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Excerpt from  Cafer's Mood Stabilizers and Antiepileptics Lithium Pharmacokinetic Interactions Lithium is removed from the body almost exclusively by the kidneys. Several medications affect the rate of lithium clearance. Since lithium has a narrow therapeutic index, blood levels need to be closely followed.  Thiazide diuretics and NSAIDS have the greatest potential to increase lithium concentrations, usually 25% to 40%.  Rarely the increase may be much greater, leading to lithium toxicity. If another prescriber insists on adding a thiaze or NSAID, a reasonable approach is to decrease lithium dose by about 30% and recheck blood level in one week.  Educate patients that NSAIDS, blood pressure meds, and diuretics can cause lithium toxicity. For OTC pain medications, they should choose Tylenol or aspirin . Advise them to inform the prescriber if they are planning to change their caffeine intake. Excedrin is OK (combo of aspirin, acetaminophen, and caffeine). Check lithi...

Excerpt from  Cafer's Mood Stabilizers and Antiepileptic Drugs ,  available on Amazon Lithium dosing  Excerpt from Cafer's Psychopharmacology, available soon on Amazon  With lithium treatment (at standard doses), it is necessary to monitor blood levels. As for any drug, blood levels should be checked at “trough”, which is about 12 hours after the last dose. For treatment of acute mania , a relatively high level of 1.0 to 1.4 mmol/L is desired. Once mood has stabilized, the maintenance dose should be decreased to achieve a level of 0.6 to 1.0 mmol/L. . For augmentation of treatment-resistant depression (TRD), the recommended target serum level is 0.5–0.8 mmol/L. A level of 2.0 mmol/L is considered toxic . Discontinuation of lithium is ideally accomplished by slow taper over about 6–12 weeks. It could be argued that there is no such thing as a subtherapeutic lithium level. Some naturopathic doctors recommend tiny dose 5–20 mg (equivalent) lithium orotate capsules as a...

Excerpt from  Cafer's Mood Stabilizers and Antiepileptics Mood stabilizer      Neuroprotectant  FDA approved for: ❖ Acute mania     ❖ Bipolar disorder (maintenance) Used off-label for:     ❖ Depression     ❖ Suicidal ideation     ❖ Dementia     ❖ Alcoholism     ❖ Agitation     ❖ Headaches     ❖ Neutropenia     ❖ SIADH     ❖ Longevity  Lithium is the gold standard treatment for bipolar disorder. It is superior to all medications at preventing suicide, reducing risk 5-fold for individuals with recurrent unipolar depression and 6-fold for those with bipolar disorder (Tondo et al, 2016).  It works by several mechanisms that are not entirely understood.  Lithium is an element on the periodic table, classified as an alkali metal. Its atomic number is 3, making it the 3rd lightest element. Lithium was one ...