From the FDA Drug Label
DOSAGE AND ADMINISTRATION Acute Mania: Optimal patient response to lithium carbonate usually can be established and maintained with 600 mg t.i.d.. Dosage must be individualized according to serum levels and clinical response.
The maximum recommended dose of lithium is not explicitly stated in the drug label. However, it is mentioned that optimal patient response can be achieved with 600 mg t.i.d. (three times a day), which translates to a total daily dose of 1800 mg.
- The label emphasizes the importance of individualized dosage based on serum levels and clinical response.
- It is crucial to monitor serum lithium levels and the patient's clinical state regularly to avoid toxicity 1.
From the Research
The maximum recommended dose of lithium carbonate for adults is typically 1300 mg per day for patients aged <40 years, 925 mg for those aged 40-60 years, and 740 mg for patients aged >60 years, as indicated by the most recent and highest quality study 2.
Key Considerations
- Treatment usually begins with lower doses (450-900 mg daily) and is gradually increased based on serum lithium levels, which should be maintained between 0.6-1.2 mEq/L for acute treatment and 0.6-0.8 mEq/L for maintenance therapy.
- Regular blood monitoring is essential, with levels checked every 3-6 months during stable maintenance and more frequently when initiating therapy or adjusting doses.
- Lithium has a narrow therapeutic window, meaning the difference between therapeutic and toxic levels is small.
- Toxicity can occur at levels above 1.5 mEq/L, causing symptoms like tremor, confusion, seizures, and potentially life-threatening complications.
Important Factors to Consider
- Factors that can increase lithium levels include dehydration, reduced salt intake, and certain medications like NSAIDs and diuretics.
- Patients should maintain consistent salt and fluid intake, take lithium with food to reduce gastrointestinal side effects, and immediately report signs of toxicity to their healthcare provider.
- The efficacy of lithium is clearly dose-dependent and reliably correlates with serum concentrations, as shown in studies 2, 3.
- A once-daily dosing schedule of lithium may be a viable method to reduce side effects and improve patient compliance, as suggested by a study 4.