Health QuestionsCategory: TreatmentsLithium ER once a day?
Astarias asked 3 years ago

Hi, I started a new doctor recently and he just made a change to my dose that I want to verify is correct. He seems as if he knows what he is doing and all but Lithium makes me nervious to play with. Yes, btw, he saw my lithium levels today. I have been taking lithium ER 450 mg twice a day. Once in the morning and once at night. He changed me to 3 450 mg pills. All taken at the same time at  night. He said that this will be better on my liver. Anyways, I want to know if that is an ok amount to take all at once. I would have talked about it with the doctor but I only really started thinking about it now that I am home and its almost midnight. Thanks for the help guys and gals.

4 Answers
martasi answered 3 years ago

Re: Lithium ER once a day?
The best thing to do is contact your PDoc and ask him. If he’s a new doctor, all the better so you can understand his approach to treating your illness rather than worry at home.  
 
I’d be interested in hearing his answer. 1,350 mg. of Li is a lot to take all at one time, but if you don’t have too many side effects and it helps w/sleep it may be right for you. Are you having any GI problems w/it? Do you know what your levels are?

martasi answered 3 years ago

Re: Lithium ER once a day?
Just saw this article online about Li dosing. It says when dosed once per day, Li dose can often be reduced — as opposed to multiple daily dosing, which may require higher doses. I wasn’t familiar with this concept.
 
 
http://www.mentalhealth.com/drug/p30-l02.html

Glen answered 3 years ago

Re: Lithium ER once a day?
Dosing Regimen
 
Clinical investigators have debated the advantages of various lithium preparations and schedules of administration. It has been noted that polyuria, a common side effect of lithium treatment, may be less frequent when lithium is given as a single dose (22). Plenge and others treated 2 groups of rats: the first group was given lithium in the daily feed and the second group had the same amount of lithium injected intraperitoneally daily. Structural and functional changes in the kidney were much more pronounced in the lithium-fed than in the injected rats, suggesting the importance of regularly reaching lithium concentrations low enough to allow renal regenerative processes to occur (46). The tubular regeneration hypothesis is, however, a less-than-adequate explanation because it has been reported that patients receiving sustained-release lithium had higher urine concentrations than did patients receiving regular lithium (47). In the same publication, results from a clinical study where lithium was given once daily showed a correlation between minimum serum lithium concentration and urine volume, whereas no correlation was found between 12-hour dosing and maximum serum lithium concentration and urine volume. The authors emphasized the importance of achieving periodically low lithium levels to avoid renal dysfunction.  
  In 1982, Plenge and others described 36 patients who were prescribed lithium in either single- or multiple-dose regimens. Renal functional and structural changes were most pronounced in patients receiving lithium in divided doses (46).  
 
In the Plenge and others study, patients receiving multiple doses received a higher daily dose of lithium. Perry and others switched 8 patients from twice-daily to once-daily schedules. Although the total daily dosage of lithium was unchanged, a significant drop in urine volume was observed after 12 days (48,49).  
 
Abraham and others monitored renal function indices and other biochemical tests after switching from a once-daily to a multiple-dose schedule or vice versa. They concluded that lithium-dosing strategies do not consistently affect renal function in lithium-treated patients (50).  
 
Clinically, once-daily dosing may enhance compliance. Single-dosing may impart a 30%-higher maximum plasma concentration (Cmax), when compared with multiple dosing. Lithium prophylactic efficacy appears unrelated to the dosing schedule. Some patients are sensitive to cognitive side effects from lithium (22). For these patients, perhaps a sustained-release preparation or multiple dosing would be preferable, although its superior cognitive profile awaits confirmation. For most patients, clinicians could either start with once-daily dosing at night or with multiple dosing, with the option of consolidating the dosing to once daily after adequate plasma levels are attained. Lithium monitoring should be completed 12 hours after the last dose of lithium.  
 
 
http://www.cpa-apc.org/Publications/Archives/CJP/2001/May/Lithium.asp

Astarias answered 3 years ago

Re: Lithium ER once a day?
Thanks for the great info. I did try it last night and everything went fine with the medicine. Only thing that happened was I had crazy, vivid dreams. But I also switched from Luvox to Zoloft last night as well so I don’t know what exactly to blame the dreams on.

Astarias asked 3 years ago

Hi, I started a new doctor recently and he just made a change to my dose that I want to verify is correct. He seems as if he knows what he is doing and all but Lithium makes me nervious to play with. Yes, btw, he saw my lithium levels today. I have been taking lithium ER 450 mg twice a day. Once in the morning and once at night. He changed me to 3 450 mg pills. All taken at the same time at  night. He said that this will be better on my liver. Anyways, I want to know if that is an ok amount to take all at once. I would have talked about it with the doctor but I only really started thinking about it now that I am home and its almost midnight. Thanks for the help guys and gals.

4 Answers
martasi answered 3 years ago

Re: Lithium ER once a day?
The best thing to do is contact your PDoc and ask him. If he’s a new doctor, all the better so you can understand his approach to treating your illness rather than worry at home.  
 
I’d be interested in hearing his answer. 1,350 mg. of Li is a lot to take all at one time, but if you don’t have too many side effects and it helps w/sleep it may be right for you. Are you having any GI problems w/it? Do you know what your levels are?

martasi answered 3 years ago

Re: Lithium ER once a day?
Just saw this article online about Li dosing. It says when dosed once per day, Li dose can often be reduced — as opposed to multiple daily dosing, which may require higher doses. I wasn’t familiar with this concept.
 
 
http://www.mentalhealth.com/drug/p30-l02.html

Glen answered 3 years ago

Re: Lithium ER once a day?
Dosing Regimen
 
Clinical investigators have debated the advantages of various lithium preparations and schedules of administration. It has been noted that polyuria, a common side effect of lithium treatment, may be less frequent when lithium is given as a single dose (22). Plenge and others treated 2 groups of rats: the first group was given lithium in the daily feed and the second group had the same amount of lithium injected intraperitoneally daily. Structural and functional changes in the kidney were much more pronounced in the lithium-fed than in the injected rats, suggesting the importance of regularly reaching lithium concentrations low enough to allow renal regenerative processes to occur (46). The tubular regeneration hypothesis is, however, a less-than-adequate explanation because it has been reported that patients receiving sustained-release lithium had higher urine concentrations than did patients receiving regular lithium (47). In the same publication, results from a clinical study where lithium was given once daily showed a correlation between minimum serum lithium concentration and urine volume, whereas no correlation was found between 12-hour dosing and maximum serum lithium concentration and urine volume. The authors emphasized the importance of achieving periodically low lithium levels to avoid renal dysfunction.  
  In 1982, Plenge and others described 36 patients who were prescribed lithium in either single- or multiple-dose regimens. Renal functional and structural changes were most pronounced in patients receiving lithium in divided doses (46).  
 
In the Plenge and others study, patients receiving multiple doses received a higher daily dose of lithium. Perry and others switched 8 patients from twice-daily to once-daily schedules. Although the total daily dosage of lithium was unchanged, a significant drop in urine volume was observed after 12 days (48,49).  
 
Abraham and others monitored renal function indices and other biochemical tests after switching from a once-daily to a multiple-dose schedule or vice versa. They concluded that lithium-dosing strategies do not consistently affect renal function in lithium-treated patients (50).  
 
Clinically, once-daily dosing may enhance compliance. Single-dosing may impart a 30%-higher maximum plasma concentration (Cmax), when compared with multiple dosing. Lithium prophylactic efficacy appears unrelated to the dosing schedule. Some patients are sensitive to cognitive side effects from lithium (22). For these patients, perhaps a sustained-release preparation or multiple dosing would be preferable, although its superior cognitive profile awaits confirmation. For most patients, clinicians could either start with once-daily dosing at night or with multiple dosing, with the option of consolidating the dosing to once daily after adequate plasma levels are attained. Lithium monitoring should be completed 12 hours after the last dose of lithium.  
 
 
http://www.cpa-apc.org/Publications/Archives/CJP/2001/May/Lithium.asp

Astarias answered 3 years ago

Re: Lithium ER once a day?
Thanks for the great info. I did try it last night and everything went fine with the medicine. Only thing that happened was I had crazy, vivid dreams. But I also switched from Luvox to Zoloft last night as well so I don’t know what exactly to blame the dreams on.