Lithium

Mohamad Hafiz Lut bin Mat Jusoh

Mbbs 0914 102
Introduction
• Drug of choice in acute mania and as prophylaxis for both manic and
depressive episodes in bipolar and schizoaffective disorders
• Metabolize by kidney
• Pre-treatment tests prior to initiating
• Renal functions
• Thyroid functions
• ECG for patients with risk factors or existing cardiac disease
Dosage, Indication &
Contraindication
Indication Contraindication
• Bipolar disorder • Severe renal disease
• Mania • Severe cardiac disease
• Recurrent Unipolar depression • Severe dehydration
• Sodium depletion
Dosage • debilitation
• Treatment : initiate at 1 to 1.5 g
daily
• Prevention : initiate at 300-400 mg
daily
• Should be taken with food
Mechanism of Action
• unclear but it alters intraneuronal metabolism of catecholamines and sodium
transport in neurons and muscle cells.
• Absorption: Readily and completely absorbed from the GI tract (oral); serum
levels increase with food.
• Distribution: Throughout the body, bones, thyroid gland, portions of the brain;
crosses the placenta, enters breast milk. Not protein-bound.
• Metabolism: Not metabolised.
• Excretion: Via urine (as unchanged drug), faeces, saliva, sweat (small
amounts). Elimination half-life: 20-24 hr (normal renal function), 36 hr (elderly),
40-50 hr (renal dysfunction).
Side Effect
• Toxic levels cause altered mental status, coarse tremors, convulsions,
delirium, coma and death
• Need to regularly monitor blood levels of lithium, thyroid function and kidney
function
• Fine tremor
• Nephrogenic diabetes insipidus
• GI disturbance
• Weight gain
• Sedation
• Benign leukocytosis
• Ebstein’s anomaly = cardiac defect in babies born to mothers taking lithium