lithium carbonate: clinical use

Prescribing considerations

• Lithium has a narrow therapeutic index and requires reliable serum-level and safety monitoring.
• Prescribe a consistent product; manage a formulation change as a new initiation because bioavailability differs.
• Assess concurrent medicines, salt and fluid intake, comorbidities, pregnancy status and ability to recognise toxicity.

Contraindications and cautions

• Check the product-specific SmPC because wording differs between brands.
• Hypersensitivity to lithium or relevant excipients.
• Severe renal impairment for Priadel and Camcolit; Liskonum lists impaired renal function more broadly.
• Untreated hypothyroidism.
• Low body sodium, dehydration, a low-sodium diet or Addison's disease.
• Brugada syndrome or a family history of Brugada syndrome.

Monitoring

• Assess renal, thyroid and cardiac function, electrolytes, calcium, blood count, body mass and pregnancy status where relevant before treatment.
• Measure serum lithium after initiation, product or treatment changes and intercurrent illness, then regularly once stable.
• Continue periodic renal, thyroid and calcium assessment and monitor adverse effects, mood and adherence.

Clinical pharmacology

Lithium carbonate supplies lithium ions. It is eliminated almost entirely by the kidneys, so renal function and sodium-water balance strongly influence exposure.

Formulation and product differences

• Priadel and Camcolit are prolonged- or controlled-release tablets; Liskonum is a controlled-release film-coated tablet.
• Priadel's score permits equal division. Camcolit's score only aids swallowing. Liskonum may be halved but should not be chewed or broken up.
• Licensed indications and age restrictions differ between selected products.

Modified-release tablet

Route: Oral

Strengths: 200 mg, 400 mg

Tablet

Route: Oral

Strengths: 250 mg, 450 mg