LITHIUM

Question 1

LITHIUM INDICATIONS

Answer 1

Treatment and prophylaxis of:

• Mania
• Bipolar disorder
• Recurrent depression
• Aggressive or self-harming behaviour

Question 2

BRAND NAMES

Answer 2

CAMCOLIT

PRIADEL

Question 3

Therapeutic drug monitoring

2 Target serum concs

Answer 3

Serum concentrations - Samples should be taken 12 hours after the dose

Maintenance: 0.4–1 mmol/litre

An acute episode of mania: 0.8–1 mmol/litre

Routine serum-lithium monitoring should be performed:

• weekly after initiation and after each dose change until concentrations are stable
• then every 3 months for the first year, and every 6 months thereafter.

Patients who are 65 years and older, taking drugs that interact with lithium, at risk of impaired renal or thyroid function, raised calcium levels or other complications, have poor symptom control or poor adherence, or whose last serum-lithium concentration was 0.8 mmol/litre or higher, should be monitored every 3 months. Additional serum-lithium measurements should be made if a patient develops significant intercurrent disease or if there is a significant change in a patient’s sodium or fluid intake.

Question 4

MONITORING PARAMETERS

Answer 4

• Assess renal, cardiac, and thyroid function before treatment initiation.
• An ECG recommended in patients with CVD or risk factors
• Body-weight or BMI, serum electrolytes, and a full blood count should also be measured before treatment initiation.

Monitor body weight or BMI, serum electrolytes, eGFR, and thyroid function every 6 months during treatment, and more often if there is evidence of impaired renal or thyroid function, or raised calcium levels.

Question 5

TOXICITY RANGE

Answer 5

> 1.5 MMOL

Question 6

Hyponatremia

Answer 6

HYPONATREMIA PREDISPOSES LITHIUM TOXICITY

Question 7

NAME 5 TOXICITY SIDE EFFECTS ( SICK + TREMOR )

Answer 7

GI EFFECTS - VOMITING + DIARRHEA

FINE TREMOR INCREASING TO A COARSE TREMOR

VISUAL DISTURBANCES

RENAL IMPAIRMENT - INCONTINENCE, POLYURIA

CNS DISTURBANCES - CONFUSION. DROWSINESS

Question 8

LITHIUM SE

Answer 8

• THYROID DISORDER
• NEPHROTOXCITIY
• RHABDOMYOLYSIS
• QT INTERVAL PROLONGATION
• TERATOGENIC IN 1 ST TRIMESTER OF PREGNANCY
• BENIGN INTRACRANIAL HYPERTENSION

Question 9

Treatment cessation

Answer 9

Abrupt discontinuation of lithium increases the risk of relapse.

If lithium is to be discontinued, the dose should be reduced gradually over a period of at least 4 weeks (preferably over a period of up to 3 months).

Question 10

LITHIUM INTERACTIONS

Answer 10

• DRUGS THAT CAUSE HYPONATRAMIA - E.G. DIURETICS, SSRI, CARBAMAZEPINE
• SALT IMBALANCE
• DRUGS THAT CAUSE SEROTONIN SYNDROME
• DRUGS THAT CAUSE QT INTERVAL PROLONGATION
• DRUGS THAT REDUCE SEIZURE THRESHOLD
• RENALLY CLEARED DRUGS ( INCREASED RISK OF TOXICITY)

Question 11

Patient and carer advice

Answer 11

Patients should be advised to report signs and symptoms of lithium toxicity, hypothyroidism, renal dysfunction (including polyuria and polydipsia), and benign intracranial hypertension (persistent headache and visual disturbance).

Maintain adequate fluid intake and avoid dietary changes which reduce or increase sodium intake.

Lithium treatment packs
A lithium treatment pack should be given to patients on initiation of treatment with lithium. The pack consists of a patient information booklet, lithium alert card, and a record book for tracking serum-lithium concentration. Packs may be purchased from