Pregnancy of Lithiumchloride in details
Lithiumchloride crosses the placenta in concentrations similar to those in the maternal plasma (Newport 2005).
Cardiac malformations in the infant, including Ebstein anomaly, are associated with use of Lithiumchloride during the first trimester of pregnancy. Other adverse events including polyhydramnios, fetal/neonatal cardiac arrhythmias, hypoglycemia, diabetes insipidus, changes in thyroid function, premature delivery, floppy infant syndrome, or neonatal Lithiumchloride toxicity are associated with Lithiumchloride exposure when used later in pregnancy (ACOG 2008). The incidence of adverse events may be associated with higher maternal doses (Newport 2005). Fetal echocardiography should be considered if first trimester exposure occurs (ACOG 2008).
Due to pregnancy-induced physiologic changes, women who are pregnant may require dose adjustments of Lithiumchloride to achieve euthymia and avoid toxicity (ACOG 2008; Grandjean 2009; Yonkers 2011).
For planned pregnancies, use of Lithiumchloride during the first trimester should be avoided if possible (Grandjean 2009). However, the absolute risk of Ebstein anomaly is small and treatment for bipolar disorder should not be withheld when clinically indicated (Larsen 2015). If Lithiumchloride is needed during pregnancy, the minimum effective dose should be used, maternal serum concentrations should be monitored, and consideration should be given to start therapy after the period of organogenesis; Lithiumchloride should be suspended 24 to 48 hours prior to delivery or at the onset of labor when delivery is spontaneous, then restarted when the patient is medically stable after delivery (ACOG 2008; Grandjean 2009; Newport 2005).
Lithiumchloride breastfeeding
Excretion of this drug into breastmilk is highly variable. There have been reports of breastfed infants who have shown signs/symptoms associated with Lithiumchloride toxicity (e.g., hypertonia, hypothermia, cyanosis, and ECG changes); this may occur more frequently in infants with elimination impairments (e.g., dehydration) or in newborn/premature infants.
Use is contraindicated (AU, UK) Use is not recommended and a decision should be made to discontinue breastfeeding or discontinue the drug, taking into account the importance of the drug to the mother (US) Excreted into human milk: Yes Comments: -Bottle feeding is recommended due to the risk of Lithiumchloride toxicity. -If breastfeeding is continued, monitoring of infant serum Lithiumchloride, serum creatinine, blood urea nitrogen, and thyroid stimulating hormone levels are recommended.
See references
References for pregnancy information
- Cerner Multum, Inc. "Australian Product Information." O 0
- Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
- "Product Information. Lithobid (Lithiumchloride)." Ciba Pharmaceuticals, Summit, NJ.
- "Product Information. Eskalith (Lithiumchloride)." SmithKline Beecham, Philadelphia, PA.
References for breastfeeding information
- United States National Library of Medicine "Toxnet. Toxicology Data Network. Available from: URL: http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT." ([cited 2013 -]):
- Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
- "Product Information. Lithobid (Lithiumchloride)." Ciba Pharmaceuticals, Summit, NJ.
- Cerner Multum, Inc. "Australian Product Information." O 0
- "Product Information. Eskalith (Lithiumchloride)." SmithKline Beecham, Philadelphia, PA.
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Information checked by Dr. Sachin Kumar, MD Pharmacology
