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Mood stabiliser Pregnancy: Ebstein's anomaly risk (smaller than historically thought). Use only if essential in first trimester; monitor levels closely throughout.

Lithium Carbonate

Brand names: Priadel, Camcolit

Adult dose

Dose: Start 200–400 mg once daily at night; titrate by serum levels to target 0.6–1.0 mmol/L
Route: Oral
Frequency: Once or twice daily (modified-release: once daily)
Max: Guided by serum levels (target 0.6–1.0 mmol/L); higher in acute mania (0.8–1.2)
Start 200–400 mg at night. Adjust every 5–7 days by serum level (12h post-dose). Maintenance: 0.6–0.8 mmol/L. Acute mania: 0.8–1.2 mmol/L. Switch between preparations (Priadel vs Camcolit) requires retitration. Adequate sodium and fluid intake essential.

Paediatric dose

Route: Oral
Frequency: Once daily at night
Max: Guided by serum level (0.6–1.0 mmol/L)
Not licensed in children <12 years. 12–17 years (specialist only): starting doses lower; 150–200 mg at night, titrate by levels. Serum levels same targets as adults.

Dose adjustments

Renal

CONTRAINDICATED in significant renal impairment. Use extreme caution if mild renal impairment — reduced excretion causes toxicity. Specialist input essential.

Hepatic

Lithium not hepatically metabolised; no hepatic dose adjustment required.

Clinical pearls

  • Narrow therapeutic index — 12-hour post-dose serum levels essential (toxicity at >1.5 mmol/L)
  • Patient must carry lithium card and blue lithium alert card
  • Any illness causing dehydration or sodium loss can cause lithium toxicity — patient education
  • Avoid NSAIDs and ACE inhibitors if possible — use paracetamol for analgesia
  • Check TFTs and eGFR every 6 months (hypothyroidism and nephropathy)

Contraindications

  • Renal impairment (significant)
  • Untreated hypothyroidism
  • Addison's disease
  • Brugada syndrome
  • Dehydration states

Side effects

  • Fine tremor
  • Polyuria and polydipsia (nephrogenic diabetes insipidus)
  • Hypothyroidism (long-term — 20–40% on long-term therapy)
  • Weight gain
  • GI upset (nausea, diarrhoea — more at start)
  • Cognitive dulling
  • Toxicity signs: coarse tremor, confusion, ataxia, seizures (levels >1.5 mmol/L)

Interactions

  • NSAIDs — significantly increase lithium levels (avoid; use paracetamol)
  • ACE inhibitors/ARBs/thiazide diuretics — increase lithium levels (reduce sodium and volume)
  • Loop diuretics (furosemide) — increase lithium levels
  • Sodium depletion (vomiting, diarrhoea, hot weather) — increases lithium levels
  • SSRIs/serotonergic agents — increased serotonin syndrome risk

Monitoring

  • Serum lithium level (12h post-dose, every 3–6 months when stable)
  • eGFR (6-monthly)
  • TFTs (6-monthly)
  • Weight
  • U&E

Reference: BNFc; BNF; NICE NG185 Bipolar; NICE NG66 Prescribing Lithium. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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