Instability of Carbolith (lithium carbonate)

• Published in: Canadian Medical Association journal (CMAJ) Vol. 172; no. 2; p. 183
• Main Author: Misak, Aleksandra
• Format: Journal Article
• Language: English
• Published: Canada CMA Impact Inc 18.01.2005; CMA Impact, Inc; Canadian Medical Association
• Series: Health And Drug Alerts
• Subjects: Bipolar disorder; Care and treatment; Chemistry, Pharmaceutical; Complications and side effects; Drug Stability; Drug therapy; Humans; Lithium carbonate; Lithium Carbonate - pharmacokinetics; Product discontinuation; Canada
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.045224

The drug: Lithium is commonly used and recommended for the treatment and prophylaxis of bipolar disorder, especially the treatment of acute mania and manic episodes.2 The mechanism of action of this therapeutic effect is still unclear. Lithium is almost completely eliminated from the body through the kidneys, and how quickly this happens depends on the patient's salt intake, renal function, fluid intake, use of other medications and serum lithium concentration.3 Because lithium has a narrow therapeutic range (0.5-1.2 mmol/L), toxic effects can occur even at therapeutic levels, especially in elderly patients, who usually respond to lower doses (< 1.0 mmol/L). Therefore, the serum concentration of lithium has to be monitored frequently (Box 1). If a patient taking the drug experiences mania or depression, it may be because his or her serum lithium concentration has fallen below 0.5 mmol/L. A worsening of the condition may occur, requiring hospital admission for the patient's own safety or the safety of others.