US Brand Name: lithium

generic name: lithium carbonate

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

Class: antipsychotics, although few people consider lithium an AP. They think: mood stabilizer.

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.  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, valproic acid, and whatever they call sodium valproate where you live) and, of all things, tamoxifen.

13.  Discussion board

Crazy Meds’ lithium discussion board

14.  Your Comments About and Experiences with lithium

Tell us what you think about lithium

This is one of the many symptoms I have experience during my half-year-long, life-altering history with Lithium — an entire novel could be written about this topic considering I was falsely diagnosed with Bi-Polar disorder (Gist: got smashed [in combination with after-effects of hallucinogens, mind you], went home, fight with father, police car, self-abuse, hospitalization, erratic behavior, prescription [i.e.: horrible doctor]) when I was about 19 years old. (authors note: damn, I wish this site offered the option to use footnotes)

    So, back to the topic at hand: Uncontrollable shitting/diarrhea [sic]: this would happen actually quite often (more background info: 1200mg of lithium, 4mg risperdal, 12.5mg ambien XR [or whatever the extended release is labeled], all at a weight of 120lbs — as unlikely as all of this sounds). Sometimes, in the unlikelihood of waking up in the middle of the night, I would have to make a bowel movement. And, so, I would do what any human being would do and head to the bathroom. Unfortunately, no matter how hard I would try, I would explode (no pun intended) in my pants. I don’t think much more has to be said about this besides the fact that I had to buy new underwear quite often (and sometimes pants/shorts/socks). I could also say that there were a couple times when I got my pants down in the bathroom but couldn’t make it to the toilet and I would soil the ground before me (mostly carpet; NOT fun to clean up).

   My psychiatrist — despite myself presenting all of the symptoms — had no idea I was experiencing lithium toxicity as blood tests were not as frequent as they should have been.

    Aw, hell, isn’t lithium a great drug? Nothing better than giving a person with MDD this. I attempted suicide seven times during that long and excruciating six months. Too bad this story doesn’t have a happy ending or really an ending at all: sure, i’ve been off the junk for years, but nothing has improved in terms of depression. 

I was diagnosed with a plethora of fun mental disorders a few years ago after I tried to off myself for the umpteenth time. Initially I was put on Seroquel XR with Celexa and Klonopin to treat my many moods (mostly suicidal). Life seemed to be bouncing along pretty good for a couple years with a few rocky periods. Mostly mania. Until my super duper great insurance through work changed to a piece of shit insurance that apparently didn’t like my Seroquel. Since I was unable to pay $600+ a month to stay medicated I quit all my meds. Big no-no for someone like me apparently. I went off the rails big time, lost my job, gained a fun little anxiety disorder, spent my saving, lost my car and nearly lost my boyfriend. Finally this year I found government resources (ha) to get some medications but THEY DON’T LIKE SEROQUEL EITHER! Turns out neither does my therapist or nurse practitioner. They started me on Lithium (600mg a day) a few months back, with lorazepam and citalopram. Recently I was bumped up to Lithium 900mg a day. And I adore it. I’ve had endless family and personal stress and have managed to deal with it all with a sense of grace I’ve never had before. Normal I’d be rocking in a corner sucking my damn thumb and now I have a “bring it on” attitude. I know others have trouble with it. And the side effect of stomach issues isn’t fun. But I’ll gladly take multiple trips to the toilet if I can get through the day without talking to myself. I’m off the lorazepam now, my shaking and teeth grinding is basically gone and I have a fantastic relationship that’s finally moving forward. Three cheers for my crazy meds!

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Enter your own Comments & Experiences with lithium here.
You must be a registered member of the Crazy Meds Talk forum to post a comment on this page.

15.  Full US PI sheet, Global SPCs & PILs, check for drug-drug interactions

lithium Full US Prescribing Information / PI Sheet

Check for drug-drug interactions

16.  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.

Date created 25 Apr 2011 - 13:52 Page Creator: JerodPoore Last edited by:

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