Lithium
Lithium is a mood stabilizer used primarily for bipolar disorder. It prevents manic and depressive episodes and has anti-suicidal properties.
About Lithium
Lithium is a mood stabilizer (alkali metal ion) (generic name: Lithium Carbonate) also sold under brand names including Lithobid and Eskalith. It is primarily used to bipolar Disorder Mania Treatment Mood Stabilization Treatment Resistant Depression (augmentation). Lithium is available in capsule 150 mg, capsule 300 mg, capsule 600 mg, tablet 300 mg, extended-release tablet 300 mg, extended-release tablet 450 mg, and oral solution 300 mg/5 ml (8 meq/5 ml) form. Healthcare providers commonly prescribe Lithium for conditions including Bipolar Disorder, Hives (Urticaria), Hypothyroidism, and Seizures.
Lithium at a Glance
- Generic name
- Lithium Carbonate
- Brand names
- Lithobid, Eskalith
- Drug class
- Mood Stabilizer (Alkali Metal Ion)
- Pregnancy category
- FDA Category Category D (evidence of human fetal risk; benefits may warrant use in serious conditions)
- Available forms
- Capsule 150 mg, Capsule 300 mg, Capsule 600 mg, Tablet 300 mg, Extended-release tablet 300 mg, Extended-release tablet 450 mg, Oral solution 300 mg/5 mL (8 mEq/5 mL)
- Therapeutic categories
- Psychiatry, Mood Stabilizers, Bipolar Disorder
- Conditions treated
- 4 related conditions on this site
What Lithium Is Used For
Dosage Quick Reference
These are general dosage guidelines for Lithium. Your doctor will determine the appropriate dose for your specific situation.
| Condition | Starting Dose | Maintenance Dose |
|---|---|---|
| Bipolar disorder — acute mania (adults) | 300 mg three times daily or 600 mg twice daily (ER) | 900–1,200 mg/day in divided doses; titrate to serum level 0.8–1.2 mEq/L |
| Bipolar disorder — maintenance (adults) | Continuation of acute dose | 600–1,200 mg/day; target serum level 0.6–1.0 mEq/L |
| Bipolar disorder (adolescents ≥12 yrs) | 300 mg twice daily | Titrate to serum level 0.6–1.2 mEq/L; typical 900–1,200 mg/day |
Side Effects
Common Side Effects:
- Tremor
- Polyuria and polydipsia
- Weight gain
- Cognitive dulling
- Nausea
- Diarrhea
- Hypothyroidism
- Acne
- Hair loss
Serious Side Effects:
- Lithium toxicity (at levels >1.5 mEq/L)
- Nephrogenic diabetes insipidus
- Chronic kidney disease
- Cardiac arrhythmias
- Hypothyroidism
- Hyperparathyroidism
- Teratogenicity (Ebstein's anomaly)
- Serotonin syndrome (rare)
See also: Drug Interactions ↓
Drug Interactions
ACE inhibitors (e.g., lisinopril, enalapril) and ARBs (e.g., losartan): Reduce renal lithium clearance, increasing lithium levels and toxicity risk. Monitor lithium levels closely when starting, stopping, or changing doses of these agents.
NSAIDs (e.g., ibuprofen, naproxen): Significantly decrease renal lithium excretion, potentially raising levels by 15–50%. Sulindac may be the safest NSAID alternative. Aspirin at low doses is generally safe.
Thiazide diuretics (e.g., hydrochlorothiazide): Reduce lithium clearance by 25–40% and can precipitate toxicity. If a diuretic is needed, amiloride is preferred because it has minimal effect on lithium levels.
Carbamazepine: Combination may increase neurotoxic effects (ataxia, tremor, nystagmus) without altering serum levels of either drug. Monitor closely for neurological side effects.
SSRIs (e.g., fluoxetine, sertraline): Increased risk of serotonin syndrome when combined with lithium. Monitor for agitation, tremor, hyperthermia, and myoclonus.
See also: Questions to Ask Your Doctor ↓
Key Considerations
Known drug interactions
Lithium has documented interactions with other medications, supplements, and certain foods. Review the Drug Interactions section below and tell your healthcare provider about every medication you take, including over-the-counter products. Jump to section →
Multiple forms available
Lithium comes in more than one form (Capsule 150 mg, Capsule 300 mg, Capsule 600 mg, Tablet 300 mg, Extended-release tablet 300 mg, Extended-release tablet 450 mg, Oral solution 300 mg/5 mL (8 mEq/5 mL)). The right form for you depends on your condition, ease of use, and your provider's recommendation.
Additional Information
Lithium is a mood stabilizer that has been the cornerstone of bipolar disorder treatment for decades. Despite its narrow therapeutic index, lithium remains a first-line treatment due to its proven efficacy in preventing manic and depressive episodes and its unique anti-suicidal effects.
Mechanism of Action
Lithium's precise mechanism of action in mood stabilization is not fully understood, but multiple effects have been identified. Lithium inhibits glycogen synthase kinase-3 (GSK-3), an enzyme involved in many cellular processes including mood regulation. It also reduces protein kinase C activity, modulates inositol monophosphatase (depleting inositol and reducing phosphatidylinositol signaling), and affects neurotransmitter systems including serotonin and norepinephrine. Lithium has neuroprotective effects, potentially increasing gray matter volume and promoting neurogenesis. It also affects circadian rhythms and gene expression through multiple pathways.
Available Formulations
Lithium is available as lithium carbonate capsules (150 mg, 300 mg, 600 mg), tablets (300 mg), extended-release tablets (300 mg, 450 mg), and lithium citrate oral solution (8 mEq/5 mL, equivalent to lithium carbonate 300 mg). Different formulations are not interchangeable on an mEq basis due to varying absorption. Serum lithium levels should be monitored when switching formulations.
Medical Uses
Lithium is FDA-approved for the treatment of manic episodes of bipolar disorder and maintenance treatment of bipolar disorder to prevent or diminish the intensity of subsequent episodes. It is also approved as an augmentation strategy for treatment-resistant depression. Lithium is considered first-line therapy for bipolar disorder due to extensive evidence of efficacy and unique anti-suicidal properties.
Dosing Guidelines
Dosing is individualized based on serum lithium levels and clinical response. For acute mania, starting dose is typically 300-600 mg two to three times daily, with dose adjustment to achieve serum levels of 0.8-1.2 mEq/L. For maintenance therapy, target levels are typically 0.6-1.0 mEq/L. Extended-release formulations allow twice-daily dosing. Serum lithium levels should be measured 12 hours post-dose (trough level). Regular monitoring of lithium levels, renal function, and thyroid function is essential.
Important Safety Information
Lithium has a narrow therapeutic index; toxicity can be fatal. Lithium toxicity can occur at therapeutic doses if sodium or fluid balance is disrupted. Signs of toxicity include tremor, ataxia, diarrhea, vomiting, drowsiness, and in severe cases, seizures, cardiac arrhythmias, and permanent neurological damage. The medication is contraindicated in patients with significant renal or cardiovascular disease. Long-term use can cause hypothyroidism, nephrogenic diabetes insipidus, and chronic kidney disease. Regular monitoring of lithium levels, renal function (creatinine, eGFR), and thyroid function (TSH) is required.
Drug Interactions
NSAIDs, ACE inhibitors, ARBs, and diuretics (especially thiazides) can increase lithium levels and toxicity risk. Sodium depletion (low-salt diet, dehydration) increases lithium retention. Caffeine and theophylline increase lithium excretion. Metronidazole may increase lithium levels. Some antipsychotics may enhance neurotoxic effects. Medications affecting renal function require careful monitoring.
Special Populations
Lithium is associated with an increased risk of Ebstein's anomaly and other cardiac malformations when taken during the first trimester of pregnancy. Use during pregnancy requires careful risk-benefit assessment. Lithium is excreted in breast milk at 30-50% of serum concentrations; breastfeeding is generally discouraged. Safety and efficacy have been established in pediatric patients 7 years and older for bipolar disorder. Elderly patients may require lower doses due to reduced renal function; closer monitoring is needed. Dose reduction is required in renal impairment; lithium is contraindicated in severe renal impairment.
Frequently Asked Questions
Questions to Ask Your Doctor About Lithium
Consider discussing these topics at your next appointment:
- How often will my lithium levels, kidney function, and thyroid function be monitored?
- What should I do if I become dehydrated due to illness, exercise, or hot weather?
- Are there specific foods or supplements I should avoid while taking lithium?
- What are the long-term effects of lithium on my kidneys and thyroid?
- How will we manage the transition if I need to switch away from lithium?
Medical Disclaimer: This information is for educational purposes only and should not be considered medical advice. Always consult with your healthcare provider before starting, stopping, or changing any medication. Your doctor can provide personalized recommendations based on your specific health condition and medical history.