Buy Lithobid Online

Lithobid (lithium carbonate)

BOXED WARNING

Lithium toxicity is closely related to serum levels, and can occur at doses close to therapeutic levels. Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.

THERAPEUTIC CLASS

Antimanic agent

DEA CLASS

RX

INDICATIONS

Treatment of manic episodes of bipolar disorder and maintenance treatment of bipolar disorder.

ADULT DOSAGE

Bipolar Disorder

Acute Mania:
AM Dose: 3 tabs (900mg)
PM Dose: 3 tabs (900mg)
May also be administered on 600mg tid dosing interval

Such doses will normally produce an effective serum level of 1-1.5mEq/L
Monitor serum levels 2X/week during acute phase, and until serum level and clinical condition have been stabilized

Long-Term Control:

AM Dose: 2 tabs (600mg)
PM Dose: 2 tabs (600mg)
May administer on tid dosing interval up to 1200mg/day

Desirable serum lithium concentrations are 0.6-1.2 mEq/L, which can usually be achieved w/ 900-1200mg/day

Serum lithium concentrations in uncomplicated cases receiving maint therapy during remission should be monitored at least every two months

Patients abnormally sensitive to lithium may exhibit toxic signs at serum levels 1-1.5mEq/L

PEDIATRIC DOSAGE

Bipolar Disorder

Individualize dose according to serum concentrations and clinical response

≥12 Years:
Acute Mania:
AM Dose: 3 tabs (900mg)
PM Dose: 3 tabs (900mg)
May also be administered on 600mg tid dosing interval

Such doses will normally produce an effective serum level of 1-1.5mEq/L
Monitor serum levels 2X/week during acute phase, and until serum level and clinical condition have been stabilized

Long-Term Control:
AM Dose: 2 tabs (600mg)
PM Dose: 2 tabs (600mg)
May administer on tid dosing interval up to 1200mg/day

Desirable serum lithium concentrations are 0.6-1.2 mEq/L, which can usually be achieved w/ 900-1200mg/day

Serum lithium concentrations in uncomplicated cases receiving maint therapy during remission should be monitored at least every 2 months

Patients abnormally sensitive to lithium may exhibit toxic signs at serum levels 1-1.5mEq/L

DOSING CONSIDERATIONS

Elderly
Start at lower end of dosing range

ADMINISTRATION

Oral route

Swallow tab whole, do not chew or crush
Blood samples for serum lithium determinations should be drawn immediately prior to next dose when lithium concentrations are relatively stable (eg, 8-12 hrs after previous dose)

HOW SUPPLIED

Tab, Extended-Release: 300mg

WARNINGS/PRECAUTIONS

Avoid w/ significant renal or cardiovascular disease (CVD), severe debilitation, dehydration, or Na+ depletion. May be associated w/ the unmasking of Brugada syndrome; avoid in patients w/ known/suspected Brugada syndrome. Use extreme caution if psychiatric indication is life-threatening, and if such patient fails to respond to other measures; hospitalization is a necessity in such instances. Chronic therapy may be associated w/ diminution of renal concentrating ability; carefully manage to avoid dehydration w/ resulting lithium retention and toxicity. Morphologic changes w/ glomerular and interstitial fibrosis and nephron atrophy reported during chronic therapy. Monitor patients w/ organic brain syndrome or other CNS impairment closely for early evidence of neurologic toxicity; d/c promptly if such signs appear. May cause fetal harm. May decrease Na+ reabsorption, which could lead to Na+ depletion; maintain normal diet, including salt, and an adequate fluid intake (2500-3500mL) at least during initial stabilization period. Decreased tolerance to lithium reported to ensue from protracted sweating or diarrhea; if this occurs, administer supplemental fluid and salt under careful medical supervision and reduce or suspend lithium intake until the condition is resolved. Concomitant infection w/ elevated temperatures may necessitate a temporary reduction or cessation of lithium. If hypothyroidism preexists, carefully monitor thyroid function during lithium stabilization and maintenance. If hypothyroidism occurs during lithium stabilization and maintenance, supplemental thyroid treatment may be used. May impair mental/physical abilities.

ADVERSE REACTIONS

Fine hand tremor, polyuria, muscle hyperirritability, mild thirst, cardiac arrhythmia, general discomfort, diarrhea, N/V, ataxia, tinnitus, blurred vision, hypertonicity, hypotension, glycosuria, drying and thinning of hair.

DRUG INTERACTIONS

Encephalopathic syndrome followed by irreversible brain damage w/ haloperidol and other neuroleptics reported; monitor for evidence of neurologic toxicity and d/c therapy promptly if such signs appear. May prolong effects of neuromuscular blockers; use w/ caution. May increase risk of neurotoxic effects w/ calcium channel blockers or carbamazepine. Increased levels w/ indomethacin, piroxicam, and other NSAIDs (eg, COX-2 inhibitors); monitor levels closely when initiating or discontinuing NSAID use. Acetazolamide, urea, xanthine preparations, and alkalinizing agents (eg, sodium bicarbonate) may decrease levels. May produce hypothyroidism w/ extended use of iodide preparations, especially potassium iodide. May provoke lithium toxicity w/ metronidazole; monitor closely. Risk of lithium toxicity w/ diuretics and ACE inhibitors; avoid concomitant use but, if necessary, may need to reduce lithium dose and lithium levels will need to be monitored more frequently. Fluoxetine may increase and decrease lithium levels; monitor closely.

PREGNANCY AND LACTATION

Category D, not for use in nursing.

MECHANISM OF ACTION

Antimanic agent; not established. Alters Na+ transport in nerve and muscle cells and effects a shift toward intraneuronal metabolism of catecholamines.

PHARMACOKINETICS

Distribution: Found in breast milk. Elimination: Urine (primary). T1/2=approx 24 hrs.

ASSESSMENT

Assess for CVD, severe debilitation, dehydration, Na+ depletion, life-threatening psychiatric indication, thyroid disorder, Brugada syndrome or risk factors for Brugada syndrome, pregnancy/nursing status, and for possible drug interactions. Assess baseline renal function.

MONITORING

Monitor for diminution of renal concentrating ability, glomerular and interstitial fibrosis, nephron atrophy, decreased tolerance to therapy, mental/physical ability impairment, decreased Na+ reabsorption, signs of lithium toxicity, unmasking of Brugada syndrome, and other adverse reactions. Monitor renal function. In patients w/ preexisting hypothyroidism, monitor thyroid function during therapy stabilization and maintenance. Monitor patient's clinical state and serum lithium levels regularly.

PATIENT COUNSELING

Inform of risks and benefits of therapy. Counsel about clinical signs of lithium toxicity (eg, diarrhea, vomiting, tremor); advise to d/c therapy and notify physician if any of these signs occur. Advise to seek immediate emergency assistance if fainting, lightheadedness, abnormal heartbeats, SOB, or other adverse reactions develop. Inform that lithium may impair mental/physical abilities; advise to use caution w/ activities requiring alertness.

STORAGE

15-30°C (59-86°F). Protect from moisture.

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