Lithium Carbonate

Lithium carbonate is a mood-stabilizing medication approved for the following uses across its supported formulations:

• Treatment of acute manic episodes in bipolar disorder (adults and, for certain formulations, patients 7 years and older)
• Maintenance treatment of bipolar disorder — to reduce how often manic episodes happen and how severe they are when they do
• One formulation is specifically approved as monotherapy (used alone) for bipolar I disorder, including both acute manic or mixed episodes and maintenance treatment, in patients 7 years and older
• Lithobid extended-release tablets are indicated for acute mania and long-term control in adults

The exact way lithium stabilizes mood is not fully understood. What is known is that it acts as a mood-stabilizing agent in the brain — but scientists have not yet identified the precise mechanism. After you swallow it, lithium is completely absorbed and distributes throughout the body's water. It is not broken down or metabolized at all; your kidneys filter it out unchanged. Because the kidneys handle lithium in a way similar to sodium (salt), changes in your hydration or salt levels directly affect how much lithium stays in your body — which is why diet and fluid balance matter so much with this drug.

Lithium carbonate is taken by mouth in capsule or tablet form, usually two to three times daily depending on the specific product and your prescriber's instructions. Extended-release formulations are typically dosed less frequently than immediate-release forms.

• Always take it exactly as prescribed — dose is carefully adjusted based on regular blood level tests
• Lithobid extended-release tablets are taken twice daily during both acute treatment and long-term maintenance, as directed
• If you miss a dose, follow your prescriber's or pharmacist's guidance — never double up without instruction
• Blood lithium levels are checked frequently at first (twice a week during the acute phase) and at least every two months during stable long-term treatment

Some side effects are common when starting lithium, while others are signs of a more serious problem:

• Fine hand tremor
• Increased thirst and urination
• Nausea, stomach discomfort, or diarrhea — especially early in treatment
• Dizziness and fatigue
• Weight changes or ankle swelling
• Metallic or salty taste in the mouth
• In children (ages 7–17): nausea/vomiting, tremor, dizziness, rash, unsteady gait, decreased appetite, and blurry vision were among the most commonly reported effects

Seek immediate medical help if you develop confusion, slurred speech, severe tremor, muscle twitching, seizures, or loss of consciousness — these are signs of lithium toxicity and require urgent care.

• Lithium toxicity: The toxic level is very close to the therapeutic level. Early signs include tremor, lightheadedness, and weakness. Severe toxicity can cause seizures, coma, and death. Blood tests to monitor your lithium level are essential throughout treatment.
• Dehydration and low sodium: Illness with fever, sweating, vomiting, or diarrhea can raise lithium to dangerous levels. Maintain normal salt intake and stay well hydrated.
• Kidney damage: Long-term lithium use can cause chronic kidney disease. Kidney function is monitored regularly during treatment.
• Thyroid problems: Lithium can cause an underactive or, less commonly, overactive thyroid. Thyroid function is checked before and during treatment.
• Serotonin syndrome: Combining lithium with certain antidepressants or other serotonergic drugs can trigger a potentially life-threatening reaction with agitation, rapid heart rate, and muscle stiffness.
• Brugada syndrome: Lithium has been linked to unmasking a heart rhythm disorder that can cause sudden death. Tell your doctor if you have unexplained fainting or a family history of sudden unexplained death.
• Brain syndrome: Combining lithium with antipsychotic medications has been linked to a serious neurological syndrome, including a risk of irreversible brain damage.
• Elevated calcium: Long-term use can raise blood calcium levels and affect the parathyroid glands.

Many common medications and health conditions can affect how much lithium stays in your body — raising it to toxic levels or lowering it so it stops working:

• Diuretics (water pills): Can reduce lithium clearance and raise blood levels dangerously
• NSAIDs (ibuprofen, naproxen): Reduce lithium excretion, increasing toxicity risk
• ACE inhibitors and ARBs (lisinopril, valsartan): Raise steady-state lithium levels
• Serotonergic drugs (SSRIs, SNRIs, MAOIs, tramadol, triptans, St. John's Wort): Increase risk of serotonin syndrome
• Antipsychotic medications: Combined use raises risk of serious neurological reactions
• Metronidazole (antibiotic): Can increase lithium levels by reducing kidney clearance
• Calcium channel blockers (verapamil, diltiazem): May worsen nervous system side effects
• Iodide preparations: Can worsen lithium-induced hypothyroidism
• Theophylline, acetazolamide, sodium bicarbonate: Can lower lithium levels by increasing how fast the kidneys clear it

This is not a complete list of interactions. Always talk with your doctor or pharmacist before starting, stopping, or changing any medication.

• Kidney disease: Lithium is cleared entirely by the kidneys; severe kidney impairment makes it very dangerous to use. Even mild-to-moderate kidney impairment requires lower starting doses and close monitoring.
• Pregnancy: Lithium may cause harm to the baby, including possible heart defects. If you are pregnant or planning to become pregnant, discuss the risks and benefits carefully with your prescriber.
• Breastfeeding: Lithium passes into breast milk at significant levels and is not recommended during breastfeeding. If you choose to breastfeed, your infant must be monitored closely for toxicity signs.
• Children: Safety and effectiveness have been established only in patients 7 years and older for certain formulations; lithium has not been established as safe in children under 7 with bipolar I disorder.
• Older adults: Kidney function naturally declines with age, raising the risk of toxicity. Dose selection should be conservative and kidney function monitored.
• Heart conditions: Lithium should be avoided in patients with Brugada syndrome. Tell your doctor about any heart rhythm problems or history of unexplained fainting.
• Thyroid or calcium problems: Tell your doctor about any existing thyroid or parathyroid conditions before starting lithium.
• Allergy to inactive ingredients: Lithium carbonate is contraindicated if you have a known allergy to any inactive ingredient in the capsule or tablet formulation.

Lithium levels above the therapeutic range can cause serious harm, and at very high levels can lead to seizures, coma, and irreversible brain damage. There is no specific antidote for lithium poisoning. If you suspect an overdose or toxic reaction, call the National Poison Control Center at 1-800-222-1222 immediately or go to the nearest emergency room. Hemodialysis (a machine that filters the blood) is the preferred treatment for severe lithium toxicity.

After you take lithium carbonate by mouth, it is completely absorbed in the upper digestive tract. Immediate-release capsules and tablets reach peak blood levels within about 15 minutes to 3 hours; extended-release preparations take 2 to 6 hours to reach peak levels. Lithium spreads throughout the body's water and binds very little to proteins in the blood. It is not metabolized at all — the liver does not process it. Instead, the kidneys filter it out and excrete it in urine, with a half-life of approximately 18 to 36 hours (meaning it takes that long for half of it to leave your body). In children, how quickly the body clears lithium increases with body weight, so smaller children require lower doses to reach comparable blood levels.

Store and Dispense Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Dispense in a tight, child-resistant container as defined in the USP/NF. Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).