Litiam ER
Generic Name
Lithium Carbonate (Extended Release)
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| litiam er 400 mg tablet | ৳ 12.00 | ৳ 120.00 |
Description
Overview of the medicine
Litiam ER is an extended-release tablet containing Lithium Carbonate, used primarily for the treatment of bipolar disorder (manic-depressive illness), including acute manic and mixed episodes, and maintenance treatment for prevention of recurrence.
Uses & Indications
Dosage
Adults
Initial dose typically 600-900 mg daily in divided doses, or as a single daily dose for ER formulations. Adjust dose to achieve target serum lithium levels (0.6-1.2 mEq/L for acute mania; 0.6-1.0 mEq/L for maintenance). Maximum dose usually 1800 mg/day.
Elderly
Lower doses and slower titration are recommended due to reduced renal clearance and increased sensitivity to side effects. Target serum levels generally lower (0.4-0.8 mEq/L).
Renal_impairment
Significant dose reduction required, with frequent monitoring of serum lithium levels and renal function. May be contraindicated in severe impairment.
How to Take
Take orally, usually with food, to minimize gastrointestinal upset. Swallow tablets whole; do not crush, chew, or break. Maintain consistent fluid intake.
Mechanism of Action
Lithium's exact mechanism of action is not fully understood, but it is believed to affect neurotransmitter systems (e.g., serotonin, norepinephrine, dopamine) and intracellular signaling pathways (e.g., second messenger systems like inositol polyphosphate and adenylate cyclase pathways), leading to mood stabilization.
Pharmacokinetics
Onset
Therapeutic effects may take several days to weeks to manifest fully.
Excretion
Primarily excreted via the kidneys (95%) with a small amount excreted in feces and sweat.
Half life
Approximately 18-36 hours in adults, but can be prolonged in elderly patients or those with renal impairment.
Absorption
Slow and complete absorption from the gastrointestinal tract due to extended-release formulation. Peak plasma concentrations are reached 4-12 hours post-dose.
Metabolism
Not metabolized by the liver; excreted unchanged.
Side Effects
Contraindications
- Severe renal impairment
- Cardiovascular disease
- Sodium depletion or dehydration
- Severe debilitation
- First trimester of pregnancy and breastfeeding
- Untreated hypothyroidism
Drug Interactions
Antipsychotics
Increased risk of neurological side effects; some combinations may increase neurotoxicity.
SSRIs and other antidepressants
Risk of serotonin syndrome with concomitant use.
NSAIDs (e.g., ibuprofen, naproxen)
May increase serum lithium levels, leading to toxicity.
ACE inhibitors (e.g., enalapril, lisinopril)
May increase serum lithium levels.
Thiazide diuretics (e.g., hydrochlorothiazide)
Can increase serum lithium levels by reducing renal clearance.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe nausea, vomiting, diarrhea, coarse tremor, ataxia, confusion, lethargy, blurred vision, seizures, and coma. Management involves immediate discontinuation of lithium, supportive care, gastric lavage, whole bowel irrigation, and hemodialysis in severe cases.
Pregnancy & Lactation
Lithium is classified as Pregnancy Category D due to potential risk of Ebstein's anomaly, especially during the first trimester. Use during pregnancy should be carefully weighed against benefits. It is excreted in breast milk and generally not recommended during breastfeeding.
Side Effects
Contraindications
- Severe renal impairment
- Cardiovascular disease
- Sodium depletion or dehydration
- Severe debilitation
- First trimester of pregnancy and breastfeeding
- Untreated hypothyroidism
Drug Interactions
Antipsychotics
Increased risk of neurological side effects; some combinations may increase neurotoxicity.
SSRIs and other antidepressants
Risk of serotonin syndrome with concomitant use.
NSAIDs (e.g., ibuprofen, naproxen)
May increase serum lithium levels, leading to toxicity.
ACE inhibitors (e.g., enalapril, lisinopril)
May increase serum lithium levels.
Thiazide diuretics (e.g., hydrochlorothiazide)
Can increase serum lithium levels by reducing renal clearance.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe nausea, vomiting, diarrhea, coarse tremor, ataxia, confusion, lethargy, blurred vision, seizures, and coma. Management involves immediate discontinuation of lithium, supportive care, gastric lavage, whole bowel irrigation, and hemodialysis in severe cases.
Pregnancy & Lactation
Lithium is classified as Pregnancy Category D due to potential risk of Ebstein's anomaly, especially during the first trimester. Use during pregnancy should be carefully weighed against benefits. It is excreted in breast milk and generally not recommended during breastfeeding.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from the date of manufacture.
Availability
Available in pharmacies nationwide
Approval Status
Approved by DGDA and international regulatory bodies
Patent Status
Generic
WHO Essential Medicine
YesClinical Trials
Numerous clinical trials have established the efficacy and safety of lithium in the treatment and prophylaxis of bipolar disorder. Ongoing research explores its neuroprotective properties and potential in other psychiatric conditions.
Lab Monitoring
- Serum lithium levels (initially 1-2 times weekly, then monthly or every 2-3 months once stable)
- Renal function tests (serum creatinine, GFR, urinalysis) every 6-12 months
- Thyroid function tests (TSH) every 6-12 months
- Electrolytes (sodium, potassium, calcium)
- ECG (especially in elderly or those with cardiac risk factors)
Doctor Notes
- Emphasize the importance of consistent medication adherence and regular monitoring to patients.
- Educate patients on symptoms of lithium toxicity and when to seek urgent medical care.
Patient Guidelines
- Take medication regularly as prescribed, do not stop abruptly.
- Attend all scheduled blood tests and doctor appointments.
- Maintain consistent fluid and salt intake to prevent lithium toxicity.
- Be aware of symptoms of toxicity (e.g., severe tremor, confusion, persistent nausea/vomiting) and seek medical attention immediately if they occur.
- Avoid excessive alcohol consumption.
Missed Dose Advice
If a dose is missed, take it as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and resume your regular dosing schedule. Do not double the dose to catch up.
Driving Precautions
Lithium may cause drowsiness, dizziness, or impaired coordination, especially at the start of treatment or during dose adjustments. Patients should be cautioned about driving or operating machinery until they know how Litiam ER affects them.
Lifestyle Advice
- Maintain a regular sleep schedule.
- Engage in regular physical activity.
- Avoid sudden changes in diet, especially salt and fluid intake.
- Manage stress effectively.
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