Lithium carbonate is an antimanic medication, typically used as a mood stabilizer and for acute mania in people with bipolar disorder. This medication must be taken as prescribed and you should always consult with your doctor before beginning the use of any other medications (prescribed or over the counter) while taking lithium carbonate, as reactions and adverse effects can occur.

Lithium carbonate brand names

  • Eskalith (discontinued in the U.S.)
  • Lithobid

What is lithium carbonate prescribed for?

Lithium carbonate is prescribed to treat acute mania in bipolar disorder and as a long-term mood stabilizer for people with bipolar disorder.

Symptoms of mania in bipolar disorder, as defined in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (American Psychological Association, 2022) [1], include:

  • Agitation or hostility
  • Fast or loud speech
  • Inability to focus
  • Racing thoughts
  • Feeling elated or euphoric
  • Grandiosity (extremely high self-esteem and inflated plans related to that ego, such as buying a mansion or flying a helicopter, that are unlikely to happen)
  • Inability to sleep, or feeling that you don’t need to sleep

Symptoms of depression include:

  • Feeling very sad
  • Feeling very tired or sleeping a lot
  • Lacking interest in things you previously enjoyed
  • Thoughts of harming yourself
  • Feeling worthless or helpless
  • Difficulty concentrating
  • Changes in appetite

The above is the FDA approved use of lithium carbonate, but it can also be prescribed for off-label uses, if it is deemed necessary, such as depression and schizophrenia [2][3].

Lithium carbonate is not typically prescribed to children under the age of 12 years old, as the safety and efficacy of this is not clear.

How does lithium carbonate work?

Although the exact way in which lithium carbonate treats mania is not currently fully understood, it has been seen to affect the way in which the brain releases certain neurotransmitters, such as increasing serotonin and GAB while decreasing dopamine and glutamate [4].

It causes a stabilization or reduction in certain brain activity, thereby alleviating severe manic episodes and helping the long-term management of bipolar disorder symptoms.

How is lithium carbonate usually taken?

Lithium carbonate is available in tablets (300mg), extended-release tablets (300mg, 450mg), capsules (150mg, 300mg, 600mg), and as a liquid. Your doctor will decide which of these methods is the most appropriate for you.

Extended-release tablets work slightly differently to other tablets, as they release the medication slowly throughout the day, so fewer doses of extended-release tablets are required. Extended-release tablets will usually be prescribed for 2-3 doses per day, while all other methods will usually be 3-4 doses per day [5].

If you are prescribed the liquid form of this medication, you should use a proper dosage implement, such as a marked spoon or cup, or a syringe. Your doctor will explain to you how to use these properly and measure your dose. Do not use a kitchen spoon as it will not give an accurate dose.

You will likely begin on a small dose, which will then be increased to find a therapeutic level.

  • For the treatment of acute mania, you may be prescribed 600-1200mg doses, three times per day.
  • For the long-term (maintenance) treatment of bipolar disorder, you may be prescribed 300mg doses, 3-4 times per day.

The amount you are prescribed will be dependent on your weight and the severity of your symptoms, so your doctor may change your prescription if there are changes in these.

Regular monitoring will take place, usually in the form of blood tests, electrocardiograms (heart monitoring), and discussions about changes in your symptoms or presentation.

Blood tests will tell your doctor the level of lithium in your blood, which will help inform them of your therapeutic dose, to ensure you are on the lowest dose that is effective. It is likely that you will have more regular testing at the beginning of your treatment, which will reduce as your condition improves and your dose is maintained [6]. Lithium blood tests are also done to ensure there is no kidney or liver damage, which can occur if long-term dosages are too high.

This medication should be taken as prescribed, without missing a dose. If a dose is missed, take the medication as soon as possible, or if it is close to the next dosage time, skip the missed dose. Never take double your prescribed dose in one go, as this can have adverse effects and may increase the risk of lithium toxicity.

How long does lithium carbonate stay in your system?

Once you begin your treatment, you may notice an improvement in some of your symptoms within the first week or two, but for some people it can take several weeks [2].

After your final dose of lithium carbonate, it may take several days before the medication is completely out of your system.

Do not suddenly stop taking lithium carbonate, even if you feel better, as this can have serious impacts on your mental and physical health. If your doctor advises that it is safe to come off this medication, they will likely reduce your prescription slowly, to prevent adverse effects.

Lithium carbonate side effects

When you begin taking this medication, you may experience some side effects. These will likely reduce over a short period of time, but if they continue or become problematic, consult your doctor.

Common side effects include:

  • Stomach upset, such as nausea, vomiting, constipation, or diarrhea
  • Dry mouth
  • Excessive saliva
  • Metallic taste in your mouth
  • Changes in your appetite or weight
  • Hair loss
  • Acne
  • Mood changes
  • Brittle nails or hair
  • Muscle pain

Serious side effects may occur. If you experience any of the following, you should consult with your doctor immediately, as they may be signs of lithium toxicity, allergic reaction, or heart or kidney disease, so you may need to come off your medication or have a reduced dose:

  • Frequent urination
  • Feeling very thirsty
  • Slow or uncontrollable movements
  • Dizziness or lightheadedness, leading to fainting
  • Abnormal heartbeat, becoming much faster or slower
  • Shortness of breath or tightness in the chest
  • Confusion
  • Hallucinations
  • Feeling very cold
  • Swelling of the lower legs
  • Blurry vision
  • Rash
  • Swelling of the face or mouth
  • Closing or tightness of the throat
  • Painful discoloration of fingers

Lithium toxicity can be fatal, so it is vital that you contact your doctor if you experience any of the above side effects, so your lithium levels can be monitored and managed safely [7].

Lithium carbonate precautions

Discuss with your doctor all your current and previous physical and mental health conditions, as this may impact your ability to take this medication safely.

You may not be able to take this medication safely if you have ever experienced heart, thyroid, or kidney problems, because of the potential side effects.

Tell your doctor about all medications you are currently taking, or plan to take (including vitamins, dietary supplements, and herbal remedies), as they may cause adverse reactions.

Discuss with your doctor if you are pregnant or planning to get pregnant, as lithium can harm your fetus. It may still be advisable to take this medication if the benefits outweigh the risks and it is required for your treatment.

Breastfeeding is not safe while you are on lithium carbonate, as it can be passed to your baby through breast milk and can be harmful [5][6].

As lithium carbonate can cause a loss of coordination and make you feel drowsy, it is recommended that you do not drive while on this medication, or until you know it is safe to do so.

If you experience excessive fluid loss, such as in the case of excessive sweating, diarrhea, or frequent urination, it is important that you replace those fluids to remain hydrated.

Lithium carbonate interactions

You should avoid drinking alcohol while taking lithium carbonate, as alcohol can cause dehydration and a decrease in the effectiveness of your medication and can increase the risk of lithium toxicity.

Inform your doctor if you are taking diuretics (water tablets) or are on a low-salt diet, as these can reduce your ability to take this medication safely. Low amounts of salt in your diet may increase the lithium levels in your blood, while diuretics may decrease the effectiveness of the medication. It is important to maintain healthy levels of fluid and salt intake while on lithium carbonate [5].

Caffeine should be limited, as it can also impact the effectiveness of this medication.

Some medications interact with lithium carbonate, impacting its effectiveness, including anti-inflammatory medications, such as Ibuprofen and naproxen, some blood pressure medications, and some antidepressant and antipsychotic medications.

Lithium carbonate storage

Always keep all medications out of reach of children.

Store lithium carbonate in its original packaging, in airtight containers, and at room temperature (never above 86 F).

If you need to dispose of medication that is out of date or no longer needed, contact a medical professional to ensure it is disposed of appropriately. Never flush medications down the toilet or put them in the bin, as this can create unnecessary risks.

What to do if you overdose on lithium carbonate

If you overdose on lithium carbonate, call a medical professional or Poison Control on 1-800-222-1222, or in case emergency medical attention is required, call 911. Symptoms of a lithium carbonate overdose may include diarrhea or vomiting, feeling drowsy or weak, blurry vision, and frequent urination. A severe overdose may cause seizures, breathing difficulties, coma, or sudden death [5][6].

FAQs on lithium carbonate

Are there any alternatives to lithium carbonate?

There are several medications used to treat bipolar disorder and the various symptoms that can be experienced by people with this condition.

Lithium has been found to be very effective at managing the extreme symptoms of bipolar, while other mood stabilizers, such as valproic acid and carbamazepine, can also be useful. Similarly, some antipsychotics, such as quetiapine and olanzapine, have been found to help manage acute symptoms [8].

Effectiveness and response to treatment will vary from person to person, so finding the right medication for your condition and symptoms may require trying different treatment options, including talking therapies.

You can discuss alternative medications with your doctor. Never stop taking your prescribed medication without medical advice and supervision.

Resources:

  1. American Psychiatric Association. (March 2022). Bipolar and Related Disorders. In The Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). APA. Retrieved from https://doi.org/10.1176/appi.books.9780890425787.x03_Bipolar_and_Related_Disorders
  2. American Society of Health-System Pharmacists, Inc. (n.d). Lithium. MedlinePlus. Retrieved from https://medlineplus.gov/druginfo/meds/a681039.html
  3. Alda M. (2015). Lithium in the Treatment of Bipolar Disorder: Pharmacology and Pharmacogenetics. Molecular Psychiatry20(6), 661–670. Retrieved from https://doi.org/10.1038/mp.2015.4
  4. Malhi, G. S., Tanious, M., Das, P., Coulston, C. M., & Berk, M. (2013). Potential Mechanisms of Action of Lithium in Bipolar Disorder. Current Understanding. CNS Drugs27(2), 135–153. Retrieved from https://doi.org/10.1007/s40263-013-0039-0
  5. Roxane Laboratories Inc. (2011). LITHIUM CARBONATE Tablets USP, LITHIUM CARBONATE Capsules USP, LITHIUM Oral Solution USP. Access Data FDA. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/017812s028,018421s027lbl.pdf
  6. The College of Psychiatric and Neurologic Pharmacists (CPNP) and the National Alliance on Mental Illness (NAMI). (2021). Lithium. NAMI. Retrieved from https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Lithium
  7. National Center for Biotechnology Information (2022). Compound Summary for CID 11125, Lithium Carbonate. PubChem. Retrieved from https://pubchem.ncbi.nlm.nih.gov/compound/Lithium-carbonate
  8. The College of Psychiatric and Neurologic Pharmacists (CPNP) and the National Alliance on Mental Illness (NAMI). (2021). Bipolar Disorder. NAMI. Retrieved from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Bipolar-Disorder/Treatment