Lithium citrate

Dosage must be individualised depending on serum lithium levels and clinical response; the minimum effective dose should be sought and maintained. Measure serum lithium four to a maximum of seven days after starting treatment; adjust the dose to maintain the serum level permanently within the diurnal range 0.5-1.0 mmol/L, with a 12-hour target of 0.5-0.8 mmol/L (take blood before a dose is due and not less than 12 hours after the previous dose). Monitor weekly until stabilisation, then intervals may be increased gradually but should not normally exceed two to three months; re-measure after dose changes, intercurrent disease, signs of manic or depressive relapse, significant changes in sodium or fluid intake, or signs of toxicity. Acute mania, hypomania and recurrent bipolar depression: a higher than normal intake may be necessary - maintain serum levels at 0.8-1.2 mmol/L until acute symptoms are controlled (not exceeding 1.5 mmol/L), then re-determine the level and re-stabilise to the prophylactic dose. Elderly patients or those below 50 kg: start 509 mg lithium citrate (equivalent to 200 mg lithium carbonate, which is 2.5 mL of liquid) in divided doses morning and evening; elderly patients may be more sensitive and long-term patients often require dose reduction over a period of years. Lithium therapy should not be initiated unless adequate facilities for routine monitoring of serum concentrations are available. Do not take a double dose to make up for a missed dose. If lithium is to be discontinued, particularly from high doses, reduce the dose gradually. When changing between lithium preparations, check the serum level first and start at a daily dose as close as possible to the previous form - bioavailability varies from product to product, so a change of product should be regarded as initiation of new treatment. Full prophylactic effect may not occur for 6 to 12 months. Children and adolescents: not recommended. eMC SPC section 4.2.