Lithium (medication)

Lithium
Lithium carbonate, an example of a lithium salt
Clinical data
Trade namesLithane, others[1]
AHFS/Drugs.comMonograph
MedlinePlusa681039
License data
Pregnancy
category
  • AU: D
Routes of
administration		By mouth, parenteral
Drug classMood stabilizer
ATC code
Legal status
Legal status
Pharmacokinetic data
Protein bindingNone
MetabolismKidney
Elimination half-life24 h, 36 h (elderly)[4]
Excretion>95% kidney
Identifiers
IUPAC name
  • Lithium(1+)
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
Chemical and physical data
FormulaLi+
Molar mass6.94 g·mol−1
3D model (JSmol)
SMILES
  • [Li+]
InChI
  • InChI=1S/Li/q+1
  • Key:HBBGRARXTFLTSG-UHFFFAOYSA-N

Certain lithium compounds, also known as lithium salts, are used as psychiatric medication,[4] primarily for bipolar disorder and for major depressive disorder.[4] Lithium is taken orally (by mouth).[4]

Common side effects include increased urination, shakiness of the hands, and increased thirst.[4] Serious side effects include hypothyroidism, diabetes insipidus, and lithium toxicity.[4] Blood level monitoring is recommended to decrease the risk of potential toxicity.[4] If levels become too high, diarrhea, vomiting, poor coordination, sleepiness, and ringing in the ears may occur.[4] Lithium is teratogenic and can cause birth defects at high doses, especially during the first trimester of pregnancy. The use of lithium while breastfeeding is controversial; however, many international health authorities advise against it, and the long-term outcomes of perinatal lithium exposure have not been studied.[5] The American Academy of Pediatrics lists lithium as contraindicated for pregnancy and lactation.[6] The United States Food and Drug Administration categorizes lithium as having positive evidence of risk for pregnancy and possible hazardous risk for lactation.[6][7]

Lithium salts are classified as mood stabilizers.[4] Lithium's mechanism of action is not known.[4]

In the nineteenth century, lithium was used in people who had gout, epilepsy, and cancer.[8] Its use in the treatment of mental disorders began with Carl Lange in Denmark[9] and William Alexander Hammond in New York City,[10] who used lithium to treat mania from the 1870s onwards, based on now-discredited theories involving its effect on uric acid. Use of lithium for mental disorders was re-established (on a different theoretical basis) in 1948 by John Cade in Australia.[8] Lithium carbonate is on the World Health Organization's List of Essential Medicines,[11] and is available as a generic medication.[4] In 2022, it was the 212th most commonly prescribed medication in the United States, with more than 1 million prescriptions.[12][13] It appears to be underused in older people,[14] and in certain countries, for reasons including patients’ negative beliefs about lithium.[15]

  1. ^ Cite error: The named reference brands was invoked but never defined (see the help page).
  2. ^ Anvisa (31 March 2023). "RDC Nº 784 – Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial" [Collegiate Board Resolution No. 784 – Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control] (in Brazilian Portuguese). Diário Oficial da União (published 4 April 2023). Archived from the original on 3 August 2023. Retrieved 16 August 2023.
  3. ^ "Lithane- lithium carbonate tablet". DailyMed. 12 June 2006. Retrieved 24 November 2024.
  4. ^ a b c d e f g h i j k "Lithium Salts". The American Society of Health-System Pharmacists. Archived from the original on 8 December 2015. Retrieved 1 December 2015.
  5. ^ Poels EM, Bijma HH, Galbally M, Bergink V (December 2018). "Lithium during pregnancy and after delivery: a review". International Journal of Bipolar Disorders. 6 (1): 26. doi:10.1186/s40345-018-0135-7. PMC 6274637. PMID 30506447.
  6. ^ a b Armstrong C (15 September 2008). "ACOG Guidelines on Psychiatric Medication Use During Pregnancy and Lactation". American Family Physician. 78 (6): 772. ISSN 0002-838X. Archived from the original on 27 January 2022. Retrieved 27 January 2022.
  7. ^ "Lithium Carbonate Medication Guide" (PDF). U.S. FDA. Archived (PDF) from the original on 27 January 2022. Retrieved 27 January 2022.
  8. ^ a b Sneader W (2005). Drug discovery: a history (Rev. and updated ed.). Chichester: Wiley. p. 63. ISBN 978-0-471-89979-2. Archived from the original on 8 September 2017.
  9. ^ Lenox RH, Watson DG (February 1994). "Lithium and the brain: a psychopharmacological strategy to a molecular basis for manic depressive illness". Clinical Chemistry. 40 (2): 309–314. doi:10.1093/clinchem/40.2.309. PMID 8313612.
  10. ^ Mitchell PB, Hadzi-Pavlovic D (2000). "Lithium treatment for bipolar disorder" (PDF). Bulletin of the World Health Organization. 78 (4): 515–517. PMC 2560742. PMID 10885179. Archived from the original (PDF) on 1 April 2012.
  11. ^ World Health Organization (2023). The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. hdl:10665/371090. WHO/MHP/HPS/EML/2023.02.
  12. ^ "The Top 300 of 2022". ClinCalc. Archived from the original on 30 August 2024. Retrieved 30 August 2024.
  13. ^ "Lithium Drug Usage Statistics, United States, 2013 - 2022". ClinCalc. Retrieved 30 August 2024.
  14. ^ Almeida OP, Etherton-Beer C, Kelty E, Sanfilippo F, Preen DB, Page A (27 March 2023). "Lithium dispensed for adults aged ≥ 50 years between 2012 and 2021: Analyses of a 10% sample of the Australian Pharmaceutical Benefits Scheme". The American Journal of Geriatric Psychiatry. 31 (9): 716–725. doi:10.1016/j.jagp.2023.03.012. PMID 37080815. S2CID 257824414.
  15. ^ "Bipolar disorder: how lithium as a treatment fell out of favour". The Guardian. 9 November 2024. Retrieved 9 November 2024.
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