Lithium carbonate is a primary medication used for the treatment of bipolar disorder, mainly to control manic symptoms and prevent mood swings. This drug helps regulate the balance of neurotransmitters in the brain, effectively reducing the frequency of manic episodes and lowering the risk of suicide. Since its introduction in the 1940s, it remains one of the cornerstone medications for bipolar disorder treatment.
In addition to its core indications, lithium carbonate is also used for treating conditions such as obsessive-compulsive disorder and borderline personality disorder. Its efficacy and safety have been validated through long-term clinical use, but regular monitoring of blood drug levels is necessary to ensure therapeutic effectiveness and avoid toxicity.
Main brand names include: Eskalith®, Lithane®, among others. The generic name is “Lithium Carbonate,” formulated as tablets or capsules in white crystalline powder form, with common dosages of 300mg, 450mg, and 600mg.
Lithium carbonate is classified as a “mood stabilizer,” belonging to the lithium salt category. Its mechanism of action involves modulation of sodium channels and regulation of neurotransmitter metabolism (such as serotonin and dopamine), which helps calm neuronal excitability in the brain.
Main uses include:
1. Treatment of acute manic episodes in bipolar disorder
2. Long-term prevention of manic/depressive episodes
3. Management of chronic manic symptoms
In certain clinical scenarios, physicians may prescribe for:
- Prevention in patients with recurrent suicidal tendencies
- Adjunct therapy for obsessive-compulsive symptoms
- Enhancement of electroconvulsive therapy (ECT) efficacy
Mild side effects include:
- Hand tremors
- Dry mouth and increased urination
- Slight weight gain
- Gastrointestinal discomfort (nausea, diarrhea)
Severe side effects require immediate medical attention:
Contraindications:
- Allergy to lithium salts
- Severe renal impairment
- Severe dehydration or electrolyte imbalance
Pregnancy is classified as Category C, with potential risks of congenital abnormalities; women of childbearing age should use strict contraception. Breastfeeding is not recommended as lithium can be secreted into breast milk.
Concurrent use with the following medications may increase toxicity risk:
Using anticonvulsants (e.g., carbamazepine) simultaneously may reduce efficacy, requiring dose adjustments. Avoid combining with iodine-containing supplements (e.g., kelp extracts), as this may induce thyroid dysfunction.
Starting dose is typically 900-1200 mg per day, divided into multiple doses, taken with or after meals to reduce gastrointestinal irritation. The target blood concentration should be maintained between 0.6-1.2 mmol/L, with weekly blood tests to monitor levels.
The maintenance dose is adjusted based on individual response; pediatric doses are calculated according to body weight. Take medication at fixed times and avoid arbitrary dose changes. Maintain consistent daily water intake to prevent dehydration and sudden increases in drug concentration.
If a dose is missed and less than 3 hours have passed, take it immediately and adjust the next dose timing; if more than 3 hours have passed, skip the missed dose and do not double the next dose. Do not increase the dose on your own to compensate for missed doses.
Signs of acute poisoning include severe tremors, confusion, frequent urination or anuria. If overdose is suspected, immediately:
1. Ensure airway patency
2. Seek medical attention and bring medication packaging
3. Consider gastric lavage or hemodialysis
Symptoms of toxicity may be delayed; even if symptoms subside, continuous observation for over 48 hours is necessary. During hospitalization, strict control of fluid balance and electrolyte levels is required.
It is recommended to take lithium carbonate at a fixed time on an empty stomach to maintain stable drug levels. Avoid high-sodium foods simultaneously, as sodium ions can affect drug efficacy. If gastrointestinal discomfort occurs, taking the medication after meals is acceptable, but dosage adjustments may be necessary under medical supervision to ensure effectiveness.
How should I manage side effects like dry mouth or frequent urination during treatment?Lithium carbonate may cause dry mouth and increased urination, which are normal. Ensure adequate daily water intake (about 2-3 liters) to prevent dehydration. If muscle tremors or severe dry mouth occur, consult your doctor promptly to evaluate blood lithium levels. Do not restrict water intake excessively, as this may increase toxicity risk.
Which common medications can interfere with lithium therapy?Diuretics (e.g., furosemide), NSAIDs (e.g., ibuprofen), and certain anxiolytics may elevate blood lithium levels, increasing toxicity risk. Antidiarrheal agents (e.g., loperamide) or antihistamines may also interfere with metabolism. Always inform your healthcare provider of any new medications while on lithium therapy.
What health checks are recommended for long-term lithium use?Long-term users should have blood lithium levels checked every 3-6 months, along with renal and thyroid function tests. Monitoring urine output, weight, and blood pressure is also advised, as prolonged use can cause kidney damage or thyroid dysfunction. Keep a record of daily symptoms for timely medication adjustments.
Can lithium be used during pregnancy or breastfeeding?Using lithium during pregnancy may increase the risk of congenital abnormalities, especially in the later stages, so careful evaluation is necessary. If planning pregnancy, discuss alternative treatments with your doctor. During breastfeeding, lithium can be secreted into breast milk and may affect the infant; thus, a risk-benefit assessment and close monitoring are required. All reproductive plans should involve close collaboration with a psychiatrist.
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