Caution/Monitor.ustekinumabMonitor Closely (1)ustekinumab, lithium. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of ustekinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.valbenazineMonitor Closely (1)valbenazine and lithium both increase QTc interval. Use Caution/Monitor.valerianMonitor Closely (1)valerian and lithium both increase sedation. Use Caution/Monitor.valsartanSerious - Use Alternative (1)valsartan increases toxicity of lithium by decreasing renal clearance. Avoid or Use Alternate Drug.vandetanibSerious - Use Alternative (1)lithium and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.vardenafilMonitor Closely (1)lithium and vardenafil both increase QTc interval. Use Caution/Monitor.vasopressinMinor (1)lithium decreases effects of vasopressin by pharmacodynamic antagonism. Minor/Significance Unknown.vecuroniumMinor (1)lithium increases effects of vecuronium by unknown mechanism. Minor/Significance Unknown.vemurafenibSerious - Use Alternative (1)lithium and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.venlafaxineMonitor Closely (2)venlafaxine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely. lithium and venlafaxine both decrease QTc interval. Use Caution/Monitor.Minor (1)venlafaxine, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.verapamilMinor (1)verapamil increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.vilazodoneSerious - Use Alternative (1)lithium, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .voclosporinMonitor Closely (1)lithium and voclosporin both increase QTc interval. Use Caution/Monitor.voriconazoleMonitor Closely (1)lithium and voriconazole both increase QTc interval. Use Caution/Monitor.vorinostatMonitor Closely (1)lithium and vorinostat both increase QTc interval. Use Caution/Monitor.vortioxetineSerious - Use Alternative (1)lithium, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.xipamideMonitor Closely (1)xipamide increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.ziprasidoneMonitor Closely (1)lithium, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).Serious - Use Alternative (1)lithium and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.zolmitriptanMonitor Closely (1)zolmitriptan and lithium both increase serotonin levels. Use Caution/Monitor. >10% Leukocytosis (most patients) Polyuria/polydypsia (30-50%) Dry mouth (20-50%) Hand tremor (45% initially, 10% after 1 year of treatment) Confusion (40%) Decreased memory (40%) Headache (40%) Muscle weakness (30% initially, 1% after 1 year of treatment) Electrocardiographic (ECG) changes (20-30%) Nausea, vomiting, diarrhea (10-30% initially, 1-10% after 1-2 years of treatment) Hyperreflexia (15%) Muscle twitch (15%) Vertigo (15%) 1-10% Extrapyramidal symptoms, goiter (5%) Hypothyroidism (1-4%) Acne (1%) Hair thinning (1%) Frequency Not Defined Coma Lethargy Seizures Renal toxicity Acute lithium toxicity Lithium-induced polyuria Ataxia/gait disturbance Postmarketing Reports Dermatologic: Drying and thinning of hair, alopecia, anesthesia of skin, chronic folliculitis, xerosis cutis, psoriasis onset or exacerbation, generalized pruritus with or without rash, cutaneous ulcers, angioedema, drug reaction with eosinophilia and systemic symptoms (DRESS) Black Box Warnings Toxicity is closely related to serum lithium concentrations and may occur at dosages close to therapeutic levels; monitor therapy by measuring serum lithium Equipped facilities should be identified before initiation of therapy to provide prompt and accurate serum lithium concentration dataContraindications Documented hypersensitivity Severe cardiovascular disease Pregnancy in 1st trimester Unstable renal function, sodium depletion, severe dehydration Severe debilitation Cautions Cardiovascular disease; reports of possible association between lithium treatment and unmasking of Brugada syndrome (abnormal ECG and risk of sudden death) Use with caution in patients with thyroid disease Narrow therapeutic index Risk of nephrogenic diabetes insipidus; such patients should be carefully managed to avoid dehydration with resulting lithium retention and toxicity; condition is usually reversible when lithium is discontinued Lithium-sensitive patients may experience toxicity symptoms with serum lithium concentrations of 1-1.5 mEq/L Lithium toxicity is closely related to serum levels and can occur at therapeutic dosages; if manifestations of toxicity occur, discontinue for 24-48 hours, then resume at lower dosage Mainitain geriatric patients on dosages that produce serum lithium concentrations at lower end of desired range May cause central nervous system (CNS) depression and impair ability to operate heavy machinery Hypercalcemia reported with or without hyperparathyroidism; women and older patients are possibly at greater risk; onset does not appear to be associated with duration of therapy Monitor changes in renal function; chronic therapy may diminish renal concentrating ability; usually reversible when lithium therapy discontinued Use caution in debilitated patients; may increase risk of lithium toxicity Use with caution in patients at risk for suicide Cases consistent with nephrotic syndrome reported with use of lithium; discontinuation of lithium in patients with nephrotic syndrome has resulted in remission of nephrotic syndrome Routine urinalysis and other tests may be used to evaluate tubular function (e.g., urine specific gravity or osmolality following a period of water deprivation, or 24-hour urine volume) and glomerular function (e.g., serum creatinine ,creatinine clearance, or proteinuria); during lithium therapy, progressive or sudden changes in renal function, even within normal range, indicate the need for re-evaluation of treatment An encephalopathic syndrome (characterized by weakness, lethargy, fever, tremulousness and confusion, extrapyramidal symptoms, leukocytosis, elevated serum enzymes, BUN, and FBS) has reported in a few patients treated with lithium plus a neuroleptic, most notably haloperidol; in some instances, the syndrome was followed by irreversible brain damage; because of possible causal relationship patients receiving such combined therapy or patients with organic brain syndrome or other CNS impairment should be monitored closely for early evidence of neurologic toxicity and treatment discontinued promptly if such signs appear; encephalopathic syndrome may be similar to or the same as Neuroleptic Malignant Syndrome (NMS) Lithium may prolong effects of neuromuscular blocking agents; neuromuscular blocking agents should be given with caution to patients receiving lithium Lithium toxicity The risk of lithium toxicity is increased in patients with significant renal or cardiovascular disease, severe debilitation or dehydration, or sodium depletion, and for patients receiving prescribed medications that may affect kidney function, such as angiotensin converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs), diuretics (loops and thiazides) and NSAIDs; for these patients, consider starting with lower doses and titrating slowly while frequently monitoring serum lithium concentrations and signs of lithium toxicity Neurological signs of lithium toxicity range from mild neurological adverse reactions such as fine tremor, lightheadedness, lack of coordination, and weakness; to moderate manifestations like giddiness, apathy, drowsiness, hyperreflexia, muscle twitching, ataxia, blurred vision, tinnitus, and slurred speech; severe manifestations such as clonus, confusion, seizure, coma, and death may occur; in rare cases, neurological sequelae may persist despite discontinuing lithium treatment and may be associated with cerebellar atrophy Cardiac manifestations involve electrocardiographic changes, such as prolonged QT interval, ST and T-wave changes and myocarditis; renal manifestations include urine concentrating defect, nephrogenic diabetes insipidus, and renal failure; respiratory manifestations include dyspnea, aspiration pneumonia, and respiratory failure; gastrointestinal manifestations include nausea, vomiting, diarrhea, and bloating; no specific antidote for lithium poisoning known Monitor for signs and symptoms of toxicity; if symptoms occur, decrease dosage or discontinue lithium treatment Serotonin syndrome Lithium can precipitate serotonin syndrome, a potentially life-threatening condition; risk is increased with concomitant use of other serotonergic drugs (including selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, triptans, tricyclic antidepressants, fentanyl, tramadol, tryptophan, buspirone, and St. John’s Wort) and with drugs that impair metabolism of serotonin, eg, MAOIs Monitor all patients taking lithium for emergence of serotonin syndrome; discontinue treatment with lithium and any concomitant serotonergic agents immediately if above symptoms occur and initiate supportive symptomatic treatment; if concomitant use of lithium with other serotonergic drugs is clinically warranted, inform patients of increased risk for serotonin syndrome and monitor for symptoms Pregnancy category: D Lactation: Drug is excreted in breast milk; use not recommendedPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Inhibits postsynaptic D2 receptor supersensitivity Alters cation transport in nerve and muscle cells and influences reuptake of serotonin or norepinephrine Inhibits phosphatidylinositol cycle second messenger systems Absorption Bioavailability: Immediate release, 95-100%; extended release, 60-90% Onset: Initial antimanic effect, 5-7 days; full effect, 10-21 days Peak serum time: Immediate release, 0.5-2 hr; extended release, 4-12 hr Peak plasma concentration: 0.4-0.9 mEq/L Steady-state therapeutic plasma concentration: 0.5-1.3 mEq/L Distribution Vd: Approximates total body water (0.7-1 L/kg) Metabolism Not metabolized Elimination Half-life: 18-24 hr; up to 36 hr with advanced age or renal impairment Dialyzable: Yes (hemodialysis, 50-90 mL/min; peritoneal dialysis, 13-15 mL/min) Renal clearance: 20-40 mL/min Excretion: Urine (95-99%) BRAND FORM. UNIT PRICE PILL IMAGE Lithobid oral- 300 mg tabletlithium carbonate oral- 300 mg tabletlithium carbonate oral- 600 mg capsulelithium carbonate oral- 600 mg capsulelithium carbonate oral- 600 mg capsulelithium carbonate oral- 150 mg capsulelithium carbonate oral- 150 mg capsulelithium carbonate oral- 300 mg capsulelithium carbonate oral- 300 mg tabletlithium carbonate oral- 300 mg capsulelithium carbonate oral- 300 mg tabletlithium carbonate oral- 300 mg tabletlithium carbonate oral- 450 mg tabletlithium carbonate oral- 300 mg tabletlithium carbonate oral- 300 mg capsulelithium carbonate oral- 600 mg capsulelithium carbonate oral- 300 mg capsulelithium carbonate oral- 150 mg capsulelithium carbonate oral- 300 mg tabletlithium carbonate oral- 450 mg tabletlithium carbonate oral- 150 mg capsulelithium carbonate oral- 150 mg capsulelithium carbonate oral- 600 mg capsulelithium carbonate oral- 450 mg tabletlithium carbonate oral- 450 mg tabletlithium carbonate oral- 300 mg tabletCopyright © 2010 First DataBank, Inc.Print Patient Educationlithium carbonate oral LITHIUM - ORAL (LITH-ee-um) COMMON BRAND NAME(S): Eskalith WARNING: It is very important to have the right amount of lithium in your body. Too much lithium may lead to unwanted effects such as nausea, diarrhea, shaking of the hands, dizziness, twitching, seizures, trouble speaking, confusion, or increase in the amount of urine. Tell your doctor right away if these effects occur.There is only a small difference between the correct amount of lithium and too much lithium. It is important that your doctor monitor you closely during treatment. Keep all medical and laboratory appointments while you are taking lithium. USES: This medication is used to treat manic-depressive disorder (bipolar disorder). It works to stabilize the mood and reduce extremes in behavior by restoring the balance of certain natural substances (neurotransmitters) in the brain.Some of the benefits of continued use of this medication include decreasing how often manic episodes occur and decreasing the symptoms of manic episodes, such as exaggerated feelings of well-being, feelings that others wish to harm you, irritability, anxiousness, rapid/loud speech, and aggressive/hostile behaviors. HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking lithium and each time you get a refill. If you have any questions, ask your doctor or pharmacist.There are different brands and forms of this medication available. They may not have the same effects. Do not change brands or forms without asking your doctor or pharmacist.Take this medication by mouth as directed by your doctor, usually 3 to 4 times daily for adults and 2 to 3 times daily for children. Take lithium with or right after meals to lessen stomach upset. Drink 8 to 12 glasses (8 ounces/240 milliliters each) of water or other fluid each day, and eat a healthy diet with normal amounts of salt (sodium) as directed by your doctor or dietician while taking this medication. Large changes in the amount of salt in your diet may change your lithium blood levels. Do not change the amount of salt in your diet unless your doctor tells you to do so.The dosage is based on your medical condition, lithium blood levels, and response to treatment. Children's dosage is also based on weight. For the best effect, take this medication regularly at evenly spaced times. To help you remember, take this medication at the same times every day.If you are taking the