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lithium carbonate
Lithobid (ER) · Eskalith · Lithium carbonate IR/ER · Lithium citrate solution
Mood stabilizer⚠ Unverified beta content
At a glance
- Class
- Mood stabilizer (alkali metal; narrow therapeutic index)
- Black box
- ⚠ Lithium toxicity is closely related to serum lithium levels and can occur at doses close to…
- Key monitoring
- Serum lithium level — 0.6–1.2 mEq/L maintenance (label); 1.0–1.5 mEq/L acute mania (label)
- Usual adult dose
- Acute mania: Titrate to serum level ~1.0–1.5 mEq/L
- Call provider / escalate if
- Coarse tremor, worsening unsteadiness (ataxia), slurred speech • Persistent vomiting/diarrhea, severe thirst or dehydration • Confusion, drowsiness, muscle twitching, blurred vision
Built-in explanation — generated offline from this app’s structured data (no AI, no network). Still unverified beta content.
What it is
- lithium carbonate (Lithobid (ER), Eskalith, Lithium carbonate IR/ER) — mood stabilizer (alkali metal; narrow therapeutic index).
- Used for: Bipolar I disorder – acute manic/mixed episodes; Bipolar I disorder – maintenance.
Usual adult dosing
- Acute mania: Titrate to serum level ~1.0–1.5 mEq/L (Label (Lithobid ER): ~1800 mg/day (e.g., 900 mg ×2) usually gives 1.0–1.5 mEq/L; individualize by level and response. Level twice weekly during acute phase until stable.)
- Maintenance: Serum level ~0.6–1.2 mEq/L (Label: 0.6–1.2 mEq/L is usually reached with 900–1200 mg/day. Many clinicians target the lower–middle of this range.)
- Level timing: ~12 h after the last dose (trough) (Draw before the morning dose.)
Boxed warning
- Lithium toxicity is closely related to serum lithium levels and can occur at doses close to therapeutic levels. Facilities should be available for prompt and accurate serum lithium determinations before initiating therapy.
Monitor
- Serum lithium level — 0.6–1.2 mEq/L maintenance (label); 1.0–1.5 mEq/L acute mania (label) [Twice weekly in acute phase until stable (label); 5–7 days after any dose/interacting-drug change; maintenance: label says at least every 2 months in uncomplicated remission – many facilities use every 3–6 months]
Nursing priorities
- Baseline: renal function (BUN/creatinine, eGFR), electrolytes (Na), TSH, calcium, pregnancy test in persons of childbearing potential, ECG if age >40 or cardiac risk, weight.
- Hydration status, diet/salt intake, vomiting/diarrhea, fever or heavy sweating.
- Draw lithium level ~12 h after last dose; hold the AM dose until the blood is drawn (follow facility policy).
- Maintain steady fluid intake (about 2–3 L/day unless restricted) and consistent sodium intake; do not start low-salt diets without provider input.
- Hold dose and notify provider for vomiting, diarrhea, poor intake, or signs of toxicity; obtain a level.
Major interactions
- NSAIDs (ibuprofen, naproxen, etc.): Reduce lithium clearance → ↑ level, toxicity. (Aspirin and sulindac have less effect.)
- ACE inhibitors, ARBs: ↑ lithium level.
- Thiazide diuretics: ↑ lithium level (loop diuretics less so).
- Dehydration / low-sodium diet / SGLT2i: Sodium depletion ↑ lithium retention.
Key teaching
- Take it exactly as prescribed, at the same time every day. Keep your blood level appointments – the blood test is taken about 12 hours after your last dose, BEFORE your morning dose.
- Drink plenty of water every day and eat a normal amount of salt. Do not go on a crash or low-salt diet.
- If you have vomiting, diarrhea, fever, or heavy sweating, call your provider – you may need to hold the dose.
Optional: AI explanation
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Boxed warning
- Lithium toxicity is closely related to serum lithium levels and can occur at doses close to therapeutic levels. Facilities should be available for prompt and accurate serum lithium determinations before initiating therapy.
Other serious warnings
- Lithium toxicity (see side-effect page)
- Hypothyroidism (and less often hyperthyroidism)
- Hypercalcemia / hyperparathyroidism
- Chronic kidney disease / nephrogenic DI with long-term use
- Teratogenicity (Ebstein’s anomaly – cardiac malformations; weigh risk/benefit)
- Sodium depletion raises lithium levels
- ECG changes (T-wave flattening; sinus node dysfunction, Brugada unmasking – rare)
- Dehydration (illness, heat, exercise) can precipitate toxicity
Sources: FDA label (DailyMed): LITHOBID (LITHIUM CARBONATE) TABLET, FILM COATED
- Serum lithium levelTarget: 0.6–1.2 mEq/L maintenance (label); 1.0–1.5 mEq/L acute mania (label)When: Twice weekly in acute phase until stable (label); 5–7 days after any dose/interacting-drug change; maintenance: label says at least every 2 months in uncomplicated remission – many facilities use every 3–6 months
- Renal function (creatinine / eGFR, BUN)Target: Stable; rising creatinine or falling eGFR → notify providerWhen: Baseline; every 3–6 months initially, then ~every 6–12 months
- TSH (± free T4)When: Baseline, ~6 months, then every 6–12 monthsHypothyroidism is common.
- Calcium (± PTH)When: Baseline and periodically
- Sodium / hydrationWhen: Baseline and with illness
- ECGWhen: Baseline if >40 or cardiac risk
- Weight / BMI; pregnancy testWhen: Baseline and periodically
Sources: FDA label (DailyMed): LITHOBID (LITHIUM CARBONATE) TABLET, FILM COATED
Assessment
- Baseline: renal function (BUN/creatinine, eGFR), electrolytes (Na), TSH, calcium, pregnancy test in persons of childbearing potential, ECG if age >40 or cardiac risk, weight.
- Hydration status, diet/salt intake, vomiting/diarrhea, fever or heavy sweating.
- All medications: NSAIDs, ACE inhibitors/ARBs, thiazide diuretics.
- Tremor, gait, speech, GI symptoms, mental status each contact.
Interventions
- Draw lithium level ~12 h after last dose; hold the AM dose until the blood is drawn (follow facility policy).
- Maintain steady fluid intake (about 2–3 L/day unless restricted) and consistent sodium intake; do not start low-salt diets without provider input.
- Hold dose and notify provider for vomiting, diarrhea, poor intake, or signs of toxicity; obtain a level.
- Give with food to reduce GI upset; swallow ER forms whole.
- Check level 5–7 days after dose change or when interacting drug started/stopped.
- Educate to avoid ibuprofen/naproxen (use acetaminophen unless provider approves).
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Coarse tremor, worsening unsteadiness (ataxia), slurred speech
- Persistent vomiting/diarrhea, severe thirst or dehydration
- Confusion, drowsiness, muscle twitching, blurred vision
- Seizure or fainting
- Slow or irregular heartbeat, dizziness
- Very little urine or swelling
- Fatigue, cold intolerance, weight gain, neck swelling (thyroid)
- Missed or doubled doses
Sources: FDA label (DailyMed): LITHOBID (LITHIUM CARBONATE) TABLET, FILM COATED · General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Fine hand tremor
- Polyuria / polydipsia (nephrogenic diabetes insipidus)
- Nausea, diarrhea, GI upset
- Weight gain
- Fatigue, mild cognitive dulling
- Metallic taste
- Acne / psoriasis flare, hair thinning
- Leukocytosis (benign)
Sources: FDA label (DailyMed): LITHOBID (LITHIUM CARBONATE) TABLET, FILM COATED
- NSAIDs (ibuprofen, naproxen, etc.) MajorReduce lithium clearance → ↑ level, toxicity. (Aspirin and sulindac have less effect.)
- ACE inhibitors, ARBs Major↑ lithium level.
- Thiazide diuretics Major↑ lithium level (loop diuretics less so).
- Dehydration / low-sodium diet / SGLT2i MajorSodium depletion ↑ lithium retention.
- Antipsychotics (esp. haloperidol), carbamazepine, SSRIs, serotonergic agentsNeurotoxicity / EPS / serotonin syndrome reported.
- Caffeine, theophylline, sodium bicarbonate, acetazolamide↓ lithium level.
Sources: FDA label (DailyMed): LITHOBID (LITHIUM CARBONATE) TABLET, FILM COATED
- Take it exactly as prescribed, at the same time every day. Keep your blood level appointments – the blood test is taken about 12 hours after your last dose, BEFORE your morning dose.
- Drink plenty of water every day and eat a normal amount of salt. Do not go on a crash or low-salt diet.
- If you have vomiting, diarrhea, fever, or heavy sweating, call your provider – you may need to hold the dose.
- Do not take ibuprofen (Advil, Motrin) or naproxen (Aleve) unless your provider says it is OK. Acetaminophen (Tylenol) is usually safer.
- Mild shaking of the hands, thirst, and peeing more are common. Tell your provider if they get worse.
- Tell your provider right away if you could be or plan to become pregnant.
- Do not stop suddenly; it raises the risk of mood episodes coming back.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
Indications
- Bipolar I disorder – acute manic/mixed episodes
- Bipolar I disorder – maintenance
- Off-label (common): augmentation in treatment-resistant depression; suicide-risk reduction in mood disorders
Dosing
- Acute mania: Titrate to serum level ~1.0–1.5 mEq/LLabel (Lithobid ER): ~1800 mg/day (e.g., 900 mg ×2) usually gives 1.0–1.5 mEq/L; individualize by level and response. Level twice weekly during acute phase until stable.
- Maintenance: Serum level ~0.6–1.2 mEq/LLabel: 0.6–1.2 mEq/L is usually reached with 900–1200 mg/day. Many clinicians target the lower–middle of this range.
- Level timing: ~12 h after the last dose (trough)Draw before the morning dose.
Sources: FDA label (DailyMed): LITHOBID (LITHIUM CARBONATE) TABLET, FILM COATED
Prescriber-oriented details; limited in this beta.
titration
- Start low (e.g., 300 mg BID–TID) and titrate by level.
renal Adjustment
- Renally cleared; avoid or use with extreme caution in significant renal impairment; reduce dose in older adults.
geriatric
- Lower levels (e.g., 0.4–0.8 mEq/L) often used; more sensitive to toxicity.
pregnancy Lactation
- First-trimester exposure associated with increased cardiac malformation risk; levels change in pregnancy; lithium in breast milk – infant monitoring.
Sources: FDA label (DailyMed): LITHOBID (LITHIUM CARBONATE) TABLET, FILM COATED
- Verified
- No – unverified beta
- Last reviewed
- 2026-10-29 (drafted; not clinician-reviewed)
- FDA label (DailyMed): LITHOBID (LITHIUM CARBONATE) TABLET, FILM COATED, EXTENDED RELEASE [ANI PHARMACEUTICALS, INC.]
- General nursing drug reference conventions (e.g., Davis Drug Guide / Lexicomp nursing) - summarized from standard practice; NOT line-by-line verified
Reviewer notes – please double-check
- The 0.6–1.2 mEq/L range is the label’s MAINTENANCE range; the label lists 1.0–1.5 mEq/L for acute mania. Many facilities cite 0.8–1.2 for acute treatment – verify against facility policy.
- Toxicity level bands (e.g., >1.5 mild, >2.0 moderate, >2.5 severe) are commonly cited clinical thresholds, not strict label values.
- Label (Lithobid): in uncomplicated maintenance, serum levels should be checked at least every 2 months; other schedules (q3–6 mo) are common practice – follow facility policy.
- Label notes patients abnormally sensitive to lithium may show toxicity at 1.0–1.5 mEq/L, and geriatric patients may show toxicity at levels tolerated by others.