These drugs work in an unclear pathway to stabilize patients with labile mood disorders. Lithium has a narrow therapeutic/toxic ratio, and patients should get regular plasma monitoring.
The mechanism of these drugs is unknown and complex, but it is believed to alter sodium transport across cell membranes in nerve and muscle cells. It is also believed to alter intracellular signaling via activity on second messenger systems.
This drug is indicated in patients with bipolar disorder. It is also useful for blocking relapse into another mood disorder and can also be used for treatment in acute manic episodes. This drug has also been used in patients with SIADH due to the excessive urination the drug causes.
As lithium is almost exclusively excreted by the kidney, it can lead to nephrogenic diabetes insipidus. An off-label use of lithium is in the treatment of SIADH, to cause urination. Patients taking these drugs should have their kidney function checked regularly.
Patients taking lithium should get regular thyroid function tests, as this drug causes thyroid suppression. A very rare side effect is papillary thyroid carcinoma.
Tremor and ataxia are side effects of lithium toxicity.
Patients taking lithium salts have been shown to have 1st degree and complete heart block, along with other various arrhythmias.
Lithium salt administration in the first trimester of pregnancy has been linked to fetal cardiac abnormalities. Ebstein's anomaly is described as atrialization of the right ventricle and tricuspid regurgitation.
Lithium has a narrow therapeutic and toxic window. This means that lithium levels should be monitored in the patient's plasma to ensure that the right dosage is being given to properly treat the disorder. Monitoring also makes sure that lithium levels are not too high, which can lead to toxicity. Plan for every 1-2 weeks until appropriate serum concentration is reached. Then every 2 to 3 months for the first 6 months. 6 to 12 months thereafter to monitor stability.
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