Pharmacology

• Renal elimination → proximal tubule → Na channel
• Anything affecting Na⁺/kidneys → affects lithium levels

Indications

• Bipolar I, II

  → Maintenance ✔

  → Acute mania ✔

  → Prevents mania > depression

  → ↓ suicide risk

Contraindications

1. Pregnancy → Ebstein’s anomaly
2. Severe renal disease (CrCl <30)
3. CVD + arrhythmia (relative)
4. Addison’s disease
5. Thyroid disorders (untreated)

Interactions (↑ Lithium levels)

• NSAID → ↑ Li
• ACEi(-pril) → ↑ Li
• Thiazide-like Diuretics → ↑ Li
• Loop Diuretics (-ide) → ↑ Li (less so)
• Metronidazole

Formulation

• PO or liquid

Dosing