- Mode of action is unkown
- Usually given as lithium carbonate, it is most useful in preventing mania. Needs to be given for 18 months for the benefits to be clear.
- At therapeutic levels the side effects are fine tremor, metallic taste, dry mouth, thirst, mild polyura, nausea, weight gain and hypothyroidism in 20% of women who take it - this is rarer in men, Renal impairment can occur after prolonged use
- Above 2.5 mmol/L you get coarse tremor, agitation, twitching, thirst and polyura, At higher levels renal failure, seizure, coma and death. Toxic levels can arise from dehydration or with a low salt diet
- Before starting perfom an ECG, electrolyte balance, creatinine clearancem TFTs.
- Measure lithium levels weekly, then every 3 months when stable
- Test thyroid function and renal function every 6 months to avoid rebound mania
- Withdraw gradually so that you avoid rebound mania
- Avoid in patients where adherence will ne an issue and avoid in renal failure and pregnancy. Best not to combine with diuretics, ACE inhibitors etc.
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