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 should be initiated at 12-24 mmol (450-900 mg) per day, with adjustments based on serum levels and clinical response, and the target therapeutic serum level should be maintained between 0.6 and 0.8 mmol/L, as recommended by the most recent study 2.
Key Considerations for Lithium Dosing
- The usual maintenance daily dose is 25-35 mmol (lithium carbonate 925-1300 mg) for patients aged <40 years; 20-25 mmol (740-925 mg) for those aged 40-60 years; and 15-20 mmol (550-740 mg) for patients aged >60 years, as indicated in the study 3.
- Extended-release formulations may allow once-daily dosing and reduce gastrointestinal side effects, as suggested by the study 4.
- Lithium should be taken with food to minimize stomach upset, and maintaining consistent salt and fluid intake is important as changes can affect lithium levels.
- Blood draws for lithium levels should be done 12 hours after the last dose for accurate measurement, as recommended by the study 3.
Monitoring and Adjustments
- Regular blood monitoring is essential, with levels checked 5-7 days after starting or changing doses, then every 1-3 months once stable.
- Dosing should be individualized based on age, weight, and kidney function, with lower doses often needed for elderly patients or those with renal impairment.
- The identified lithium level thresholds associated with risks of physical complications, such as hypothyroidism, hyperthyroidism, and CKD3+, may facilitate the development of evidence-based guidelines recommending lithium treatment, as suggested by the study 2.
Potential Side Effects and Interactions
- Lithium is associated with a mildly increased risk of thyroid dysfunction and CKD in a predominantly Chinese population, as indicated by the study 2.
- Higher lithium serum levels are associated with elevated rates of hypothyroidism, hyperthyroidism, and CKD3+, as suggested by the study 2.
- Valproate, olanzapine, quetiapine, and risperidone generally exhibited reduced likelihood of thyroid dysfunction and CKD3+ compared with lithium, without any difference in advanced CKD, as indicated by the study 2.