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Bipolar disorder - Management
How should I prescribe lithium?
- Always prescribe lithium by brand name.
- Lithium is available as two salts, lithium carbonate and lithium citrate, which are not dose equivalent.
- Lithium carbonate is supplied in tablet form (Camcolit®, Liskonum®, and Priadel®).
- Lithium citrate is supplied as a liquid (Priadel® liquid and Li-Liquid®).
- One 5 mL spoonful of Priadel® liquid (520 mg lithium citrate) is equivalent to 204 mg lithium carbonate.
- One 5 mL spoonful of Li-Liquid® (509 mg lithium citrate) is equivalent to 200 mg lithium carbonate.
- All lithium preparations vary widely in bioavailability and lack of clarity over which preparation is intended can lead to the person receiving a subtherapeutic or toxic dose.
- The lithium dose is usually adjusted to achieve a plasma level of 0.6 mmol/L to 1 mmol/L.
- A serum lithium level of 0.6–0.8 mmol/L is suitable for people who are being prescribed lithium for the first time.
- Higher serum lithium levels (0.8–1.0 mmol/L) are suitable for people who have relapsed previously while taking lithium or who still have sub-threshold symptoms with functional impairment while receiving lithium.
[National Collaborating Centre for Mental Health, 2006; BNF 56, 2008; MHRA, 2009a; ABPI Medicines Compendium, 2010]
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