Lithium carbonate is a prescription medication used to treat symptoms associated with bipolar disorder. Brand names for lithium carbonate include Eskalith and Lithobid.
Lithium is in a class of medications known as mood stabilizers. Mood stabilizers are used to treat conditions that have extreme mood shifts, especially the mania that occurs in bipolar disorder. It’s also used to stabilize mood in some individuals with schizoaffective disorder.
The U.S. Food and Drug Administration (FDA)
has approved lithium for use in adults and children 7 years and older. It has a very narrow therapeutic range (the dose that can be administered to treat disease effectively without causing toxic effects). Therefore, lithium dosage is variable, determined on a case-by-case basis, and monitored closely by a healthcare professional.
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Lithium forms and strengths
Lithium is available in several formulations and strengths for adults and children:
Capsule: 150 mg, 300 mg, 600 mg
Tablet: 300 mg
Extended-release tablet: 300 mg, 450 mg
Solution: 8 mEq per 5 mL
Lithium dosage for adults
Lithium is used to treat acute or mixed mania in bipolar disorder. It also stabilizes mood in schizoaffective disorder. It may be used to treat symptoms acutely or as a maintenance medication that is taken for a longer time. Individuals who take lithium will need to have regular blood tests to monitor levels of lithium in the body. Always discuss your full health history, medications, concerns, and treatment goals with your healthcare provider before taking lithium.
Lithium dosage chart* |
||||
|---|---|---|---|---|
| Indication | Form | Starting dosage | Standard dosage | Maximum dosage |
| Bipolar I disorder: Acute mania/mixed | Capsule/tablet | 300 mg by mouth three times per day | 1200-1800 mg by mouth per day, divided into two or three doses | Not to exceed serum lithium levels of 1.5 mEq/L |
| ER tablet | 1800 mg by mouth per day, divided into two or three doses | |||
| Solution | 8 mEq by mouth three times per day | 32-48 mEq by mouth per day, divided into two or three doses | ||
| Bipolar I disorder: Maintenance treatment | Capsule/tablet | 300 mg by mouth three times per day | 600-1800 mg by mouth per day divided into two or three doses | Not to exceed serum lithium levels of 1.5 mEq/L |
| ER tablet | 900 mg by mouth per day, divided into two or three doses | 900-1200 mg by mouth per day, divided into two or three doses | ||
| Solution | 8 mEq by mouth three times per day | 16-48 mEq by mouth per day, divided into two or three doses | ||
| Schizoaffective disorder | Capsule/tablet | 900 mg by mouth per day, divided into three or four doses | 900-1200 mg by mouth per day, divided into three or four doses | Not to exceed serum lithium levels of 1.5mEq/L |
| ER tablet | 900-1200 mg by mouth per day, divided into two or three doses | |||
| Solution | 24 mEq by mouth per day, divided into three or four doses | 24-32 mEq by mouth per day, divided into three or four doses |
* The amount of lithium is adjusted based on response and serum lithium levels. All dosages are for lithium immediate-release unless specified as ER (extended-release).
Lithium dosage for bipolar I disorder
Bipolar I disorder is characterized by extreme changes in mood with periods of mania and depression. Some people may experience impaired thinking and psychosis. Lithium has been used for decades to stabilize extreme changes in mood for people with bipolar disorder.
When beginning treatment, lithium doses will be adjusted to treat the symptoms but avoid toxic levels in the blood. Once an acceptable therapeutic range has been reached, lithium therapy will continue with a maintenance dose that is usually taken two or three times a day. During an active manic episode, the dose of lithium may be higher than the daily maintenance dose to control manic symptoms as quickly as possible. Once resolved, individuals will return to a daily maintenance dose schedule.
People who have never taken lithium will start treatment at lower doses, typically around 900 mg per day. Most people take 900-1800 mg per day in tablet/capsule form or 16-48 mEq per day in solution form.
Individuals with bipolar I disorder may also be prescribed antipsychotics, mood stabilizers, or antidepressants. These may include medications such as risperidone, olanzapine, or fluoxetine.
Lithium dosage for bipolar II disorder
Bipolar II disorder is also characterized by episodes of major depression but with less of a manic component. This condition is less well-characterized, but depression and hypomania still negatively impact the quality of life for individuals and family members with this condition.
Lithium may be used to reduce hypomanic events. Lithium is also used to treat bipolar depression and suicidality. In a review of medications and suicidality in mood disorders, lithium was associated with a lower suicide rate in individuals with bipolar disorder.
For bipolar II disorder, people who have never taken lithium will start treatment at lower doses. As with all doses of lithium, the dosage for bipolar II disorder will be adjusted to treat symptoms and avoid toxicity.
Lithium dosage for schizoaffective disorder
Schizoaffective disorder is a chronic mental health condition characterized by some symptoms of schizophrenia (hallucinations and delusions) and other symptoms of a mood disorder (mania and depression). Symptoms usually cycle with periods of apparent improvement in between episodes.
In this condition, the use of lithium as part of a comprehensive treatment plan can help decrease symptoms of mania. In one study, lithium significantly reduced the number of days spent in the hospital when used as long-term maintenance treatment in individuals with schizoaffective disorder.
For schizoaffective disorder, lithium is typically dosed at 900-1200 mg per day in tablet/capsule form or 24-32 mEq per day of solution. Lithium dosing usually requires several weeks of adjustments to reach optimum therapeutic levels.
Lithium dosage for children
Lithium has been approved by the FDA for use in children 7 years of age and older for the treatment of bipolar disorder. It is used for acute episodes of mania and for maintenance treatment of bipolar disorder. Lithium is typically used in children when other mood stabilizers such as valproate, carbamazepine, and lamotrigine have not been effective.
Optimum dosing strategies for children also focus on improving symptoms while avoiding toxic lithium levels.
Lithium dosage by weight/age* |
||||
|---|---|---|---|---|
| Indication | Age | Weight | Recommended dosage (CAP/TAB) | Recommended dosage (SOL) |
| Bipolar disorder I: Acute manic/mixed | 7 years of age and older | 20-30 kg | Start 300 mg by mouth twice a day, then 600-1500 mg by mouth per day in divided doses | Start 8 mEq by mouth twice a day, then 16-40 mEq by mouth per day in divided doses |
| >30 kg | Start 300 mg by mouth three times a day, then 1200-1800 mg by mouth per day divided into two or three doses | Start 8 mEq three times a day, then 32-48 mEq by mouth per day, divided into two or three doses | ||
| 12 years of age and older, extended release tablet | 1800 mg by mouth per day, divided into two or three doses | |||
| Bipolar disorder I: Maintenance treatment | 7 years of age and older | 20 - 30 kg | Start 300 mg by mouth twice a day, then 600-1200 mg by mouth per day in divided doses | Start 8 mEq by mouth twice a day, then 16-32 mEq by mouth per day in divided doses |
| > 30 kg | Start 300 mg by mouth three times a day, then 600-1800 mg by mouth per day, divided into two or three doses | Start 8 mEq by mouth three times per day, then 16-48 mEq by mouth per day, divided into two or three doses | ||
| 12 years of age and older, extended release tablet | 900-1200 mg by mouth per day, divided into two or three doses |
* Dosages are adjusted based on response and serum lithium level. Avoid serum lithium concentrations above 1.5 mEq/L.
Lithium dosage restrictions
For some people, lithium use should be avoided, used with caution, or strictly monitored. Individuals with poor kidney function, usually described as having a creatinine clearance of less than 30, should not use lithium as the toxic effects will outweigh any therapeutic benefit. People with a heart rhythm disorder called Brugada syndrome should also not take lithium.
Lithium is primarily excreted by the kidneys. Individuals with decreased kidney function may have a greater risk of side effects. Older individuals and those with other health conditions may also require lower doses and closer monitoring to minimize the risk of toxicity.
Lithium dosage for pets
There are a few, very limited studies that have documented lithium use in dogs to combat myelosuppression associated with cancer therapy. These studies are inconclusive regarding the efficacy of lithium use in dogs but did recommend serum lithium levels be closely monitored if lithium was used for this purpose.
How to take lithium
Lithium is a medication that may be associated with serious adverse effects. It is important to take this medication exactly as it is prescribed, even if you feel well.
Lithium should be taken daily, at the same time each day. If you miss a dose, and it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose. If you forget to take this medicine for several days in a row, talk to your doctor before you start taking it again to see if your dose needs to be adjusted.
It may take several weeks for this medication to reach optimal effects. The dose may need to be adjusted several times during this period.
Take this medication as directed. Your dose may be changed several times to find what works best for you. Take only the dose prescribed by a healthcare professional. Do not take more medication and do not take less. Take each dose how and when it is prescribed, at the same time each day.
Swallow the tablet/capsule whole or take the liquid exactly as it was prepared. Do not crush, break, chew, or open the tablet/capsule or dilute the liquid.
Read and follow the instructions that come with this medication. Talk to your healthcare provider if you have any questions.
Store this medication in a closed container at room temperature, away from heat, moisture, and direct light.
This medication can cause toxicity that can be exacerbated by what you eat or drink. Avoid too much caffeine or sugar and don’t drink too much alcohol.. Avoid low sodium diets and dehydration. Minimize the use of non-steroidal anti-inflammatory drugs (NSAIDs).
Ensure that blood levels are routinely monitored at times recommended by your healthcare provider.
Talk to your healthcare provider about all health conditions and other medications you take to lower the risk of toxicity.
Lithium dosage FAQs
Lithium vs. lithium ER: What’s the difference in doses?
Lithium carbonate is available in both an immediate-release (IR) and extended-release (ER) formulation. The main difference between these preparations is how the medication is released into the body. The extended-release form is typically a tablet that will slowly release lithium in the body during the day, potentially minimizing the number of times lithium needs to be taken each day.
The IR and ER forms of this medication are equally effective and have a similar toxicity profile. The preparation that is used depends on factors such as lifestyle and the ability to independently take medications safely.
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How long does it take lithium to work?
Most people will see a reduction in manic symptoms within a week of beginning lithium treatment. However, it usually takes several weeks for the full effects of treatment to be reached. Lithium has a very narrow range where it is both effective and non-toxic. Side effects are minimized when this medication is taken exactly as prescribed.
How long can you take lithium?
Lithium is used in both short- and long-term treatment of bipolar and schizoaffective disorder. As maintenance treatment, lithium is typically taken every day for years. As long as individuals are routinely and closely monitored for signs of lithium toxicity, lithium may be taken indefinitely.
How do I stop taking lithium?
Bipolar disorder is a very serious condition that could lead to extreme manic and depressive episodes with harm to self or others, recurrent hospitalizations, and even suicide if not properly managed. While lithium does not cause specific withdrawal symptoms, it is important that this medicine is not stopped without talking to your healthcare provider.
RELATED: Bipolar disorder statistics
Can you overdose on lithium?
It is possible to overdose on lithium. Lithium overdose is associated with very serious side effects, even death. The FDA has issued a “black box warning” regarding lithium toxicity. Lithium toxicity can occur from taking too much or because the body can’t excrete it well enough. If you believe that you have taken too much lithium or have new symptoms while taking it, talk to your healthcare provider right away.
The possible side effects of lithium include:
Common side effects:
Excessive urination or thirst
Problems with appetite
Weight gain
Gastrointestinal symptoms, including nausea, vomiting, and diarrhea
Nervous system effects, including trouble with thinking or coordination, blurry vision, dizziness, tremors, and muscle weakness
Skin concerns such as a rash or acne
Dry mouth
Fatigue or drowsiness
Hair loss
Reversible leukocytosis (elevated white blood cell count)
Edema
Low sodium
Chronic tubulointerstitial nephropathy (injury to the tubules in the kidney)
Serious side effects:
Coma
Seizures
Syncope (fainting or passing out)
Heart rhythm problems that could lead to sudden death
Thyroid function problems like hypothyroidism
Fluid imbalance
Elevated blood calcium
Severe drug reaction
Pseudotumor cerebri (elevated pressure in the brain)
Serotonin syndrome (potentially life-threatening elevated serotonin levels)
Raynaud phenomenon (decreased blood flow to the fingers and sometimes ears, toes, nipples, and nose causing a blue or white appearance)
Is it safe to take lithium during pregnancy?
Women who are pregnant or breastfeeding should discuss the benefits and risks of taking this medication with a healthcare provider. If used, dosages may need to be adjusted or the medication changed at different stages of pregnancy and breastfeeding. Extra tests may need to be performed to monitor the well-being of the woman and the infant.
Related resources for lithium dosages:
Highlights of prescribing information for lithium and lithium carbonate
, FDALithium - Drug summary
, Prescribers’ Digital ReferenceAdult dosing
, EpocratesProphylaxis of schizoaffective disorder with lithium or carbamazepine: outcome after long-term follow-up
, Journal of Affective DisordersLithium in the prevention of suicide in mood disorders: updated systemic review and meta-analysis
, Database of Abstracts of Reviews of Effects (DARE)Pediatric dosing
, EpocratesLithium: Practical considerations for children with suicidal thinking
, The Carlat Child Psychiatry ReportUse of lithium carbonate to prevent lomustine-induced myelosuppression in dogs: A pilot study
, Canadian Journal of Veterinary ResearchEffects of lithium carbonate on carboplatin-induced thrombocytopenia in dogs
, American Journal of Veterinary ResearchContraindications
, EpocratesPregnancy/lactation
, Epocrates
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