Lithium carbonate is a primary medication used to treat bipolar disorder, mainly for controlling manic symptoms and preventing 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 first use in the 1940s, it remains one of the cornerstone drugs 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 group. Its mechanism of action involves regulation of sodium channels and metabolism of neurotransmitters such as serotonin and dopamine, which helps calm neural 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 specific clinical situations, physicians may prescribe it for:
- Prevention of 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
- Mild weight gain
- Gastrointestinal discomfort (nausea, diarrhea)
Severe side effects require immediate medical attention:
Contraindications:
- Allergic 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 strictly avoid pregnancy. It is not recommended during breastfeeding, as lithium can be secreted into breast milk.
Concomitant use with the following drugs increases toxicity risk:
Concurrent use with anticonvulsants (e.g., carbamazepine) may reduce efficacy, requiring dose adjustments. Avoid combining with iodine-containing supplements (e.g., kelp extracts), as this may induce thyroid dysfunction.
Initial doses are typically 900-1200 mg daily, 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 stable daily water intake during treatment 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 dose the next day. 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 nearby and bring medication packaging
3. Consider gastric lavage or hemodialysis
Symptoms of toxicity may be delayed; even if symptoms improve, continuous observation for over 48 hours is necessary. During hospitalization, strict control of fluid balance and electrolytes is required.
It is recommended to take lithium carbonate at a fixed time on an empty stomach to maintain stable drug levels. Avoid consuming high-sodium foods simultaneously, as sodium ions can affect the drug’s efficacy. If gastrointestinal discomfort occurs, taking the medication after meals is acceptable, but dosage adjustments should be discussed with your doctor to ensure effectiveness.
How should I manage side effects like dry mouth or increased urination during treatment?Lithium carbonate may cause dry mouth and increased urination, which are normal reactions. Ensure adequate daily water intake (about 2-3 liters) to prevent dehydration. If muscle tremors or severe dry mouth occur, return to your doctor for blood lithium level assessment. Do not restrict water intake excessively to avoid increasing toxicity risk.
Which common medications can interfere with lithium’s effectiveness?Diuretics (e.g., furosemide), NSAIDs (e.g., ibuprofen), and certain anxiolytics may increase blood lithium levels, raising toxicity risk. Use of antidiarrheal agents (e.g., loperamide) or antihistamines may also interfere with metabolism. Always inform your healthcare provider about any new medication while taking lithium.
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 may cause kidney damage or thyroid dysfunction. Keep a record of daily symptoms to facilitate timely medication adjustments.
Can lithium be used during pregnancy or breastfeeding?Use during pregnancy may increase the risk of congenital abnormalities, especially in the later stages. If planning pregnancy, discuss alternative treatments with your doctor. During breastfeeding, lithium passes into breast milk and may affect the infant; careful assessment of risks and benefits is necessary. All reproductive plans should involve close collaboration with a psychiatrist.
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