Lithium: Drug Effects, Side Effects, Dosage and Uses

Products

Lithium is commercially available in the form of tablets and sustained-release tablets (e.g., Quilonorm, Priadel, Lithiofor).

Structure and properties

The lithium ion (Li+) is a monovalent cation found in pharmaceuticals in the form of various salts. These include lithium citrate, lithium sulfate, lithium carbonate, and lithium acetate. For example, lithium carbonate (Li2CO3, Mr = 73.9 g/mol) exists as a white powder that is sparingly soluble in water.

Effects

Lithium (ATC N05AN01) has antimanic, antidepressant, antipsychotic, and antisuicidal properties. The mechanism of action is not fully understood. Lithium has effects on several neurotransmitter systems, among others. It has a half-life of about 24 hours and is excreted unchanged by the kidneys.

Indications

  • For the treatment of acute episodes of mania and hypomania.
  • For the prevention of manic-depressive episodes (bipolar disorder).
  • For the treatment of depression (combination therapy with antidepressants).
  • For the treatment of severe chronic aggressiveness.

Dosage

According to the professional information. The dose is adjusted on an individual basis. Lithium has a narrow therapeutic range and blood levels must therefore be monitored regularly (therapeutic drug monitoring). Other parameters must also be measured regularly (eg, thyroid function).

Contraindications

  • Hypersensitivity
  • Kidney disease
  • Cardiovascular diseases such as heart failure, congenital QT syndrome, QT prolongation.
  • Hypothyroidism (untreated)
  • Disturbed sodium balance due to dehydration (eg, after heavy sweating).
  • Reduced intake of table salt, e.g. due to a low-salt diet.
  • Addison’s disease
  • Pregnancy, lactation

Full precautions can be found in the drug label.

Interactions

Numerous drug-drug interactions have been reported in the literature, including with NSAIDs, ACE inhibitors, psychotropic drugs, sodium-containing drugs, and diuretics. Full details can be found in the SmPC.

Adverse effects

The most common possible adverse effects include increased thirst, nausea, frequent urination, ECG changes, prolongation of the QT interval, hypothyroidism, mild hand tremor, weight gain, and dry mouth. An overdose can be life-threatening.