfunction
- Hematologic: Leucocytosis, aplastic anemia.
- Renal: renal failure, chronic interstitial nephritis,
nephrogenic diabetes insipidus.
- Miscellaneous: Weight gain (5-10 kg); chest tightness; reversible
respiratory failure; swollen or painful joints, eye irritation,
worsening
of cataracts, disturbance of visual accommodation
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