pms-Lithium Carbonate Warnings

Lithium toxicity is closely related to serum lithium levels, and can occur at doses close to the therapeutic levels. Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.
The ability to tolerate lithium is greater during the acute manic phase and decreases when manic symptoms subside (see Dosage under Dosage & Administration).
Impaired Renal Function: Chronic lithium therapy is frequently associated with a decrease in renal concentrating capacity with development of thirst, polyuria, micturia, weight gain and altered kidney function tests, occasionally presenting as nephrogenic diabetes insipidus. Such patients should be carefully managed to avoid dehydration with resulting lithium retention and toxicity. The evidence suggests that impaired renal function during chronic therapy may be in most instances, only partially reversible when lithium is discontinued.
Prevention of renal toxicity and other toxic effects of long-term therapy requires a firm diagnosis of bipolar manic depressive illness; careful screening for pre-existing renal and other diseases; establishment of standardized 12 hour serum lithium levels which are as low as possible yet clinically effective; maintaining control of treatment by monitoring serum lithium levels and exercising clinical and laboratory surveillance over possible side effects or signs of lithium intoxication; exercising maximum control of at-risk patients; insuring that long-term lithium therapy is maintained only when clinical response has been clearly established; and adjusting the dosage schedule and preparation used so as to obtain temporarily periods of lithium concentrations as low as possible in the kidney.
Glomerular sclerosis and interstitial fibrosis as well as tubular lesions have been reported in patients on chronic lithium therapy. When kidney function is assessed for baseline data prior to starting lithium therapy or thereafter, routine urinalysis and other tests may be used to evaluate tubular function (e.g. urine specific gravity or osmolality or 24 hour urine volume) and glomerular function (e.g. serum creatinine or creatinine clearance).
During lithium therapy, progressive or sudden changes in renal function, even within the normal range indicate the need for re-evaluation of treatment including dosage and frequency of lithium administration, and a reassessment of the risk-benefit of long-term lithium therapy.
Parathyroid Abnormalities: A systematic review and meta-analysis indicates that about 10% of patients on long-term lithium therapy may develop hypercalcemia with or without hyperparathyroidism. Screening of serum calcium level and if necessary serum parathormone level need to be considered.
Use in Children: Since information regarding the safety and effectiveness of lithium in children under 12 years of age is not available, the use of pms-LITHIUM CARBONATE in such patients is not recommended at this time.