Indications & Dose: BIPOLAR DISORDER PO Adult 900-2400mg/day in 3-4 divided doses, or ER tab 900-1800mg/day in 2 divided doses Elderly Initially 300mg OD/BID, increase wkly increments of 300mg/day

Precautions: DM, thyroid disorders, mild-to-moderate renal impairment, CVD

ADR: Serious: coma, epileptiform seizures, sinus node dysfunction with severe bradycardia & syncope, arrhythmias, peripheral circulatory collapse, oliguria, leucocytosis, angioedema, pseudotumor cerebri, psychomotor retardation, hypothyroidism, euthyroid goiter, hyperthyroidism, diabetes insipidus, tremor, blurred vision, coldness & painful discoloration of fingers & toes, Others: brugada syndrome, ataxia, nystagmus, nausea, vomiting, diarrhea, xerostomia, salivary gland swelling, urinary incontinence, polyuria, leukocytosis, hyperglycemia, vertigo, dry/thinning of hair, alopecia, rash, dizziness, headache, lethargy

DDI: Serious Phenothiazines blood level decreases or increases drug level, greater risk of neurotoxicity, Iodine causes synergistic effects, increases risk of hypothyroidism, Sodium Bicarbonate/Acetazolamide/Verapamil/Xanthines decreases drug level, TCAs Increased antidepressant effects, CCBs/Carbamazepine/Haloperidol/Methyl dopa increased risk of neurotoxicity, Diuretics increased sodium loss, increases risk of drug toxicity, Loop diuretics/Fluoxetine/Metronidazole/NSAIDs increases risk of lithium toxicity, Sympathomimetics/SSRIs increases risk of tremor, confusion, dizziness, agitation & diarrhea, Neuromuscular blockers prolongs neuromuscular blockade, severe respiratory depression

Diet: With food

Monitor: Serum lithium/electrolytes, renal, thyroid & cardiovascular function, fluid status, CBC, monitor signs of toxicity, ß-hCG pregnancy