Lithium

Lithium

Drug monograph · NCLEX study reference
Trade names	Lithobid
Therapeutic class	Mood stabilizer
Pharmacologic class	Alkali metal salt (NTI)
Onset / peak / duration	Mood stabilization over 1 to 3 weeks.
Half-life / level	Half-life 18 to 36 hours; therapeutic level 0.6 to 1.2 mEq/L (acute up to 1.5).
Routes	PO (oral)
High-alert (ISMP)	No
Black box warning	Yes (see Safety)
Antidote / reversal	None; hemodialysis for severe toxicity, hydration and sodium correction.
Pregnancy / lactation	Cardiac teratogen risk (Ebstein anomaly); use only if essential.

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Lithium (brand name Lithobid) — Mood stabilizer; Alkali metal salt (NTI).

Identification

• Therapeutic class: Mood stabilizer.
• Pharmacologic class: Alkali metal salt (NTI).

Pharmacology

• Mechanism of action: Alters neuronal sodium transport and second messengers to stabilize mood (exact mechanism not fully known).
• Onset / peak / duration: Mood stabilization over 1 to 3 weeks.
• Half-life / therapeutic level: Half-life 18 to 36 hours; therapeutic level 0.6 to 1.2 mEq/L (acute up to 1.5).

Clinical use

• Indications: Bipolar disorder (acute mania and maintenance).
• Usual dose, route, frequency: PO two to three times daily, dosed by level.
• Maximum dose / adjustments: Dose by level; reduce with renal impairment, dehydration, and sodium changes.

Safety

• Contraindications: Significant renal or cardiovascular disease, severe dehydration, sodium depletion.
• Black box warning: Lithium toxicity is closely related to serum levels and can occur at doses close to therapeutic; facilities for prompt and accurate level testing must be available.
• Interactions: Thiazide and loop diuretics, ACE inhibitors and ARBs, NSAIDs (all raise lithium), sodium intake changes, caffeine (food/drink), dehydration.
• Pregnancy / lactation: Cardiac teratogen risk (Ebstein anomaly); use only if essential.
• High-alert: No.

Adverse effects

• Common side effects: Fine tremor, increased thirst and urination, weight gain, GI upset.
• Serious effects to report: Toxicity (coarse tremor, confusion, ataxia, vomiting, slurred speech, seizures), hypothyroidism, nephrogenic diabetes insipidus.
• Antidote / reversal: None; hemodialysis for severe toxicity, hydration and sodium correction.

Nursing process

• Assessment before administration: Renal function, thyroid, sodium and hydration, level, pregnancy status.
• Interventions during therapy: Maintain steady salt and fluid intake; draw levels (trough, about 12 hours after dose); hold and call for toxicity signs.
• Monitor: Lithium level, renal function, thyroid, sodium, hydration.
• Evaluation / expected outcome: Mood stability without toxicity.

Patient teaching

• Patient teaching: Keep salt and fluid intake consistent; stay hydrated in heat or illness; keep lab appointments.
• Notify provider if: Coarse tremor, confusion, severe vomiting or diarrhea, unsteady gait, slurred speech.
• Administration tips: With food; consistent timing; steady sodium and fluids.