Lithium+Tablets

=Lithium= [|Asus Eee pad transformer]

How it works
Quilonum SR is used to treat mental illness. It is taken both to treat and prevent episodes of mood swing, either up (mania) or down (depression), in a condition called either manic-depression or bipolar disorder. //Unknown; its actions include inhibition of dopamine release, enhancement of serotonin release and decreased formation of intracellular second messengers. Lithium has little or no psychotropic effect in normal individuals.//

Questions to Ask
What medications? drugs that may contribute to serontonin toxicity, ACEi and ARB (decrease lithium excretion), loop diuretics and NSAIDs (increase lithium levels), potassium and sodium citrate (increases excretion by alkalinising urine) - medical conditions? acute hyponatraemia (//Addison's disease, dehydrated or debilitated patients, low sodium diet - increases lithium toxicity),// psoriasis (may be exacerbated by lithium), renal dysfunction (reduce dose even if mild) - allergies?

Avoid use, particularly during the first trimester; lithium may increase the risk of congenital heart defects; ADEC category D. Carbamazepine or valproate are not suitable alternatives for use during pregnancy. Lithium clearance increases during pregnancy (dose adjustment may be required) and falls immediately after delivery. Reduce dose in the last days of pregnancy to avoid maternal and fetal toxicity. Neonatal neurotoxicity and hypothyroidism have also been reported. Avoid use.
 * Pregnancy**
 * Breastfeeding**

How to take
Initially 750–1000 mg daily in divided doses (every 12 hours if using controlled release product); increase dose by 250–500 mg daily (depending on serum concentration) until symptoms resolve. Maximum dose 2500 mg daily. 250–1000 mg daily in divided doses (every 12 hours if using controlled release product) for 2 weeks, then adjust dose according to serum concentration. Use reduced dose and monitor carefully Take blood for lithium concentration at least 8–12 hours after last dose. Measure concentration 5–7 days after starting treatment and after each dose change until stabilised, then every 3 months. Steady state may not be reached for 4–7 days (longer in the elderly or those with renal impairment). Monitor lithium concentration more frequently during illness (eg gastroenteritis), manic or depressive phases, changes in diet or temperature, pregnancy and concomitant medication (eg diuretics).
 * Acute mania**
 * Prophylaxis**
 * Elderly, renal impairment**
 * Concentration monitoring**

//Acute mania//, 0.5–1.2 mmol/L. //Prophylaxis//, 0.4–1 mmol/L. Symptoms of toxicity are common >1.5 mmol/L (>1.2 mmol/L in elderly). Sometimes clinical toxicity can occur at lower concentrations, particularly in those with organic neurological damage or other CNS illness (eg epilepsy).
 * Therapeutic range**

Side effects
metallic taste, nausea, diarrhoea, epigastric discomfort, weight gain, fatigue, headache, vertigo, tremor, acne, psoriasis, leucocytosis, polyuria, hypothyroidism, benign T wave changes on ECG nephrogenic diabetes insipidus with polydipsia and polyuria, memory impairment, hair loss, hyperparathyroidism arrhythmias, hyperthyroidism blurred vision, increasing diarrhoea, nausea, vomiting, muscle weakness, drowsiness, apathy, ataxia, flu-like illness increased muscle tone, hyper-reflexia, myoclonic jerks, coarse tremor, dysarthria, disorientation, psychosis, seizures, coma Renal damage has never been conclusively demonstrated for those with well-controlled lithium treatment without multiple episodes of acute toxicity.
 * Common**
 * Infrequent**
 * Rare**
 * Mild-to-moderate toxicity**
 * Severe toxicity**
 * Nephrotoxicity**

Other advice?
- Regular blood tests are important during treatment. - Be alert for signs and symptoms of lithium toxicity (eg extreme thirst and frequent urination, nausea and vomiting), especially during illness, excessive sweating or low fluid intake; if these occur, stop taking the tablets and seek medical attention immediately. - Take with food. Do not break, crush or chew controlled release lithium tablets, and avoid taking with hot drinks. - Maintain a normal diet with regular salt and fluid intake. Drink more non-alcoholic fluid during hot weather to avoid toxicity. - Avoid sodium bicarbonate (found in products such as indigestion medicines, eg Salvital®, and products like Ural®, Citralite® or Citravescent®) as they make lithium less effective.
 * Practice points**
 * most patients require hospitalisation for acute mania
 * as onset of action may be delayed for 6–10 days, consider adding a benzodiazepine or antipsychotic in severe mania; use oral agents when possible but supervise compliance carefully, and withdraw after acute mania has resolved
 * after acute mania resolves, titrate lithium dose to achieve concentration for prophylaxis; treat for 6–12 months
 * obtain renal and thyroid function tests at baseline, then every 3–6 months; monitor for clinical signs and symptoms of thyroid dysfunction
 * for patients with significant cardiac disease, consider an ECG at baseline and at follow-up
 * nephrogenic diabetes insipidus greatly increases risk of lithium toxicity; reassess need for lithium if this develops
 * antidepressants may be used with lithium during the depressive phase of bipolar illness
 * do not stop lithium treatment abruptly; withdraw gradually to avoid relapse

CMI
[|Quilonum SR] [|AMH]