Alkali metal cation·Psychiatry - Mood Stabilisers

Lithium carbonate (IR/SR)

Bipolar I disorder (mania and maintenance), prevention of recurrent depression

PBSMOOD STABQuilonum SR (450 mg), Lithicarb (250 mg)250 mg tabletS4+1

At a glance

Target Range

0.6–0.8 mmol/L

Half-life

24 h

High risk: Toxicity Risk

HIGH

High risk: Renal Adj.

MANDATORY

Cautions

Avoid / Cautions

Severe renal impairment, uncorrected sodium depletion/dehydration. Pregnancy Category D. Causes Ebstein's anomaly (severe fetal cardiac defect).

Where it stands

Rapid Summary

Overview

The absolute gold standard mood stabiliser. Dramatically reduces suicide rates in Bipolar Disorder. Incredibly narrow therapeutic index. Treated like a toxic heavy metal by the kidneys.

Clinical Focus

The kidneys cannot tell the difference between Lithium and Sodium. If a patient gets dehydrated (low sodium), the kidney will hoard Lithium, causing fatal toxicity in days.

Bottom Line

Lithium carbonate (IR/SR) is the gold-standard mood stabiliser for bipolar disorder with unique anti-suicidal properties, but has an extremely narrow therapeutic index requiring regular serum level, renal, and thyroid monitoring.

Formulation & Access

Brand Names

Quilonum SR (450 mg), Lithicarb (250 mg)

Oral Routes

Tablets IR (250 mg). Tablets SR (450 mg).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Bipolar I disorder (mania and maintenance), prevention of recurrent depression.

Clinical Place

Unmatched efficacy in true Bipolar disorder. The only psychiatric drug definitively proven to prevent suicide.

Quick reference

Class & Role

Alkali metal cation — The absolute gold standard mood stabiliser.

Route / Formulation

Tablets IR (250 mg). Tablets SR (450 mg). (Quilonum SR (450 mg), Lithicarb (250 mg))

Usual Dose & Max

Start PO 250 mg (IR) BD or 450 mg (SR) OD. Titrate carefully over weeks. Target blood level: 0.6 - 0.8 mmol/L (Maintenance) or up to 1.0 mmol/L (Acute Mania). Titrated strictly via Therapeutic Drug Monitoring (TDM).

Key Indication Doses

Bipolar Maintenance: Start PO 250 mg (IR) BD or 450 mg (SR) OD. Titrate carefully over weeks. Target blood level: 0.6 - 0.8 mmol/L (Maintenance) or up to 1.0 mmol/L (Acute Mania). Renal Impairment: Excreted 100% by the kidneys. Avoid entirely in severe renal failure. If eGFR drops, dose MUST drop.

Best Uses

Key Risks

Neurological (Toxicity): Coarse tremor, ataxia, confusion, seizures, coma, permanent cerebellar damage (SILENT syndrome). Renal: Nephrogenic Diabetes Insipidus (polyuria, extreme thirst), chronic interstitial nephritis leading to permanent CKD. Endocrine: Hypothyroidism (competes with iodine in the thyroid), hyperparathyroidism/hypercalcemia. Gastrointestinal: Nausea, diarrhea (often early signs of toxicity).

Key Interactions

NSAIDs, ACEi/ARBs, and Thiazide Diuretics. All three of these completely destroy the kidney's ability to excrete Lithium, doubling blood levels and causing lethal toxicity. DO NOT prescribe Ibuprofen, Perindopril, or HCTZ to a Lithium patient.

Monitoring

TDM (Serum Lithium Level) checked strictly 12 HOURS post-dose. Must wait 5-7 days after a dose change to check. Target 0.6-0.8 mmol/L. 6-monthly U&E, eGFR, TFTs, and Calcium levels for life. 'Sick Day Rules': If the patient gets gastro/vomiting, they must stop Lithium immediately and go to hospital. Dehydration = Toxicity.

Clinical Pearl

A patient on stable Lithium takes Nurofen (Ibuprofen) for a sprained ankle for 3 days. The NSAID restricts renal blood flow. The Lithium spikes to 2.5 mmol/L. The patient seizes and dies. Always check the medication list.

Access

Quilonum SR (450 mg), Lithicarb (250 mg)250 mg tablet

Brand: Quilonum SR (450 mg), Lithicarb (250 mg)
Formulation: Tablets IR (250 mg). Tablets SR (450 mg).

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