Brand Name(s): Eskalith, Eskalith CR, Lithotabs (available in generic)

Manufacturer: Eskalith and Eskalith CR - SmithKline Beecham Pharmaceuticals; Lithotabs - Solvay Pharmaceuticals.

Description: Lithium is an element of the alkali-metal group. Its specific mechanism of action in controlling mania is unknown. The CR designation after the name indicates a controlled release tablet. They are designed to release a portion of the dose initially and the remainder gradually, reducing the variability in lithium blood levels.

Indications and Uses: Lithium is indicated in the treatment of manic episodes of manic-depressive illness (bipolar disorder). It is also used in maintenance therapy to prevent or decrease the intensity of future mood swings. Though not FDA approved, Lithium has been effective in treating trichotillomania (a morbid impulse to pull out ones own hair). It is also sometimes used to augment (increase the effectiveness of) other medications.

Contraindications, Warnings, and Precautions: Lithium should not be used in patients who have significant renal (kidney) or cardiovascular (heart) disease, or severe debilitation or dehydration. Baseline kidney functioning should be assessed prior to initiating lithium therapy as well as periodically during therapy. Use of a neuroleptic (antipsychotic) medication with lithium increases the potential for neurotoxicity. Lithium may harm the fetus in pregnant women. It is also excreted in human breast milk posing a hazard to the newborn. Lithium must be used with caution with diuretics. Patients on lithium should not restrict salt intake as lithium decreases sodium reabsorption in the kidneys and could lead to sodium depletion. Lithium can suppress functioning of the thyroid gland, therefore, thyroid parameters should be monitored periodically. Many of the NSAIDs (nonsteroidal anti-inflammatory drugs) may cause an increase in lithium levels. Use of Flagyl with lithium may cause lithium toxicity. Concurrent use of lithium with enalapril, catopril, or calcium channel blockers may also cause increased lithium levels or neurotoxicity.

Adverse Reactions: Possible common initial side effects are fine hand tremor, frequent urination, increased thirst and perhaps mild nausea (lessened by taking lithium with food). Diarrhea, vomiting, drowsiness, muscular weakness, and poor coordination may indicate early lithium toxicity. Later toxic symptoms include ataxia, giddiness, tinnitis, blurred vision, and a large output of dilute urine.

Dosing Range: Immediate release preparations may be given three or four times a day. Controlled release tablets are usually given twice a day. Dosing is always individualized based on serum lithium levels. A therapeutic lithium level is 0.5 to 1.3 mEq/L. Some sensitive patients may exhibit toxic symptoms a lithium levels below 1.0 millieqivalents per liter.

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© 2000 Red Oak Psychiatry Associates, P.A.    Updated 11/26/2007