Lithium

(lithium carbonate)

starting dose

300mg BID?

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Acute Mania:

1200-1800 mg per day in divided doses (900 BID)

Such doses will normally produce the desired serum lithium level ranging between 1.0 and 1.5 mEq/l.

Long-Term Control/Maintenence:

900 mg to 1200 mg per day

(450-600 BID)

The desirable serum lithium levels are 0.6 to 1.2 mEq/l.

( lithium levels in uncomplicated cases receiving maintenance therapy during remission should be monitored at least every two months.)

Patients unusually sensitive to lithium may exhibit toxic signs at serum levels below 1.0 mEq/l.

N.B.: Blood samples for serum lithium determinations should be drawn immediately prior to the next dose (trough)

(i.e., 8-12 hours after the previous dose).

Total reliance must not be placed on serum levels alone. Accurate patient evaluation requires both clinical and laboratory analysis.

Elderly patients often respond to reduced dosage, and may exhibit signs of toxicity at serum levels ordinarily tolerated by younger patients.

Eskalith Capsules: contains lithium carbonate, 300 mg.

Eskalith Controlled Release Tablets:

contains lithium carbonate, 450 mg.

Lithobid Tablets: 300 mg lithium carbonate

The first-line pharmacological treatment for more severe manic or mixed episodes is the initiation
of either

lithium plus an antipsychotic

or

valproate plus an antipsychotic.

For less ill
patients, monotherapy with lithium, valproate, or an antipsychotic may be
sufficient.

For mixed episodes, valproate may be preferred over lithium

The first-line pharmacological treatment for

bipolar depression

is either lithium
or

lamotrigine.

Antidepressant monotherapy is not recommended

As an alternative,
especially for more severely ill patients, some clinicians will initiate simultaneous
treatment with lithium and an antidepressant

In patients with life-threatening inanition,
suicidality, or psychosis, ECT also represents a reasonable alternative

ECT is also a potential
treatment for severe depression during pregnancy

Before starting do

SMA (creatine)

& UA

(for urine specific gravity)

&

TFT's

& EKG (if over 50)