Lithium carbonate

Mood stabiliser

Indications

Bipolar — acute mania, maintenance, prophylaxisAugmentation in treatment-resistant depressionReduces suicide risk

Adult dose

Start 400 mg nocte (200 mg in elderly). Titrate to target serum level 12h post-dose: 0.6–0.8 mmol/L (maintenance), 0.8–1.0 mmol/L (acute mania / augmentation).

Common side effects

Fine tremorPolyuria/polydipsiaWeight gainGI upset (early)HypothyroidismAcne/psoriasis

Serious side effects

Toxicity: coarse tremor, ataxia, dysarthria, confusion, seizures, coma — at >1.5 mmol/L emergencyNephrogenic diabetes insipidusChronic kidney diseaseHyperparathyroidismCardiac (T-wave changes, sinus node dysfunction)

Contraindications

Severe renal impairmentUntreated hypothyroidism (caution)Addison's diseaseBrugada syndromePregnancy (1st trimester — Ebstein's anomaly; specialist)

Monitoring

Pre-treatment: U&E, eGFR, TFT, calcium, FBC, weight, ECG if cardiac risk, pregnancy test
Levels: 5–7 days after starting/dose change, then 3-monthly first year, 6-monthly thereafter
U&E, TFT, calcium, weight 6-monthly

Notable interactions

NSAIDs raise levels (avoid or monitor closely)
ACE inhibitors / ARBs raise levels
Thiazide diuretics raise levels significantly
Loop diuretics — variable, monitor
Metronidazole, tetracyclines raise levels
Dehydration (vomiting, diarrhoea, fever, low salt) → toxicity (sick day rules)

Notes

Narrow therapeutic index — issue lithium alert card, info booklet, record book.

Curated reference based on BNF, Maudsley Prescribing Guidelines and NICE. Verify against current BNF and local guidelines before prescribing.