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.. Such doses will normally produce an effective serum lithium level ranging between 1 and 1. 5 mEq/L. Long-term Control: The desirable serum lithium levels are 0. 6 to 1.2 mEq/l. Dosage will vary from one individual to another, but usually 300 mg of lithium carbonate t.i.d. or q.i.d., will maintain this level.
The typical dosing for lithium is:
- Acute Mania: 600 mg three times a day (t.i.d.) to achieve a serum lithium level between 1 and 1.5 mEq/L.
- Long-term Control: 300 mg three or four times a day (t.i.d. or q.i.d.) to maintain a serum lithium level between 0.6 and 1.2 mEq/L 1.
From the Research
Lithium dosing typically starts at 450-900 mg per day, with adjustments based on serum levels and clinical response, and the most recent evidence suggests that a single daily dose may be a viable method to reduce side effects and improve patient compliance 2.
Key Considerations
- The target therapeutic serum level for acute mania is 0.8-1.2 mEq/L, while maintenance treatment aims for 0.6-0.8 mEq/L 3.
- Dosing must be individualized as lithium has a narrow therapeutic window, and regular blood monitoring is essential to ensure safe and effective treatment 3.
- Renal function, thyroid function, and electrolytes should also be monitored regularly, as changes in these parameters can affect lithium levels and increase the risk of toxicity 3.
- Elderly patients and those with renal impairment typically require lower doses, and extended-release formulations may be preferred for once-daily dosing and fewer side effects 3, 2.
Administration Schedule
- The classical administration schedule is two or three times daily, but a single daily dose may be a viable alternative, especially in patients who can tolerate this schedule 2.
- Taking lithium in a single dose may prevent or limit the increase in urine output and subsequent thirst, but it is essential to monitor patients for potential side effects and adjust the dose accordingly 2.
Monitoring and Adjustments
- Serum lithium levels should be checked 12 hours after the last dose, and adjustments should be made based on these levels to ensure that the patient remains within the therapeutic range 3.
- Regular monitoring of renal function, thyroid function, and electrolytes is also crucial to prevent potential complications and ensure safe treatment 3.