lithium citrate: clinical use

Prescribing considerations

• Confirm the exact brand, salt and formulation; switching should be managed like treatment initiation because bioavailability varies.
• Assess renal, thyroid and cardiac status, calcium, electrolytes, full blood count, weight or BMI and pregnancy status before initiation.
• Review fluid and sodium balance, interacting medicines, and ability to recognise toxicity and attend monitoring.
• Use particular caution with older or frail people, renal impairment, significant fluid loss and after bariatric surgery.
• Provide a lithium alert card and monitoring record.

Contraindications and cautions

• Hypersensitivity to lithium or product excipients
• Severe renal impairment
• Cardiac disease or cardiac insufficiency
• Untreated hypothyroidism
• Low body sodium, dehydration or a low-sodium diet
• Addison's disease
• Brugada syndrome or a family history of Brugada syndrome
• Breastfeeding under the selected product licences

Monitoring

• Use correctly timed trough serum lithium measurements against an individual clinical target.
• Monitor renal function, thyroid function, calcium, electrolytes and weight or BMI.
• Increase monitoring after formulation changes, interacting medicines, intercurrent illness or substantial changes in fluid or sodium intake.
• Withhold lithium, obtain urgent lithium and renal-function tests, and seek specialist advice if toxicity is suspected.

Clinical pharmacology

Lithium has a narrow therapeutic index. Oral solutions are rapidly absorbed; lithium is not metabolised, is not protein-bound and is eliminated predominantly by the kidneys.

Formulation and product differences

• Priadel Liquid is a sugar-free, pineapple-flavoured preparation containing ethanol; dilution is not recommended.
• Li-Liquid is cherry-flavoured and contains glucose, sorbitol, propylene glycol, parabens, ethanol and sunset yellow.
• The selected liquids differ in concentration and excipients and must not be interchanged without review and lithium monitoring.

Syrup

Route: Oral

Strengths: 509 mg/5 mL, 1018 mg/5 mL