Lithium should be prescribed by brand name as bioavailability differs between branded preparations.
Before starting treatment
- Discussion of treatment, side effects and precautions.
- ECG if over 75 or other indication eg cardiac disease.
- Lithium levels
- Initially weekly until stable (usually 2 weeks) then at 1-2 month intervals for the first 6 months.
- Routine lithium level 3-monthly.
- Urgent lithium level if suspicion of toxicity. Toxicity can occur from co-prescription of particularly thiazides or NSAID which reduce lithium excretion. Symptoms include ataxia, coarse tremor, increased muscle tone, dysarthria and confusion.
- Therapeutic level 0.4-1.0 mmol/litre.
- Blood should be taken 12 hours after the last dose of the drug.
- TFT and U&E every year or every 6 months in patients over 65.
- Seen by a doctor at least twice a year.