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Lithium 720-729

Ledya Ayudila
For the treatment of acute mania, initial doses are usually 9001200
mg/d of lithium carbonate

If the drug is being used for bipolar disease prophylaxis, an initial


dose of 600 mg/d lithium carbonate is recommended. In both cases,
the total daily dose is given in 23 divided daily doses

To avoid adverse side effects, lithium doses are slowly increased by


300600 mg/d every 23 days according to clinical response and
lithium serum concentrations. (Bauer, 720)
If creatinine clearance is 1050 mL/min, the prescribed initial dose is 5075% of
that recommended for patients with normal renal function.

For creatinine clearance values below 10 mL/min, the prescribed dose should be
2550% of the usual dose in patients with good renal function.

Recommended doses for children and adolescents with normal renal function are
1560 mg/kg/d and 6001800 mg/d, respectively, with doses administered three to
four times daily.
(Bauer, 720)
Linear Pharmacokinetics Method
D new / Css new = D old / Css old

Atau

D new = (Css new / Css old) D old


(Bauer, 726)
Exp.
YC is a 37-year-old, 55-kg (5 ft 1 in) female with bipolar disease. She is
currently not experiencing an episode of acute mania and requires prophylactic
treatment with lithium. Her serum creatinine is 0.6 mg/dL. The patient is
receiving 900 mg of lithium carbonate at 0800 H, 1400 H, and 2000 H, and her
12-hour postdose steady-state lithium serum concentration equals 1.1 mmol/L.
Compute a new lithium dose to achieve a steady-state concentration of 0.6
mmol/L.
(Bauer, 727)
Answer
Using linear pharmacokinetics, the new dose to attain the desired concentration
should be proportional to the old dose (2700 mg/d) that produced the measured
concentration:

D new = (Css new / Css old) D old


= (0.6 mmol/L / 1.1 mmol/L) 2700 mg/d
= 1473 mg/d, round to 1500 mg/d
(Bauer, 726)
DOSING STRATEGIES
Initial dose and dosage adjustment techniques using serum concentrations
can be used in any combination as long as the limitations of each method are
observed. Some dosing schemes link together logically when considered
according to their basic approaches or philosophies.

(Bauer, 729)
(Bauer, 730)