Lithium (Formulary: CNS)

Lithium has a narrow therapeutic index and regular physical health monitoring is required.  See: CMO(2019)04: National guidance for monitoring Lithium. This includes regular therapeutic drug monitoring.  If lithium toxicity develops seek specialist advice.  Early features include an exacerbation of existing side-effects: nausea, vomiting and tremor.  As toxicity develops further, disorientation and dysarthria appear, followed by convulsions, coma and eventually death from cardiac effects or pulmonary complication.

Note: Lithium

• Always prescribe the same brand of lithium to avoid differences in bioavailablity.
• All patients starting lithium should be offered written information; ensure your patient has a copy of the Choice and Medication lithium patient information leaflet.
• In long-term use lithium has been associated with thyroid disorders and mild cognitive and memory impairment.
• Avoid abrupt cessation of lithium. NICE recommends titrating down over 3 months routinely.