Lithium

Summary

Lithium is a mood stabilizer used to treat bipolar disorder, particularly episodes of mania. Lithium has a delayed onset of action, taking 1-2 weeks to reach full effect. Lithium levels should be drawn in the morning to ensure that they are within the narrow therapeutic range of 0.6-1.2 mEq/L.

Side effects include weight gain, increased urination, nausea, arrhythmias, hypothyroidism, and thirst. Lithium is teratogenic and is generally not recommended in pregnancy. Other side effects include fine hand tremors, and kidney damage. Lithium should be taken with food to prevent nausea. Patients on lithium therapy should maintain adequate fluid and salt intake, and should avoid caffeine.

Key Points

• Lithium
  • Mechanism
    • Not well understood - thought to alter electrical activity in the brain
  • Clinical Use
    • Mood stabilizer
      • Bipolar Disorder
        • Manic episodes
      • Effects seen in 1-2 weeks
  • Lithium Levels
    • Therapeutic range 0.6-1.2 mEq/L
      • Draw lithium levels in the morning
        • Aim to draw lithium levels approximately 12 hours after the last dose for the most accurate reading
  • Side Effects
    • Nausea
    • Weight gain
      • Lithium may alter metabolism and increase appetite.
      • Encourage a balanced diet and regular exercise
    • Thirst (Polydipsia)
      • Patient may feel like they have a dry mouth
      • Monitor fluid intake and output
      • Educate patients on the importance of regular hydration
    • Fine hand tremors
      • A mild tremor is an expected side effect, while coarse tremors could be a sign of toxicity
    • Kidney damage
      • Polyuria
        • Lithium impairs the kidney's ability to concentrate urine.
      • Monitor renal function
    • Hypothyroidism
      • Monitor thyroid function
      • Patient may need additional thyroid hormone supplementation
    • Dysrhythmias
      •  Lithium can alter sodium transport, leading to ECG changes and dysrhythmias
    • Teratogenic
      • Lithium crosses the placenta, potentially causing fetal abnormalities (Pregnancy Risk Category D)
      • Notify the provider immediately if pregnancy is suspected. The provider and patient will carefully weigh risks and benefits of continued therapy.
  • Administration
    • Take with food
      • To help prevent side effect of nausea
    • Maintain adequate fluid intake
    • Maintain adequate salt intake
      • Hyponatremia increases risk for toxicity
      • Patients should maintain a consistent intake of sodium in their diet. They should NOT limit sodium intake.
    • Avoid caffeine
      • Caffeine decreases the effectiveness of lithium
      • Limit intake of caffeinated beverages, including coffee, tea, and cola