Lithium
Uses: mania, rapid cycling BPD, acute episode of MDD and prevention of recurrent MDD, cluster
headaches
TOXICITY IS EASY as range between therapeutic and toxic levels is EXTREMELY narrow
High risk (75%) for side effects, lowering dose may reduce incidence
Starting dose: 300-400 mg TID based upon age and weight
Steady state expected within 5 days of starting
Target concentration: 0.5-1.2 mEq/L (if on diuretic might reduce lithium dose by 50%)
Check more frequently nearing upper limits of therapeutic range, especially in OLDER pts or LIVERS
Upper range in older patients =~= 0.6 mEq/L
WATCH THESE LABS: renal, thyroid, U/A, CBC w/ diff., electrolytes, EKG, and weight. PREGNANCY TEST
PRIOR TO STARTING!!!
Persistent Effects: fine tremor, mild polyuria and polydipsia, increased WBC, nontoxic goiter and
hypothyroidism, exacerbation of psoriasis, acne, alopecia, weight gain
Severe toxicity: seizures, coma, cardiovascular collapse