Lithium Carbonate (Lithobid)

For treatment of manic episodes of bipolar disorder and some schizoaffective disorders.

Approved for maintenance therapy to help prevent episodes of mania or depression.

As an augmenting agent for antidepressants. Has also been used to treat aggression, PTSD, and conduct disorder in children.

For hyperthyroidism (e.g., Graves disease) (may eventually lead to hypothyroidism).

Extremely narrow therapeutic level with desired serum levels of 0.4-1 mmol/L.

Interaction with depolarizing and nondepolarizing muscle relaxants causes a prolonged response, specifically with pancuronium and succinylcholine.

Decreased dose requirement for IV and inhalational anesthetics (reduced MAC).

Elderly pts are especially at risk for toxicity. Problems include GI (e.g., nausea, vomiting, and diarrhea), neurologic (e.g., sluggish, ataxia, confusion, agitation, tremors), cardiac (e.g., prolonged QTc, bradycardia, arrhythmias), and somatic (e.g., fatigue, chills, rhinorrhea, myalgias) symptoms.