Lithium

Overview

Categories

Primary Characterstics

Molecular Structure of Lithium

Lithium citrate, Lithium citrate are the derivatives of LithiumLithium citrate, Lithium citrate are the derivatives of Lithium It is of Natural origin and belongs to Alkaline Metal. It belongs to Psychotropic Drugs pharmacological group on the basis of mechanism of action. The Molecular Weight of Lithium is 73.90.

Indications

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Pharmacokinetics

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Contraindications

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Drug Interactions

Lithium is known to interact with other drugs, the details of drug interactions is as follows:

Severity N/A

Bendrofluazide

Interaction of Bendrofluazide with Lithium

Bumetanide

Interaction of Bumetanide with Lithium

Chlorothiazide

Interaction of Chlorothiazide with Lithium

Chlorpromazine (HCl)

Interaction of Chlorpromazine (HCl) with Lithium

Chlortetracycline (HCl)

Interaction of Chlortetracycline (HCl) with Lithium

Chlorthalidone

Interaction of Chlorthalidone with Lithium

Clopamide

Interaction of Clopamide with Lithium

Cyclopenthiazide

Interaction of Cyclopenthiazide with Lithium

Demeclocycline (HCl)

Interaction of Demeclocycline (HCl) with Lithium

Desipramine (HCl)

Interaction of Desipramine (HCl) with Lithium

Desmopressin (Acetate)

Interaction of Desmopressin (Acetate) with Lithium

Dexamphetamine (Sulphate)

Interaction of Dexamphetamine (Sulphate) with Lithium

Diltiazem (HCl)

Interaction of Diltiazem (HCl) with Lithium

Distigmine (Br)

Interaction of Distigmine (Br) with Lithium

Doxepin (HCl)

Interaction of Doxepin (HCl) with Lithium

Droperidol

Interaction of Droperidol with Lithium

Ethacrynic Acid

Interaction of Ethacrynic Acid with Lithium

Fluphenazine

Interaction of Fluphenazine with Lithium

Human Insulin

Interaction of Human Insulin with Lithium

Hydroflumethiazide

Interaction of Hydroflumethiazide with Lithium

Iodine

Interaction of Iodine with Lithium

Ketoprofen

Interaction of Ketoprofen with Lithium

Lisinopril

Interaction of Lisinopril with Lithium

Mannitol

Interaction of Mannitol with Lithium

Mefruside

Interaction of Mefruside with Lithium

Methyclothiazide

Interaction of Methyclothiazide with Lithium

Methyldopa

Interaction of Methyldopa with Lithium

Metoclopramide (HCl)

Interaction of Metoclopramide (HCl) with Lithium

Minocycline (HCl)

Interaction of Minocycline (HCl) with Lithium

Naproxen

Interaction of Naproxen with Lithium

Neostigmine

Interaction of Neostigmine with Lithium

Pancuronium (Br)

Interaction of Pancuronium (Br) with Lithium

Polythiazide

Interaction of Polythiazide with Lithium

Ramipril

Interaction of Ramipril with Lithium

Sodium Bicarbonate

Interaction of Sodium Bicarbonate with Lithium

Spectinomycin (HCl)

Interaction of Spectinomycin (HCl) with Lithium

Suxamethonium (Cl)

Interaction of Suxamethonium (Cl) with Lithium

Tetracycline (HCl)

Interaction of Tetracycline (HCl) with Lithium

Theophylline

Interaction of Theophylline with Lithium

Ticarcillin (di Na)

Interaction of Ticarcillin (di Na) with Lithium

Tienilic Acid

Interaction of Tienilic Acid with Lithium

Verapamil (HCl)

Interaction of Verapamil (HCl) with Lithium

Cilazapril

Interaction of Cilazapril with Lithium

Paroxetine

Interaction of Paroxetine with Lithium

Perindopril

Interaction of Perindopril with Lithium

Potassium Iodide

Interaction of Potassium Iodide with Lithium

Rivastigmine

Interaction of Rivastigmine with Lithium

Secnidazole

Interaction of Secnidazole with Lithium

Tramadol (HCl)

Interaction of Tramadol (HCl) with Lithium

Fosinopril (Na)

Interaction of Fosinopril (Na) with Lithium

Ketorolac (Tromethamine)

Interaction of Ketorolac (Tromethamine) with Lithium

Sodium Iodide

Interaction of Sodium Iodide with Lithium

Oxtriphylline (Choline Theophyllinate)

Interaction of Oxtriphylline (Choline Theophyllinate) with Lithium

Bupropion (HCl)

Interaction of Bupropion (HCl) with Lithium

Gallopamil

Interaction of Gallopamil with Lithium

Lypressin

Interaction of Lypressin with Lithium

Vasopressin

Interaction of Vasopressin with Lithium

Azapropazone

Interaction of Azapropazone with Lithium

Tetrabenazine

Interaction of Tetrabenazine with Lithium

Piretanide

Interaction of Piretanide with Lithium

Celecoxib

Interaction of Celecoxib with Lithium

Insulin Lispro

Interaction of Insulin Lispro with Lithium

Sibutramine

Interaction of Sibutramine with Lithium

Rubidium Iodide

Interaction of Rubidium Iodide with Lithium

Baclofen

Interaction of Baclofen with Lithium

Details: Effects of muscle relaxants (e.g Baclofen) enhanced by Lithium; Baclofen possibly aggravates hyperkinesis caused by lithium.
Diazepam

Interaction of Diazepam with Lithium

Details: When both drugs given in combination cause Hypothermia
Diclofenac (Na)

Interaction of Diclofenac (Na) with Lithium

Details: decrease in plasma concentration of diclofenac by sucralfate
Enalapril (Maleate)

Interaction of Enalapril (Maleate) with Lithium

Details: coadministration may increase lithium plasma level and lithium toxcity occur
Management: lithium levels should be monitored
Fluoxetine (HCl)

Interaction of Fluoxetine (HCl) with Lithium

Details: co administration may lead to lithium toxicity, symptomps include agitation, restlessness, GI distress
Management: lithium level should be monitored
Hydrochlorothiazide

Interaction of Hydrochlorothiazide with Lithium

Details: Volume depletion by Hydrochlorothiazide increases lithium absorption and causes Lithium toxicity
Metronidazole

Interaction of Metronidazole with Lithium

Details: Lithium toxicity occurs when lithium is used with metronidazole.
Nabumetone

Interaction of Nabumetone with Lithium

Details: Nabumetone has produced an elevation of plasma lithium levels and a reduction in renal lithium clearance.
Pyridostigmine (Br)

Interaction of Pyridostigmine (Br) with Lithium

Details: lithium interfere with neuromuscular conduction
Tiaprofenic Acid

Interaction of Tiaprofenic Acid with Lithium

Details: Lithium levels can be increased.
Management: Avoid concurrent use if possible or monitor lithium levels and adjust dose.
Aescin

Interaction of Aescin with Lithium

Rofecoxib

Interaction of Rofecoxib with Lithium

Details: Rofecoxib have produced an elevation of plasma lithium levels and a reduction in renal lithium clearance resulting in lithium toxcity.
Imidapril

Interaction of Imidapril with Lithium

Tenoxicam

Interaction of Tenoxicam with Lithium

Details: Lithium toxicity may result due to decreased elimination of lithium.
Chlorocarbachol

Interaction of Chlorocarbachol with Lithium

Iodide

Interaction of Iodide with Lithium

Telmisartan

Interaction of Telmisartan with Lithium

Details: Reversible increases in serum lithium concentrations and toxicity have been reported during concomitant administration of lithium with Telmisartan.
Moexipril

Interaction of Moexipril with Lithium

Dexketoprofen

Interaction of Dexketoprofen with Lithium

Molindone

Interaction of Molindone with Lithium

Details: The risk of certain serious side effects is increased when taken with Molindone.
Oxyphenbutazone

Interaction of Oxyphenbutazone with Lithium

Details: These drugs should not be taken concurrently with out doctor and pharmacist approval.
Salsalate

Interaction of Salsalate with Lithium

Details: Salsalate may increase the blood levels of lithium by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.
Piroxicam-beta-cyclodextrin

Interaction of Piroxicam-beta-cyclodextrin with Lithium

Details: Piroxicam decreases renal excretion of lithium
Lornoxicam

Interaction of Lornoxicam with Lithium

Details: Might lead to an increase of the lithium peak concentration and thus to a possible increase in adverse events.
Management: Monitor lithium serum levels.
Dexibuprofen

Interaction of Dexibuprofen with Lithium

Details: NSAIDs can increase the plasma levels of lithium, by reducing its renal clearance.
Management: The combination is not recommended. Frequent lithium monitoring should be performed. The possibility of reducing the dose of lithium should be considered.
Dapoxetine HCl

Interaction of Dapoxetine HCl with Lithium

Details: may lead to an incidence of serotonin associated effects.
Management: Dapoxetine should not be used in combination with other SSRIs, MAOIs or other serotonergic medicinal/herbal products
Vortioxetine

Interaction of Vortioxetine with Lithium

Details: increases the level of vortioxetine
Management: monitor closely ,use alternative

Major

Amiloride (HCl)

Interaction of Amiloride (HCl) with Lithium

Details: Renal clearance of lithium is reduced by amiloride due to oncrease in serum lithium levels which leads to lithium toxicity.
Management: This combination should be avoided or used with extreme caution include reduce dose of lithium.ithium levels should be monitor.
Eplerenone

Interaction of Eplerenone with Lithium

Details: Cause lithium toxicity.
Management: Monitor serum lithium levels frequently.

Minor

Frusemide or Furosemide

Interaction of Frusemide or Furosemide with Lithium

Details: Furosemide may decrease the excretion of Lithium.
Management: No action required.

Moderate

Captopril

Interaction of Captopril with Lithium

Details: Captopril may increase the serum concentration of Lithium
Onset: Delayed
Management: Monitor for increased serum concentrations/toxic effects of lithium if Captopril is initiated/dose increased, or decreased effects if Captopril is discontinued/dose decreased. Lithium dosage reductions will likely be needed following the addition of Captopril.
Carbamazepine

Interaction of Carbamazepine with Lithium

Details: Neurotoxicity,lethargy,muscular weakness,ataxia,dystonia,tremor and sinus node dysfunction may occur when Carbamazepine given with Lithium.
Management: Adverse neurologic and cardiac effects,lithium toxicity and altered thyroxine levels must be monitor.
Alcohol

Interaction of Alcohol with Lithium

Details: Coadministration result in additive central nervous system and impairment, thinking and psychomotor skills.
Management: Patient should be warned of interaction and advised to limit alcohol cosumption.
Haloperidol

Interaction of Haloperidol with Lithium

Details: Both of them have been use together safely.Fewer patients may observe encephalopathic syndrome consisting of neurotoxic effect and extra pyramidal symptoms followed by irreversible brain damage.
Management: . Larger doses should be avoided. Mainly reduce the haloperidol dose.During the first week of treatment careful observation should be done and if any sign of encephalopathic syndrome occurs discontinued the treatment.
Indomethacin

Interaction of Indomethacin with Lithium

Details: Indomethacin increases the serum concentration of lithium results in increased toxicity.
Management: Closely monitor the serum level of lithium.
Clozapine

Interaction of Clozapine with Lithium

Details: Both agents act as additive serotonergic result in the development of neurologic toxicity.
Management: Closely monitor for neurologic symptoms and check the level of blood glucose regularly.
Tubocurarine (Cl)

Interaction of Tubocurarine (Cl) with Lithium

Details: Lithium exacerbate the pharmacological effects of tubocurarineresults in prolonged apnea and delayed recovery from anesthesia.
Management: Closely monitor for respiratory depression and life support should be readily available in case of emergency
Losartan (K)

Interaction of Losartan (K) with Lithium

Details: Losartan increases the plasma level of lithium by inhibiting secretion of aldosterone result in increased toxicity.
Management: Closely monitor the patient for lithium toxicity.
Thioridazine (HCl)

Interaction of Thioridazine (HCl) with Lithium

Details: Coadministration may initiate the number of neurologic and psychiatric symptoms such as extrapyramidal effects, seizures, change in mental status, delirium, fever etc
Management: Closely monitor the patient for changed efficacy and safety. Discontinue one or both agents if necessary.
Doxacurium

Interaction of Doxacurium with Lithium

Details: Llithium potentiate the pharmacological effect of doxacurium.Prolong apnea and delayed recovery from anesthesia occurs when they administered in combination.
Management: Close monitoring for the development of respiratory depression.

These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.

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Side Effects

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Dosage

Lithium's dosage details are as follows:
Dose Single Dose Frequency Route Instructions

Adult Dosage

0.4 to 1.2 mg0.8 (0.8)24 hourlyPOFor first 5-7 days. Initial dose then adjusted according to serum lithium estinations.
1.5 to 2 g1.8 (1.75)24 hourlyPOFor 5-7 days for acute mania.

Paedriatic Dosage (20kg)

Not recommended for this age group

Neonatal Dosage (3kg)

No data regarding the neonatal dosage details of Lithium is available.

High Risk Groups

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Warning / Precautions

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Storage Conditions

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Interference in Pathology

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Brands / Trade Names of Lithium

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