lithium

Mood stabilizer

Brands: LITHOBID

Last reviewed 2025-12-28

Reviewed by PsychMed Editorial Team.

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Quick answers

What is lithium?
Lithium carbonate is a classic mood stabilizer with robust evidence for acute mania, maintenance prophylaxis, and suicide prevention in bipolar disorder.
What is LITHOBID?
LITHOBID is a brand name for lithium.
What is LITHOBID (lithium) used for?
Label indications include: Acute manic and maintenance treatment of bipolar I disorder.
What drug class is LITHOBID (lithium)?
Mood stabilizer.
What is the mechanism of action of LITHOBID (lithium)?
Modulates second messenger systems; neuroprotective/neurotrophic effects (exact mechanism not fully known).
What strengths does LITHOBID (lithium) come in?
Immediate-release capsules/tablets: 150 mg, 300 mg, 600 mg.
Is LITHOBID (lithium) a controlled substance?
No — it is not scheduled as a controlled substance under U.S. federal law.

Snapshot

Class: Mood stabilizer
Common US brands: LITHOBID
Therapeutic drug monitoring recommended; reference range 600–1200 ng/mL.
Last reviewed: 2025-12-28

Label indications

Acute manic and maintenance treatment of bipolar I disorder.

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Clinical Highlights

Lithium carbonate is a classic mood stabilizer with robust evidence for acute mania, maintenance prophylaxis, and suicide prevention in bipolar disorder. This profile focuses on bipolar I/II management and emphasizes safe monitoring given lithium’s narrow therapeutic index.

Remains first-line for many patients due to efficacy in mania and maintenance plus anti-suicidal properties; requires ongoing laboratory monitoring for renal, thyroid, and lithium levels. The compare tool, the lithium evidence feed, and the bipolar disorder hub can support side-by-side review of alternatives and patient education.
Because lithium is renally cleared, dehydration and common medications (NSAIDs, ACE inhibitors, thiazides) can raise levels; education on toxicity symptoms (tremor, GI upset, confusion) and when to seek urgent evaluation is central to safe use.
Benefit and side effects both evolve over weeks: lab follow-up after dose changes and consistent salt/hydration habits matter more than day to day fluctuations in mood.
Acute mania (bipolar disorder) (FDA 1970)
Maintenance therapy for bipolar disorder (FDA 1974)
Generic: All formulations widely available generically.

Dosing & Formulations

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.
Acute mania: start 600–900 mg/day divided BID/TID; titrate to serum 0.8–1.2 mEq/L (draw 12-hour trough). Typical total 1,200–1,800 mg/day.
Maintenance: 900–1,200 mg/day (BID or TID IR; BID ER) targeting 0.6–1.0 mEq/L; lower range (0.4–0.8) for older adults or long-term stability.
Adjust doses in 300 mg increments with repeat levels 5–7 days later; maintain consistent formulation.

Monitoring & Risks

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.
Ongoing: Periodic renal and thyroid function; assess for toxicity symptoms.
Education often emphasizes hydration, consistent salt intake, and key interactions (NSAIDs/ACE inhibitors/diuretics).
Gastrointestinal upset: Nausea, diarrhea common during initiation.

Drug Interactions

Sodium/water depletion (diuretics, dehydration) raises levels—hydration and consistent salt intake are commonly emphasized. Thiazide diuretics, ACE inhibitors, ARBs, and NSAIDs increase levels—dose reduction and closer level monitoring are typically needed.

Caffeine and theophylline can lower levels—adjust dose if necessary.
Serotonergic agents rarely cause serotonin syndrome; closer monitoring is common when combining with SSRIs/SNRIs.

Practice Notes

Education often covers maintaining hydration, consistent sodium intake, and recognizing toxicity symptoms. Chronic NSAID use can raise lithium levels; acetaminophen is often preferred when feasible.

During pregnancy, lithium levels are monitored more frequently (clearance increases), with risk/benefit discussions that include teratogenic risk; postpartum clearance decreases and dose adjustments may be needed.
Baseline labs (BMP, TSH, CBC, pregnancy test, ECG as indicated) are obtained, and lithium/renal/thyroid parameters are monitored per guidelines.

References

Lithium prescribing information — DailyMed (2024)
The CANMAT and ISBD Guidelines for the Management of Patients With Bipolar Disorder: 2021 Update — Bipolar Disorders (2021)Guidelinebipolarclinical
Mcknight2012 Lithium Toxicity
Gitlin2016 Lithium Side Effects
Lithium IN THE Prevention OF Suicide IN Mood Disorders: Updated Systematic Review AND Meta Analysis — BMJ (2013)