Litijum karbonat is used to treat mania that is part of bipolar disorder (manic-depressive illness). It is also used on a daily basis to reduce the frequency and severity of manic episodes. Manic-depressive patients experience severe mood changes, ranging from an excited or manic state (e.g., unusual anger or irritability or a false sense of well-being) to depression or sadness.
It is not known how Litijum karbonat works to stabilize a person's mood. However, it does act on the central nervous system. It helps you to have more control over your emotions and helps you cope better with the problems of living.
It is important that you and your family understand all the effects of Litijum karbonat. These effects depend on your individual condition and response and the amount of Litijum karbonat you use. You also must know when to contact your doctor if there are problems with using the medicine.
Litijum karbonat is available only with your doctor's prescription.
Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, Litijum karbonat is used in certain patients with the following medical conditions:
Neutropenia (a blood condition where there is a decreased number of a certain type of white blood cells).
Litijum karbonat indications
An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
Adult: Dose depends on the preparation used. Doses should be adjusted to produce a serum-Litijum karbonat concentration of 0.4-1 mmol/l. Litijum karbonat® tablets: Treatment: Initiate at 1-1.5 g daily; Prevention: Initiate at 300-400 mg daily. Priadel® tablets: Treatment and prevention: Initially, 400-1,200 mg daily in 1-2 divided doses. Priadel® syrup: Treatment and prevention: Initially, 1.04-3.12 g daily in 2 divided doses. Liskonum® tablets: Treatment: Initially, 450-675 mg bid; Prevention: Initially, 450 mg bid. Doses should be divided throughout the day during the initial period; once-daily dosing may be used when serum-Litijum karbonat concentrations have stabilised. Adjust initial dose 4-7 days after starting based on results of serum-Litijum karbonat concentrations. Monitor serum-Litijum karbonat concentrations once wkly until dosage has remained constant for 4 wk, after which monitoring may be reduced to once every 3 mth.
Child: ≥12 yr: Acute phase: Serum concentrations of 1-1.2 mEq/l. Max dose: 1.5 mEq/l. Initially, 1.8 g Litijum karbonat carbonate daily as conventional capsules/tablets in 3-4 divided doses, or 30 ml (approx 48 mEq) Litijum karbonat citrate oral solution daily in 3-4 divided doses. Alternatively, initially 1.8 g Litijum karbonat carbonate daily as extended-release tablets in 2-3 divided doses.
Maintenance: Maintain serum concentrations at the lower end of 0.6-1.2 mEq/l.
50-75% of normal dose.
25-50% of normal dose.
How should I use Litijum karbonat?
Use Litijum karbonat controlled-release and extended-release tablets as directed by your doctor. Check the label on the medicine for exact dosing instructions.
Take Litijum karbonat controlled-release and extended-release tablets by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.
Swallow Litijum karbonat controlled-release and extended-release tablets whole. Do not break, crush, or chew before swallowing.
Drinking extra fluids while you are taking Litijum karbonat controlled-release and extended-release tablets is recommended. Check with your doctor for instructions.
Do not change your diet, including the amount of salt in your diet, unless instructed by your doctor.
If you miss a dose of Litijum karbonat controlled-release and extended-release tablets, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.
Ask your health care provider any questions you may have about how to use Litijum karbonat controlled-release and extended-release tablets.
Uses of Litijum karbonat in details
There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
Use: Labeled Indications
Immediate release: Treatment of manic and mixed episodes and maintenance treatment in patients ≥7 years of age with a diagnosis of bipolar disorder.
Extended release: Treatment of manic episodes and maintenance treatment in patients ≥12 years of age with a diagnosis of bipolar disorder.
Off Label Uses
Bipolar disorder, hypomania
Data from a limited number of patients studied suggest that Litijum karbonat may be beneficial in the treatment of hypomania.
Litijum karbonat description
Litijum karbonat was used during the 19th century to treat gout. Litijum karbonat salts such as Litijum karbonat carbonate (Li2CO3), Litijum karbonat citrate, and Litijum karbonat orotate are mood stabilizers. They are used in the treatment of bipolar disorder, since unlike most other mood altering drugs, they counteract both mania and depression. Litijum karbonat can also be used to augment other antidepressant drugs. It is also sometimes prescribed as a preventive treatment for migraine disease and cluster headaches. The active principle in these salts is the Litijum karbonat ion Li+, which having a smaller diameter, can easily displace K+ and Na+ and even Ca+2, in spite of its greater charge, occupying their sites in several critical neuronal enzymes and neurotransmitter receptors.
Litijum karbonat dosage
Immediate-release capsules are usually given t.i.d. or q.i.d. Doses of controlled-release tablets are usually given b.i.d. (approximately 12-hour intervals). When initiating therapy with immediate-release or controlled-release Litijum karbonat, dosage must be individualized according to serum levels and clinical response.
When switching a patient from immediate-release capsules to Litijum karbonat (Litijum karbonat carbonate) CR Controlled-Release Tablets, give the same total daily dose when possible. Most patients on maintenance therapy are stabilized on 900 mg daily, e.g., Litijum karbonat (Litijum karbonat carbonate) CR 450 mg b.i.d. When the previous dosage of immediate-release Litijum karbonat is not a multiple of 450 mg, e.g., 1,500 mg, initiate Litijum karbonat (Litijum karbonat carbonate) CR at the multiple of 450 mg nearest to, but below, the original daily dose, i.e., 1,350 mg. When the 2 doses are unequal, give the larger dose in the evening. In the above example, with a total daily dose of 1,350 mg, generally 450 mg of Litijum karbonat (Litijum karbonat carbonate) CR should be given in the morning and 900 mg of Litijum karbonat (Litijum karbonat carbonate) CR in the evening. If desired, the total daily dose of 1,350 mg can be given in 3 equal 450-mg doses of Litijum karbonat (Litijum karbonat carbonate) CR. These patients should be monitored at 1- to 2-week intervals, and dosage adjusted if necessary, until stable and satisfactory serum levels and clinical state are achieved.
When patients require closer titration than that available with doses of Litijum karbonat (Litijum karbonat carbonate) CR in increments of 450 mg, immediate-release capsules should be used.
Acute Mania: Optimal patient response to Litijum karbonat (Litijum karbonat carbonate) can usually be established and maintained with 1,800 mg per day in divided doses. Such doses will normally produce the desired serum Litijum karbonat level ranging between 1.0 and 1.5 mEq/L.
Dosage must be individualized according to serum levels and clinical response. Regular monitoring of the patient's clinical state and serum Litijum karbonat levels is necessary. Serum levels should be determined twice per week during the acute phase, and until the serum level and clinical condition of the patient have been stabilized.
Long-Term Control: The desirable serum Litijum karbonat levels are 0.6 to 1.2 mEq/L. Dosage will vary from one individual to another, but usually 900 mg to 1,200 mg per day in divided doses will maintain this level. Serum Litijum karbonat levels in uncomplicated cases receiving maintenance therapy during remission should be monitored at least every two months.
Patients unusually sensitive to Litijum karbonat may exhibit toxic signs at serum levels below 1.0 mEq/L.
N.B.: Blood samples for serum Litijum karbonat determinations should be drawn immediately prior to the next dose when Litijum karbonat concentrations are relatively stable (i.e., 8 to 12 hours after the previous dose). Total reliance must not be placed on serum levels alone. Accurate patient evaluation requires both clinical and laboratory analysis.
Elderly patients often respond to reduced dosage, and may exhibit signs of toxicity at serum levels ordinarily tolerated by younger patients.
Litijum karbonat (Litijum karbonat carbonate) Capsules 300 mg are gray and yellow capsules imprinted with "Litijum karbonat (Litijum karbonat carbonate) " and "SB" on one side of each half of the capsule, in bottles of 100 (NDC 0007-4007-20).
Litijum karbonat (Litijum karbonat carbonate) CR Tablets 450 mg are round, yellow, biconvex, controlled-release tablets, debossed with "SKF" and "J10" on one side and scored on the other side, in bottles of 100 (NDC 0007-4010-20).
STORAGE CONDITIONS: Store at 25°C (77°F), excursions permitted to 15-30°C (59-86°F).
Manufactured by: Cardinal Health., Winchester, KY 40391 for GlaxoSmithKline., Research Triangle Park, NC 27709. September 2003
Caution should be used when Litijum karbonat and diuretics are used concomitantly because diuretic-induced sodium loss may reduce the renal clearance of Litijum karbonat and increase serum Litijum karbonat levels with risk of Litijum karbonat toxicity. Patients receiving such combined therapy should have serum Litijum karbonat levels monitored closely and the Litijum karbonat dosage adjusted if necessary.
Litijum karbonat levels should be closely monitored when patients initiate or discontinue NSAID use. In some cases, Litijum karbonat toxicity has resulted from interactions between an NSAID and Litijum karbonat. Indomethacin and piroxicam have been reported to increase significantly steady-state plasma Litijum karbonat concentrations. There is also evidence that other nonsteroidal anti-inflammatory agents, including the selective cyclooxygenase-2 (COX-2) inhibitors, have the same effect. In a study conducted in healthy subjects, mean steady-state Litijum karbonat plasma levels increased approximately 17% in subjects receiving Litijum karbonat 450 mg b.i.d. with celecoxib 200 mg b.i.d. as compared to subjects receiving Litijum karbonat alone.
Concurrent use of metronidazole with Litijum karbonat may provoke Litijum karbonat toxicity due to reduced renal clearance. Patients receiving such combined therapy should be monitored closely.
There is evidence that angiotensin-converting enzyme inhibitors, such as enalapril and captopril, and angiotension II receptor antagonists, such as losartan, may substantially increase steady-state plasma Litijum karbonat levels, sometimes resulting in Litijum karbonat toxicity. When such combinations are used, Litijum karbonat dosage may need to be decreased, and plasma Litijum karbonat levels should be measured more often.
Concurrent use of calcium channel blocking agents with Litijum karbonat may increase the risk of neurotoxicity in the form of ataxia, tremors, nausea, vomiting, diarrhea, and/or tinnitus. Caution is recommended.
The concomitant administration of Litijum karbonat with selective serotonin reuptake inhibitors should be undertaken with caution as this combination has been reported to result in symptoms such as diarrhea, confusion, tremor, dizziness, and agitation.
The following drugs can lower serum Litijum karbonat concentrations by increasing urinary Litijum karbonat excretion: acetazolamide, urea, xanthine preparations, and alkalinizing agents such as sodium bicarbonate.
The following have also been shown to interact with Litijum karbonat: methyldopa, phenytoin, and carbamazepine.
The likelihood of toxicity increases with increasing serum Litijum karbonat levels. Serum Litijum karbonat levels greater than 1.5 mEq/L carry a greater risk than lower levels. However, patients sensitive to Litijum karbonat may exhibit toxic signs at serum levels below 1.5 mEq/L.
Diarrhea, vomiting, drowsiness, muscular weakness and lack of coordination may be early signs of Litijum karbonat toxicity, and can occur at Litijum karbonat levels below 2.0 mEq/L. At higher levels, giddiness, ataxia, blurred vision, tinnitus and a large output of dilute urine may be seen. Serum Litijum karbonat levels above 3.0 mEq/L may produce a complex clinical picture involving multiple organs and organ systems. Serum Litijum karbonat levels should not be permitted to exceed 2.0 mEq/L during the acute treatment phase.
Fine hand tremor, polyuria and mild thirst may occur during initial therapy for the acute manic phase, and may persist throughout treatment. Transient and mild nausea and general discomfort may also appear during the first few days of Litijum karbonat administration.
These side effects are an inconvenience rather than a disabling condition, and usually subside with continued treatment or a temporary reduction or cessation of dosage. If persistent, a cessation of dosage is indicated.
The following adverse reactions have been reported and do not appear to be directly related to serum Litijum karbonat levels.
Neuromuscular: Tremor, muscle hyperirritability (fasciculations, twitching, clonic movements of whole limbs), ataxia, choreoathetotic movements, hyperactive deep tendon reflexes.
Central Nervous System: Blackout spells, epileptiform seizures, slurred speech, dizziness, vertigo, incontinence of urine or feces, somnolence, psychomotor retardation, restlessness, confusion, stupor, coma, acute dystonia, downbeat nystagmus.
Cardiovascular: Cardiac arrhythmia, hypotension, peripheral circulatory collapse, sinus node dysfunction with severe bradycardia (which may result in syncope).
Neurological: Cases of pseudotumor cerebri (increased intracranial pressure and papilledema) have been reported with Litijum karbonat use. If undetected, this condition may result in enlargement of the blind spot, constriction of visual fields and eventual blindness due to optic atrophy. Litijum karbonat should be discontinued, if clinically possible, if this syndrome occurs.
Thyroid Abnormalities: Euthyroid goiter and/or hypothyroidism (including myxedema) accompanied by lower T3 and T4. Iodine 131 uptake may be elevated.. Paradoxically, rare cases of hyperthyroidism have been reported.
EEG Changes: Diffuse slowing, widening of frequency spectrum, potentiation and disorganization of background rhythm.
EKG Changes: Reversible flattening, isoelectricity or inversion of T-waves.
Miscellaneous reactions unrelated to dosage are: Transient electroencephalographic and electrocardiographic changes, leukocytosis, headache, diffuse nontoxic goiter with or without hypothyroidism, transient hyperglycemia, generalized pruritis with or without rash, cutaneous ulcers, albuminuria, worsening of or-ganic brain syndromes, excessive weight gain, edematous swelling of ankles or wrists, and thirst or polyuria, sometimes resembling diabetes insipidus, and metallic taste.
A single report has been received of the development of painful discoloration of fingers and toes and coldness of the extremities within one day of the starting of treatment of Litijum karbonat. The mechanism through which these symptoms (resembling Raynaud's Syndrome) developed is not known. Recovery followed discontinuance.
Do not use this medication without telling your doctor if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.
Call your doctor at once if you have any early signs of Litijum karbonat toxicity, such as nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, lack of coordination, blurred vision, or ringing in your ears.
Do not crush, chew, or break an extended-release tablet. Swallow the pill whole.
Drink extra fluids to keep from getting dehydrated while you are taking Litijum karbonat. Tell your doctor if you have been sweating excessively, or if you are sick with fever, vomiting, or diarrhea.
Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.
Litijum karbonat can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
The results of a survey conducted on ndrugs.com for Litijum karbonat are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Litijum karbonat. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.
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Information checked by Dr. Sachin Kumar, MD Pharmacology