Lithium

Question 1

Monitoring

Answer 1

THYROID 
- every 6 months 
Li serum 
- Weekly
- then 3 months when stable 
BLOOD 
- 12hours after dose change

Question 2

Toxicity signs

Answer 2

N+V
Visual disturbances 
Muscle weakness
Fine tremor
CNS disturbances 
- confusion 
- drowsiness
- pack of coordination 
AV block 
Polyuria
Arrythmias 
QT prolongation
Skin reactions (ulcers)

Question 3

Interactions

Answer 3

Diuretics ( thiazide more)
ACE inhibitors/ ARBs
NSAIDs
Antiepileptics

Question 4

Patient advice

Answer 4

Same brand
Maintain adequate fluid
Avoid salt changes in diet ( ↓ salt = Li toxicity)
Avoid abrupt withdrawal
- over 4weeks - 3months ( if need to stop abruptly change to atypical antipsychotics/ valproate