side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more

> Lithium

US brand name: lithium
Generic name: lithium carbonate

Other Forms: Eskalith-Cr, Lithobid, lithium citrate syrup

Class: Technically lithium is an antipsychotic, although few people consider lithium an AP. They think: mood stabilizer, which is how I’m categorizing it from now on. I’ll call it an AP where I don’t have mood stabilizer as a distinct category.

1.  Other brand names & branded generic names1

  • Eskalith
  • Eskalith-Cr
  • Lithane
  • Lithobid
  • Lithonate
  • Lithotabs
  • Camcolit (Bahamas; Bahrain; Barbados; Belgium; Belize; Benin; Bermuda; Burkina Faso; Curacao; Cyprus; Egypt; Ethiopia; Gambia; Ghana; Guinea; Guyana; Hong Kong; Iran; Iraq; Ireland; Ivory Coast; Jamaica; Jordan; Kenya; Kuwait; Lebanon; Liberia; Libya Lebanon; Malawi; Mali; Mauritania; Mauritius; Morocco; Dutch Antilles; Netherlands; Niger; Nigeria; Oman; Qatar; Republic of Yemen; Saudi Arabia; Senegal; Seychelles; Sierra Leone; Singapore; South Africa; Sudan; Surinam; Syria; Taiwan; Tanzania; Trinidad; Tunisia; Uganda; United Arab Emirates; United Kingdom, Zambia; Zimbabwe)
  • Carbolit (Colombia; Mexico)
  • Carbolith (Canada)
  • Ceglution (Argentina)
  • Ceglution 300 (Ecuador)
  • Duralith (Canada)
  • Hynorex Retard (Germany; Switzerland)
  • Lentolith (South Africa)
  • Licab (India)
  • Licarb (Thailand)
  • Licarbium (Israel)
  • Lidin (Taiwan)
  • Limas (Japan)
  • Liskonum (Bahrain; Benin; Burkina Faso; Cyprus; Egypt; Ethiopia; Gambia; Ghana; Guinea; Iran; Iraq; Ivory Coast; Jordan; Kenya; Kuwait; Lebanon; Liberia; Libya; Lebanon; Malawi; Mali; Mauritania; Mauritius; Morocco; Niger; Nigeria; Oman; Qatar; Republic of Yemen; Saudi Arabia; Senegal; Seychelles; Sierra Leone; Sudan; Syria; Tanzania; Tunisia; Uganda; United Arab Emirates; United Kingdom, Zambia; Zimbabwe)
  • Litheum 300 (Mexico)
  • Lithicarb (Australia; Malaysia; New Zealand)
  • Lithionate (Taiwan)
  • Lithocap (India)
  • Litilent (Argentina)
  • Litocarb (Peru)
  • Maniprex (Belgium)
  • Phanate (Thailand)
  • Plenur (Spain)
  • Priadel (Belgium; England; Netherlands; New Zealand; Singapore)
  • Priadel Retard (Greece; Switzerland)
  • Quilonium-R (Philippines)
  • Quilonorm Retardtabletten (Switzerland)
  • Quilonum Retard (Czech Republic; Germany; South Africa, Ukraine, , Luxembourg)
  • Quilonum SR (Australia)
  • Teralithe (France)
  • Theralite (Colombia)

2.  FDA Approved Uses:

Acute and chronic bipolar mania.

3.  Off-Label Uses of

  • Cluster Headaches (although it still appears over the years not to be that effective)
  • Augmenting antidepressants to treat refractory depression
  • Graves’ Disease (hyperthyroidism)

4.  lithium’s pros and cons

4.1  Pros

The gold standard for classic bipolar 1. Inexpensive. Consistent. Available around the world.

4.2  Cons

The side effects suck donkey dong! You need to have regular blood tests. Changes in other meds, diet or even the seasons can require an adjustment in your dosage, but you’ll need a blood panel to determine that. Usually doesn’t help much for non-standard forms of bipolar disorder (e.g. rapid cycling, bipolar 3–6).

5.  Side Effects

5.1  Typical Side Effects

Weight gain, tremor (sometimes bad enough to require a beta blocker such as Inderal to quell it) and acne. It’ll be just like two weeks before the Junior Prom and you still don’t have a date.

5.2  Not So Common Side Effects

While every day won’t be as bad of a hair day as with a valproate, lithium does mess with your hair. Food will sometimes have a salty or weird metallic taste added to it. There can be edema and other mysterious swellings. You may not think as clearly as you did before you started taking a lithium variant. While valproates may turn you instantly old, lithium will force you to relive your adolescence.

5.3  Freaky Rare Side Effects

Anorexia, not feeling anything on your skin, not being able to move your limbs completely. Those wacky adolescent fantasies about becoming a Barbie doll – lithium can make them happen!

6.  Interesting Stuff Your Doctor Probably Won’t Tell You

  • Lithium toxicity has resulted from interactions between an NSAID and lithium. Indocin(indomethacin) and Feldene(piroxicam) have been reported to increase significantly steady-state plasma lithium concentrations. There is also evidence that other nonsteroidal anti-inflammatory agents, including the selective cyclooxygenase-2 (COX2) inhibitors (e.g. Celebrex), have the same effect. In a study conducted in healthy subjects, mean steady-state lithium plasma levels increased approximately 17% in subjects receiving lithium 450 mg BID with Celebrex (celecoxib) 200mg BID as compared to subjects receiving lithium alone. Ibuprofen and Aleve(naproxen) can also affect lithium levels.
  • One study testing the various products available had the same brand release differing amounts of lithium in different batches, and not everything labeled “sustained release” really was. Yow! This explains why I’ve read reports on support groups about problems people have had when switching brands.
  • Combining Prozac and lithium can cause unpredictable serum levels. Be sure to have regular level checks if mixing the two.
  • The same applies if you combine lithium with Topamax. A study referenced in “Topiramate: drug interactions” by Barry E. Gidal PharmD Antiepileptic Drugs has Topamax lowering lithium levels 11% to 16%. Yet a case report has them being raised, and that’s what made it into the Drug-Drug Interactions checker. So get those levels tested if you insist on adding Topamax for weight loss.
  • The way lithium works in your brain can wind up canceling the effects of some blood pressure medications. Or the other way around. So if you’re taking blood pressure meds that work on sodium channels, lithium may not be for you.
  • You really do need to drink between 2.5 and 3 quarts/liters of fluids, preferably water, a day when taking lithium. Lithium isn’t really metabolized, it petty much hits your brain as is and is then flushed out of your system via your kidneys. A lot of the problems people have with lithium stem from used lithium hanging around the exit.

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7.  Lithium’s Dosage and How to Take Lithium

Like Depakote lithium is all about your blood serum levels. The sweet spot is somewhere between 0.6 and 1.2. Good doctors will take into consideration your age, weight, previous history with medications (if any), and just how freakin’ manic you are at the time to determine where to start you. Lazy doctors will start you at 900mg a day if you’re mildly crazy and 1800mg a day if you’re climbing the walls.

Unless you or your family member has utterly lost it with mania, I’m for starting out at 450mg a day for controlled-release versions (Eskalith CR, Lithobid, Duralith, etc.), 300mg a day for immediate release. That is highly unlikely to get you near the therapeutic level of 0.6, but it does allow you to acclimate to the lithium. After a week you get a blood level and you see where you need to go. Probably up, but you never know.

8.  How Long Lithium Takes to Work

First you have to reach the therapeutic range of 0.6 to 1.2. Then you have to find where in that range you have the best results, which can vary throughout the year along with other factors in our life. Then you have to give it a couple weeks after that. It can literally take a couple years to figure out if lithium is going to be the drug for you or not.

9.  How to Stop Taking Lithium

Your doctor should be recommending that you reduce your dosage by 300mg a day every five to six days, based on the 24 hour half-life, if not more slowly than that. To make everyone’s life easier it might just be rounded up to a week and you may or may not have a blood level done for shits and grins during the process.

10.  Lithium’s Half-Life & Average Time to Clear Out of Your System

Half-life: about 24 hours (but the pharmacokinetics are really different from other crazy meds). It clears your system in around five days, but there are a lot of factors involved.

11.  Days to Reach a Steady State

Usually a week, but there are far too many variables involved with lithium.

12.  Shelf life

  • Lithium carbonate tablets: 5 years.
  • Lithium citrate syrup: 2 years, 6 months after opening - which is a remarkably long time for a liquid crazy med.

13.  How Lithium Works

Good question! For a medication that has been used for as long as lithium has, how it works shouldn’t be as much of a mystery as it is.

According to Dr. Stephen Stahl in his Essential Psychopharmacology of Depression and Bipolar Disorder, lithium controls bipolar mood swings and helps with unipolar depression by modulating the G proteins in the phosphatidylinositol system, modulating the protein kinase, or by inhibiting the enzyme inositol monophosphatase.

However, another psychopharmacological hero of ours, Dr. Husseini Manji, has done a bunch more research subsequent to that, and pretty much shot those hypotheses down. His take on it is that it’s all about PKC signaling pathways and the inhibition of PKC isozymes. And the only meds currently on the market known to do that sort of thing are the valproates (Depakote, Stavzor (valproic acid), and whatever they call sodium valproate where you live) and, of all things, tamoxifen.

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14.  lithium Ratings, Reviews, & Other Sites of Interest

lithium Ratings & Reviews Page.

14.1  Rate lithium

Give your overall impression of lithium on a scale of 0 to 5. Detailed ratings and reviews are available on the lithium Ratings & Reviews Page.

Get all critical about lithium

4 stars Rating 3.7 out of 5 from 88 criticisms.
Vote Distribution: 9 – 2 – 7 – 8 – 28 – 34

14.2  Rate this article

If you’re still feeling judgmental as well as just mental2, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.

Get all judgmental about the lithium (lithium carbonate) Synopsis

4.5 stars Rating 4.1 out of 5 from 28 value judgments.
Vote Distribution: 0 – 1 – 2 – 1 – 13 – 11

14.3  Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, check for drug-drug interactions

lithium’s Full US Prescribing Information / PI Sheet

UK Liskonum SPC

UK lithium citrate syrup’s drug-drug and drug-food interaction checker

It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.

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14.4  Discussion board

If you have any questions not answered here, please see the Crazymeds lithium discussion board.

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15.  Bibliography

Essential Psychopharmacology 2nd Edition Stephen M. Stahl, M.D., Ph. D. © 2000. Published by Cambridge University Press

Essential Psychopharmacology of Depression and Bipolar Disorder 2nd Edition Stephen M. Stahl, M.D., Ph. D. © 2001. Published by Cambridge University Press

Physicians’ Desk Reference Edition 56 Maria Deutsch & Anu Gupta, Drug Information Specialists, et al. © 2002. Published by Medical Economics Company.

Instant Psychopharmacology 2nd Edition Ronald J. Diamond M.D. © 2002. Published by W.W. Norton

A Primer of Drug Action Robert M. Julien, M.D., Ph. D. © 2001. Ninth Edition.

The Complete Guide to Psychiatric Drugs Edward Drummond, M.D. © 2000. Published by John Wiley & Sons, Inc.

Mosby’s 2004 Drug Guide David Nissen PharmD, Editor.© 2004. An imprint of Elsevier.

The Bipolar Disorder Survival Guide David J. Miklowitz, Ph.D. © 2002. Published by The Guilford Press.

1 The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions.

2 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!

If you have any questions not answered here, please see the Crazymeds lithium discussion board. I welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why I write these damn things. I’m frustrated enough as it is. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds.

Last modified on Friday, 28 March, 2014 at 03:03:30 by SomeMedCriticPage Author: JerodPooreDate created Monday, 25 April, 2011 at 13:52:02

Lithium by JerodPoore is copyright © 2011 JerodPoore

lithium, and all other drug names on this page and use throughout the site, are a trademark of someone else. Look on the the PI sheet or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing.

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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.

All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else.
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All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
All brand names of the drugs listed in this site are the trademarks of the companies named on the PI/SPC sheet associated with the medication, sometimes on the pages about the drugs, even though those companies may have been acquired by other companies who may or may not be listed in this site by the time you read this. Or the rights to the drug were sold to another company. And any or all of the companies involved may have changed their names.
Crazymeds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Safari or Chrome, although more than half of the visitors to this site use either Safari or Internet Explorer, so I’m doing my best to make things look nice for IE as well. I’m using Firefox and running Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
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‘Everything is true, nothing is permitted.’ - Jerod Poore

1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazymeds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had a forerunner of QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]

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