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For full information see Lithium Standards
For patients with known cardiac disorders or cardiac risk factors including those on medications known to prolong QTc e.g. antipsychotics, citalopram
Include Sodium, Potassium, Urea, Creatinine & eGFR. Patients must have adequate renal function (eGFR>60ml/min) before commencing lithium. Note in some populations the eGFR may over estimate renal function and therefore calculation of creatinine clearance would be more appropriate. For further advice see impaired renal function section.
Request via bone profile from biochemistry
Lithium can cause significant weight gain. Baseline weight is useful to support on-going physical health monitoring
|Review for potential drug interactions||
NSAIDs, diuretics, ACE inhibitors and other drugs that may adversely affect renal function or increase lithium levels. Note there is an increased risk of neurotoxicity when lithium is combined with antipsychotics
Patients will be provided with appropriate education prior to commencing lithium treatment. This should focus on
Use the Choice & Medication website to provide information
Priadel, as either lithium carbonate (tablets) or lithium citrate (liquid) is the recommended lithium preparation in NHS Greater Glasgow & Clyde. Different preparations may vary in bioavailability.
The recommended starting dose is 200 – 400mg* once daily (100 – 200mg daily in older adults) in the case of the tablets or in divided doses in the case of the liquid preparation. Note: 5ml (520mg) of Priadel liquid is considered equivalent to 200mg of Priadel tablets.
Lithium tablets should be prescribed once daily at night to enable morning trough plasma levels. Lithium liquid is usually prescribed twice daily.
*Note the SPC for Priadel and the BNF entry make reference to dosing by patient weight and allow a starting dose range of 0.2 – 1.2g daily. However accepted practice is to start low for all patients and titrate the dose upwards depending on response, level measurements and adverse effects.
The lower end of the range is usually target for treatment and maintenance therapy of older adults and special populations.
Last reviewed: 03 September 2019
Next review: 12 July 2021
Approved By: PMG-MH
Reviewer Name(s): Andrew walker, Suzanne Burke