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# Lithium carbonate

The classic mood stabilizer for bipolar disorder. Its safe range is narrow, so blood levels are checked and toxicity signs watched.

Updated 2026-11-01

- Class: [Mood stabilizers](https://durgical.com/en/pharmacology/classes/mood-stabilizers/)
- Enzyme: Inositol monophosphatase and GSK-3 (proposed)
- ATC code: N05AN01
- WHO Model List of Essential Medicines

## Mechanism of action

Lithium is a simple ion. Its mood-stabilising mechanism is not fully known; the leading ideas are that it inhibits inositol monophosphatase, dampening phosphatidylinositol signalling, and that it inhibits GSK-3. The kidney handles it like sodium, which explains why low sodium, dehydration and some drugs raise its levels.

- Lithium inhibits inositol monophosphatase and GSK-3
- Phosphatidylinositol signalling in neurons is dampened
- Fewer manic and depressive relapses over time
- The kidney treats it like sodium: low sodium raises lithium

## Pharmacokinetics

**Absorption**
Taken by mouth (immediate- and extended-release forms, solution)

**Metabolism**
Not metabolised

**Elimination**
By the kidney, in proportion to its blood level; reduced kidney function raises toxicity risk

## Indications

- Acute manic and mixed episodes of bipolar I disorder
- Maintenance treatment of bipolar I disorder

## Adverse effects

### Common

- Fine hand tremor
- Polyuria and thirst
- Nausea, diarrhoea and abdominal discomfort early on
- Weight gain
- Acne and rash

### Serious (rare, important)

- Lithium toxicity: from coarse tremor, vomiting, diarrhoea, unsteadiness and slurred speech to confusion, seizures, coma and death (boxed warning)
- Nephrogenic diabetes insipidus and reduced kidney function
- Hypothyroidism
- Hypercalcaemia and hyperparathyroidism
- Unmasking of Brugada syndrome (dangerous arrhythmias)
- Serotonin syndrome with serotonergic drugs

## Contraindications

- Severe kidney impairment (avoided)
- Brugada syndrome or suspected Brugada syndrome (avoided)
- Marked dehydration or sodium depletion
- Hypersensitivity to lithium

## Key interactions

**Thiazide and other diuretics**
Higher lithium levels and toxicity

**NSAIDs**
Higher lithium levels

**ACE inhibitors and ARBs**
Higher lithium levels

**Antipsychotics (haloperidol and others)**
Rare encephalopathic syndrome; also additive neurotoxicity

**SSRIs and other serotonergic drugs**
Serotonin syndrome

## What is monitored

- Serum lithium level, drawn just before the next dose, regularly and after any change in dose, other drugs or health
- Kidney function and electrolytes (sodium)
- Thyroid function
- Calcium
- ECG when there are cardiac risk factors
- Pregnancy status in women who could become pregnant

## Administration and safety

- Immediate- and extended-release forms are different products and are not substituted for each other unnoticed
- Blood for levels is drawn at trough, just before the next dose
- Kidney function, electrolytes, thyroid function and pregnancy status are checked before starting

## Nursing care

- Watches for early toxicity (diarrhoea, vomiting, coarse tremor, unsteadiness, drowsiness) and holds the next dose pending review if they appear
- Teaches the patient to keep a steady salt and fluid intake and to avoid dehydration in heat, exercise, fever or diarrhoea
- Teaches to avoid over-the-counter NSAIDs and to report any new prescription (diuretics, ACE inhibitors)
- Checks that levels and kidney and thyroid tests are up to date

## Pregnancy and breastfeeding

First-trimester use has been linked to Ebstein's anomaly and other heart defects, with a smaller risk than once thought; newborns can show lithium toxicity. Use weighs relapse risk against fetal risk.

## Memory aid

LITHIUM: Low thyroid, Insipidus (nephrogenic diabetes), Tremor, Heart (Ebstein, Brugada), Increased calcium, Urine (polyuria), Monitor levels.

## Test yourself

Think of the answer, then tap the question to see it.

## Why are lithium levels measured regularly?

Its therapeutic range is narrow: toxicity can occur at levels close to the effective ones.

## A patient on lithium starts hydrochlorothiazide and an NSAID and develops coarse tremor and confusion. What happened?

Lithium toxicity: both drugs reduce renal lithium excretion and raise its level.

## What is the treatment of choice for severe lithium toxicity?

Haemodialysis, which removes lithium quickly.

## Which drug may be used for lithium-induced nephrogenic diabetes insipidus?

Amiloride.

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## Related drugs

- [Haloperidol](https://durgical.com/en/pharmacology/haloperidol/)
- [Quetiapine](https://durgical.com/en/pharmacology/quetiapine/)

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - LITHIUM CARBONATE tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d20ed2aa-aa56-4709-9e7a-9243c71465c9) (DailyMed (U.S. National Library of Medicine), 2026); [Lithium: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a681039.html) (MedlinePlus (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 19 (McGraw Hill, 2023).

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Representative model, for educational purposes only.

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