Lithium

Should be taken with food.

Severe CV disease, cardiac disease associated with rhythm disorder, cardiac insufficiency, low body Na levels (e.g. dehydrated patients, on low Na diets, or with Addison's disease), debilitation; known, suspected or family history of Brugada syndrome; untreated or untreatable hypothyroidism. Severe renal impairment. Concomitant use with diuretics.

Patient with risk factors for QT interval prolongation (e.g. cardiac disease, bradycardia, thyroid disease, hypokalaemia, hypomagnesaemia, hypocalcaemia, female, advanced age); myasthenia gravis, suicidal tendency, seizure, family history of cardiac arrest or sudden death. Patients undergoing electroconvulsive therapy (ECT). Avoid abrupt withdrawal. Mild to moderate renal impairment. Children and elderly. Pregnancy and lactation. Patient Counselling This drug may cause CNS disturbances (e.g. somnolence, dizziness, hallucination), if affected, do not drive or operate machinery. Monitoring Parameters Monitor serum lithium levels (twice weekly until both patient's clinical status and levels are stable, then repeat every 1-3 months or as clinically indicated), renal function (at baseline, every 2-3 months during the 1st 6 months of treatment, then once a year in stable patients or as clinically indicated), serum Ca concentrations (at baseline, 2-6 weeks after initiation, then every 6-12 months thereafter as clinically indicated), thyroid (at baseline, 1-2 times within the first 6 months of treatment, then once a year in stable patients or as clinically indicated), serum electrolytes, ECG, and CBC with differential (at baseline and as clinically indicated); weight. Observe for clinical worsening, suicidality, or unusual changes in behaviour (particularly during the initial course of treatment or dose changes). Assess for signs of thyroid abnormalities, kidney changes, electrolyte imbalance, polyuria, polydipsia.

Significant: Heart failure, hyperparathyroidism, hypercalcaemia, hypothyroidism, pseudotumor cerebri, nephrogenic diabetes insipidus, polydipsia, polyuria, unmask or aggravate Brugada Syndrome. Blood and lymphatic system disorders: Leucocytosis. Cardiac disorders: Cardiac arrhythmia, bradycardia. cardiac arrest, ventricular fibrillation, ventricular tachycardia, Torsade de pointes, QT interval prolongation, cardiomyopathy, sinus node dysfunction, ECG changes. Endocrine disorders: Disturbance of thyroid function (e.g. euthyroid goitre, thyrotoxicosis). Eye disorders: Blurred vision, scotoma. Gastrointestinal disorders: Dysgeusia, abdominal discomfort, nausea, vomiting, diarrhoea, dry mouth, gastritis. General disorders and administration site conditions: Peripheral oedema. Investigations: Weight gain, ECG changes, prolonged QT interval, T-wave depression. Metabolism and nutrition disorders: Hypermagnesaemia, hyperglycaemia, anorexia. Musculoskeletal and connective tissue disorders: Muscle weakness, rhabdomyolysis. Nervous system disorders: Fine hand tremors, ataxia, dizziness, slurred speech, stupor, coma, myasthenia gravis, hyperactive deep tendon reflexes, giddiness, memory impairment, vertigo, seizure, extrapyramidal disorders, encephalopathy, nystagmus, peripheral neuropathy (prolonged treatment), neuroleptic malignant syndrome. Psychiatric disorders: Delirium, confusion. Renal and urinary disorders: Nonspecific nephron atrophy, renal interstitial fibrosis. Reproductive system and breast disorders: Sexual dysfunction. Skin and subcutaneous tissue disorders: Acne, alopecia, folliculitis, pruritus, exacerbation of psoriasis, rash. Vascular disorders: Hypotension, peripheral circulatory collapse.
Potentially Fatal: Serotonin syndrome.

May increase serum lithium concentration and risk of toxicity with antibiotics (e.g. metronidazole, tetracycline, co-trimoxazole, trimethoprim, spectinomycin), NSAIDs (including selective cyclooxygenase [COX] II inhibitors), drugs affecting the renin-angiotensin system (e.g. ACE inhibitors, angiotensin II receptor antagonists), drugs affecting electrolyte balance (e.g. steroids). May decrease serum lithium concentration and risk of loss of efficacy with xanthine derivatives (e.g. caffeine, theophylline), Na bicarbonate, carbonic anhydrase inhibitors, urea. May increase risk of toxicity with antipsychotics (e.g. olanzapine, clozapine, haloperidol at high doses), carbamazepine, phenytoin, methyldopa, clonazepam, TCAs, tetracyclic antidepressants, neuromuscular blocking agents. May increase risk of neurotoxicity with Ca channel blockers. May precipitate serotonin syndrome with SSRIs, triptans, serotonin and norepinephrine reuptake inhibitors (SNRI), MAOIs, fentanyl, tramadol, tryptophan, buspirone. May lower seizure threshold with antidepressants, antipsychotics, anaesthetic, theophylline. Increase risk of prolonging QTc interval with antiarrhythmics (e.g. disopyramide, hydroquinidine, procainamide, quinidine, amiodarone, sotalol), antipsychotics (e.g. haloperidol, droperidol, thioridazine), antibiotics (e.g. IV erythromycin, sparfloxacin), serotonin antagonists (e.g. ketanserin, dolasetron mesylate), antihistamine (e.g. astemizole, terfenadine), antimalarials (e.g. artemisinin derivatives, mefloquine, halofantrine), arsenic trioxide, cisapride, ranolazine. May enhance hypothyroid effect with potassium iodide.

Antipsychotics

N05AN01 - lithium ; Belongs to the class of lithium antipsychotics.
N05AN - Lithium ; Used in the management of psychosis.