Lithium

Generic Name: Lithium Carbonate, Lithium Cation

Brand Names: Eskalith, Lithobid

Drug Class: NMDA modulator, Bipolar disorder agent

Similar Class Drugs: Carbamazepine, Valproate

Available Dosage forms: Oral tablet, capsule, and solution

What is Lithium?

Lithium is used for its mood-stabilizing properties for the first-line treatment of mania in Bipolar disorder. It is also used off-label as an adjunct to treat major depression, neutropenia, bipolar disorder without manic episodes, and headaches of vascular origin.¹

The exact mechanism of action of Lithium stays unclear. However, it is postulated that Lithium acts as a modulator to NMDA receptors in the brain. A lack of glutamate results in depression, while an excess causes mania. Lithium modulates the activity of NMDA, increases glutamate release from NMDA in case of depression, and decreases glutamate concentration to reduce manic symptoms.

It can also inhibit inositol monophosphatase, an enzyme implicated in the regulation of intracellular levels of Myo-inositol (vitamin B3).¹

How to use Lithium?

– Oral tablets and capsules of dosage 300mg are prescribed 3 times daily for both adults and children.

– Tests for lithium serum concentration should be done for every patient after 12 hours of initial dosage. The tests are repeated regularly until manic symptoms subside.

– Dosages are titrated according to the patient’s response to Lithium therapy.

– It takes 1 to 3 weeks for the emergence of mood-stabilizing effects.¹

What are the side effects of Lithium?

Adverse effects related to Lithium:

– Bradycardia, heart block, sick sinus syndrome

– Seizures, memory issues, tremors

– Nephrotic diabetes insipidus

– Leukocytosis, aplastic anemia

– Ebstein’s anomaly in infants of pregnant mothers

– Hypotonia, floppy infant syndrome in newborns of mothers receiving Lithium during delivery

– Encephalopathy syndrome after coadministration of Lithium and haloperidol¹

Who should not use Lithium?

– Lactating mothers

– Patients with end-stage renal disease

– Pregnant women

– Obese people

– Those with metabolic disturbances

– Patients with medication history involving drugs known to interact with Lithium

References

1. Chokhawala K, Lee S, Saadabadi A. Lithium. [Updated 2021 Jul 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519062/
2. Won E, Kim YK. An Oldie but Goodie: Lithium in the Treatment of Bipolar Disorder through Neuroprotective and Neurotrophic Mechanisms. Int J Mol Sci. 2017;18(12):2679. Published 2017 Dec 11. doi:10.3390/ijms18122679