lithium

Mood stabilizer • Brands: LITHOBID

Last reviewed: 2026-02-22

General information

Class: Mood stabilizer
Common US brands: LITHOBID
Typical dose range: Acute mania: typical starting doses are 600–900 mg/day divided BID/TID, titrated to serum 0.8–1.2 mEq/L (12-hour trough). Typical total daily dose is 1,200–1,800 mg/day.
Therapeutic drug monitoring recommended; reference range 0.6–1.2 mEq/L.
Last reviewed: 2026-02-22

Dosing & forms

Forms/strengths: Immediate-release capsules/tablets: 150 mg, 300 mg, 600 mg.; Extended-release tablets (Lithobid, Eskalith CR): 300 mg, 450 mg.; Oral solution (lithium citrate): 8 mEq/5 mL.
Frequency: Acute mania: typical starting doses are 600–900 mg/day divided BID/TID, titrated to serum 0.8–1.2 mEq/L (12-hour trough). Typical total daily dose is 1,200–1,800 mg/day.
Typical range: Acute mania: typical starting doses are 600–900 mg/day divided BID/TID, titrated to serum 0.8–1.2 mEq/L (12-hour trough). Typical total daily dose is 1,200–1,800 mg/day.
Therapeutic range: 0.6–1.2 mEq/L

Mechanism (brief)

Modulates second messenger systems; neuroprotective/neurotrophic effects (exact mechanism not fully known).

Metabolism & Half‑life

Metabolism: Not metabolized
Half‑life: Steady-state mean 24 h

Therapeutic Drug Monitoring (TDM)

Recommended: Yes

Reference range: 0.6–1.2 mEq/L

Sampling: 12‑h trough (or pre‑AM dose)

View labelExact

Monitoring highlights

Baseline: BMP (BUN/Cr), electrolytes, TSH, pregnancy test if relevant, weight/BMI.
Level timing: 12-hour trough (or pre-morning dose if BID).
Level cadence: 5–7 days after each dose change; then every 3–6 months when stable.
Lithium levels are typically rechecked after dehydration/illness or when starting or stopping interacting medications (NSAIDs, ACE inhibitors/ARBs, thiazides), often within 5–7 days of the change.
Ongoing: Periodic renal and thyroid function, with assessment for toxicity symptoms.
Periodic calcium monitoring (hyperparathyroidism risk) and follow-up for urine concentrating symptoms (polyuria/polydipsia) are often part of long-term therapy.

Sources

Lithium carbonate extended-release tablets — Prescribing Information — DailyMed (2024)
AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology — Pharmacopsychiatry (2018)
The CANMAT and ISBD Guidelines for the Management of Patients With Bipolar Disorder: 2021 Update — Bipolar Disorders (2021)
Bipolar disorder: assessment and management (NICE guideline CG185) — National Institute for Health and Care Excellence (2020)
Lithium plus valproate combination therapy versus monotherapy for relapse prevention in bipolar I disorder (BALANCE) — The Lancet (2010)
Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis — BMJ (2013)

General information

Class: Mood stabilizer

Common US brands: LITHOBID

Typical dose range: Acute mania: typical starting doses are 600–900 mg/day divided BID/TID, titrated to serum 0.8–1.2 mEq/L (12-hour trough). Typical total daily dose is 1,200–1,800 mg/day.

Therapeutic drug monitoring recommended; reference range 0.6–1.2 mEq/L.

Last reviewed: 2026-02-22

Dosing & forms

Forms/strengths: Immediate-release capsules/tablets: 150 mg, 300 mg, 600 mg.; Extended-release tablets (Lithobid, Eskalith CR): 300 mg, 450 mg.; Oral solution (lithium citrate): 8 mEq/5 mL.

Frequency: Acute mania: typical starting doses are 600–900 mg/day divided BID/TID, titrated to serum 0.8–1.2 mEq/L (12-hour trough). Typical total daily dose is 1,200–1,800 mg/day.

Typical range: Acute mania: typical starting doses are 600–900 mg/day divided BID/TID, titrated to serum 0.8–1.2 mEq/L (12-hour trough). Typical total daily dose is 1,200–1,800 mg/day.

Therapeutic range: 0.6–1.2 mEq/L

Monitoring highlights

Baseline: BMP (BUN/Cr), electrolytes, TSH, pregnancy test if relevant, weight/BMI.

Level timing: 12-hour trough (or pre-morning dose if BID).

Level cadence: 5–7 days after each dose change; then every 3–6 months when stable.

Lithium levels are typically rechecked after dehydration/illness or when starting or stopping interacting medications (NSAIDs, ACE inhibitors/ARBs, thiazides), often within 5–7 days of the change.

Ongoing: Periodic renal and thyroid function, with assessment for toxicity symptoms.

Periodic calcium monitoring (hyperparathyroidism risk) and follow-up for urine concentrating symptoms (polyuria/polydipsia) are often part of long-term therapy.