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Back to Psychiatry Drug Index

Back to Antimanics

Name: Lithium carbonate

Pregnancy Category D

Drug classes

  • Antimanic agent

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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