Last update June 14, 2022

Lithium Carbonate

Likely Compatibility

Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.

Lithium is effective in the treatment of mania, bipolar disorder, and recurrent unipolar depression. It is necessary to control the serum concentration, since the margin between therapeutic and toxic concentrations is narrow (0,5 - 1,2 mmol/L). Oral administration in two daily doses.

It is excreted in breast milk in moderate amounts (Imaz 2019, Bogen 2012, Viguera 2007, Moretti 2003, Schou 1973), which could be clinically significant as it frequently exceeds 10% of the relative dose (see Pharmacokinetics section).

Plasma levels in the infant can reach up to 10%-60% of therapeutic levels in the mother. (Gehrmann 2021, Imaz 2021(sep y jun), Imaz 2020, Marín 2018 y 2011, Khan 2016, Frew 2015, Bogen 2012, Viguera 2007, Moretti 2003, Skausig 1977, Sykes 1976, Schou 1973, Tunnessen 1972)

Most infants (≈80%) whose mothers take lithium have no short- or long-term clinical, growth, or problems. (Gehrmann 2021, Imaz 2021(sep y jun) y 2020, Marín 2018 y 2011, Frew 2015, Bogen 2012, Tanaka 2008, Moretti 2003, Viguera 2007, Sykes 1976)

Expert authors consider treatment with lithium during lactation to be possible with caution, periodically carrying out clinical, weight and analytical controls (lithium, TSH, kidney function) on mother and infant. (Uguz 2021 and 2016, Imaz 2020, Rybakowski 2019, Petzold 2018, Pacchiarotti 2016, Khan 2016, Sriraman 2015, Hotham 2015, Grover 2015, Larsen 2015, Rowe 2013, Bogen 2012, Davanzo 2011, Sharma 2009, Rubin 2004, WHO 2002, Iqbal 2001, Moretti 2000, Koren 1999, Austin 1998, Villeneuve 1989), which is not always going to be possible. (Galbally 2018)

Other authors discourage it. (Newmark 2019, Poels 2018, Hermann 2019, Even 2006, Schou 1973)

During the first week, in newborns or premature infants and in dehydrated or infected infants, who may have reduced lithium elimination mechanisms, signs of lithium toxicity taken with breast milk have been described: cyanosis, lethargy, hypotonia or mild and transient increased TSH plasma levels. (Marin 2011, Viguera 2007, Tunnessen 1972)

Breastfeeding is less risky for healthy term infants whose mothers are treated with lithium when she or her family has capacity enough to monitor the occurrence of adverse effects, medical supervision and with the possibility of monitoring of lithium levels and thyroid function in the mother-infant dyad (Marín 2011, Viguera 2007, Moretti 2003).The measurement of lithium levels in infants must be done with adequate technique (Tanaka 2008). There is less risk in monotherapy and if the infant is older than two months.

Some authors recommend stopping or reducing lithium administration 1 to 2 days before the start of labor or scheduled caesarean section (Rybakowski 2019, Bogen 2012, Newport 2005) to lower plasma levels in the newborn. Other authors (Wesseloo 2017, Khan 2016, Bergink 2014) advise against this suspension and recommend adjusting the dose to adequate lithium levels. After delivery, it is advisable to reduce the maternal dose by 50% or to the previous one before pregnancy (Khan 2016, Bergink 2014, Bogen 2012), depending on maternal lithemia controls, which should be frequent during pregnancy and in the pre and immediate postpartum. (Wesseloo 2017, Westin 2017)

Although some cases of lithium galactorrhea have been published (Ohishi 1983), lithium does not usually alter prolactin levels and in some studies it has decreased them, so it may be a good protector against other drugs that tend to increase prolactin levels. prolactin. (Pacchiarotti 2015, Lanng 1977)

Multidisciplinary management of mother and baby should be done in collaboration with psychiatrists, obstetricians, pediatricians, and analysts (Austin 1998). The decision about lithium treatment and breastfeeding should be made by the patient, after collaborative discussion with her psychiatrist, obstetrician, and pediatrician. (Bergink 2014, Schou 1998)


See below the information of this related product:

Alternatives

  • Carbamazepine (Safe substance and/or breastfeeding is the best option.)
  • Lamotrigine (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
  • Valproate, Valproic Acid (Safe substance and/or breastfeeding is the best option.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Lithium Carbonate is also known as


Lithium Carbonate in other languages or writings:

Groups

Lithium Carbonate belongs to these groups or families:

Tradenames

Main tradenames from several countries containing Lithium Carbonate in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 80 - 100 %
Molecular weight 74 daltons
Protein Binding 0 %
VD 0.7 - 1 l/Kg
pKa 6.05 -
Tmax 2 - 4 hours
24 (18 - 36) hours
M/P ratio 0.49 ± 0.19 (0.2 – 1) -
Theoretical Dose 0.13 a 0.72 mg/Kg/d
Relative Dose 11.2 ± 8.5 (3.5 – 24.7) %

References

  1. Imaz ML, Langohr K, Torra M, Soy D, García-Esteve L, Martin-Santos R. Neonatal Feeding Trajectories in Mothers With Bipolar Disorder Taking Lithium: Pharmacokinetic Data. Front Pharmacol. 2021 Sep 22;12:752022. Abstract
  2. Imaz ML, Soy D, Torra M, García-Esteve L, Soler C, Martin-Santos R. Case Report: Clinical and Pharmacokinetic Profile of Lithium Monotherapy in Exclusive Breastfeeding. A Follow-Up Case Series. Front Pharmacol. 2021 Jun 24;12:647414. Abstract
  3. Uguz F. A New Safety Scoring System for the Use of Psychotropic Drugs During Lactation. Am J Ther. 2021 Jan-Feb 01;28(1):e118-e126. Abstract
  4. Gehrmann A, Fiedler K, Leutritz AL, Koreny C, Kittel-Schneider S. Lithium Medication in Pregnancy and Breastfeeding-A Case Series. Medicina (Kaunas). 2021 Jun 18;57(6). pii: 634. Abstract
  5. Imaz ML, Torra M, Soy D, Garcia-Esteve L, Martin-Santos R. Pharmacokinetics of lithium in nursing infants. Eur Psychiatry. 2020;63 Suppl 1:S21–Oral Com. O0072. Full text (link to original source) Full text (in our servers)
  6. Hermann A, Gorun A, Benudis A. Lithium Use and Non-use for Pregnant and Postpartum Women with Bipolar Disorder. Curr Psychiatry Rep. 2019 Nov 7;21(11):114. Abstract
  7. Imaz ML, Torra M, Soy D, García-Esteve L, Martin-Santos R. Clinical Lactation Studies of Lithium: A Systematic Review. Front Pharmacol. 2019 Sep 10;10:1005. Abstract
  8. Newmark RL, Bogen DL, Wisner KL, Isaac M, Ciolino JD, Clark CT. Risk-Benefit assessment of infant exposure to lithium through breast milk: a systematic review of the literature. Int Rev Psychiatry. 2019 May;31(3):295-304. Abstract
  9. Rybakowski J, Cubała WJ, Gałecki P, Rymaszewska J, Samochowiec J, Szulc A, Dudek D. Recommendations of the Polish Psychiatric Association regarding the treatment of affective disorders in women of childbearing age. Part II: Bipolar disorder. Psychiatr Pol. 2019 Apr 30;53(2):263-276. Abstract Full text (link to original source)
  10. Marín Gabriel MA, Malalana Martínez AM, Olza Fernández I. [Lithium while breastfeeding: Case report]. Arch Argent Pediatr. 2018 Abstract
  11. Galbally M, Bergink V, Vigod SN, Buist A, Boyce P, Chandra P, Kohan R, Howard LM. Breastfeeding and lithium: is breast always best? Lancet Psychiatry. 2018 Abstract
  12. Poels EMP, Bijma HH, Galbally M, Bergink V. Lithium during pregnancy and after delivery: a review. Int J Bipolar Disord. 2018 Abstract
  13. Petzold J, Bauer M, Severus E. [Update - Lithium in the Long-Term Treatment of Bipolar Disorders]. Fortschr Neurol Psychiatr. 2018 Abstract
  14. Westin AA, Brekke M, Molden E, Skogvoll E, Aadal M, Spigset O. Changes in drug disposition of lithium during pregnancy: a retrospective observational study of patient data from two routine therapeutic drug monitoring services in Norway. BMJ Open. 2017 Abstract
  15. Wesseloo R, Wierdsma AI, van Kamp IL, Munk-Olsen T, Hoogendijk WJG, Kushner SA, Bergink V. Lithium dosing strategies during pregnancy and the postpartum period. Br J Psychiatry. 2017 Jul;211(1):31-36. Abstract
  16. Khan SJ, Fersh ME, Ernst C, Klipstein K, Albertini ES, Lusskin SI. Bipolar Disorder in Pregnancy and Postpartum: Principles of Management. Curr Psychiatry Rep. 2016 Abstract
  17. Pacchiarotti I, León-Caballero J, Murru A, Verdolini N, Furio MA, Pancheri C, Valentí M, Samalin L, Roigé ES, González-Pinto A, Montes JM, Benabarre A, Crespo JM, de Dios Perrino C, Goikolea JM, Gutiérrez-Rojas L, Carvalho AF, Vieta E. Mood stabilizers and antipsychotics during breastfeeding: Focus on bipolar disorder. Eur Neuropsychopharmacol. 2016 Oct;26(10):1562-78. Abstract
  18. Uguz F, Sharma V. Mood stabilizers during breastfeeding: a systematic review of the recent literature. Bipolar Disord. 2016 Abstract
  19. Frew JR. Psychopharmacology of bipolar I disorder during lactation: a case report of the use of lithium and aripiprazole in a nursing mother. Arch Womens Ment Health. 2015 Abstract
  20. Grover S, Avasthi A. Mood stabilizers in pregnancy and lactation. Indian J Psychiatry. 2015 Abstract Full text (link to original source) Full text (in our servers)
  21. Larsen ER, Damkier P, Pedersen LH, Fenger-Gron J, Mikkelsen RL, Nielsen RE, Linde VJ, Knudsen HE, Skaarup L, Videbech P. Use of psychotropic drugs during pregnancy and breast-feeding. Acta Psychiatr Scand Suppl. 2015 Abstract
  22. Pacchiarotti I, Murru A, Kotzalidis GD, Bonnin CM, Mazzarini L, Colom F, Vieta E. Hyperprolactinemia and medications for bipolar disorder: systematic review of a neglected issue in clinical practice. Eur Neuropsychopharmacol. 2015 Aug;25(8):1045-59. Abstract
  23. Sriraman NK, Melvin K, Meltzer-Brody S. ABM Clinical Protocol #18: Use of Antidepressants in Breastfeeding Mothers. Breastfeed Med. 2015 Abstract Full text (link to original source) Full text (in our servers)
  24. Hotham N, Hotham E. Drugs in breastfeeding. Aust Prescr. 2015 Abstract Full text (link to original source) Full text (in our servers)
  25. Bergink V, Kushner SA. Lithium during pregnancy. Am J Psychiatry. 2014 Jul;171(7):712-5. Abstract
  26. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  27. Bogen DL, Sit D, Genovese A, Wisner KL. Three cases of lithium exposure and exclusive breastfeeding. Arch Womens Ment Health. 2012 Abstract Full text (link to original source) Full text (in our servers)
  28. Davanzo R, Copertino M, De Cunto A, Minen F, Amaddeo A. Antidepressant drugs and breastfeeding: a review of the literature. Breastfeed Med. 2011 Abstract
  29. Marín Gabriel MA, Olza Fernández I, Donoso E, Gutiérrez Cruz N. Litio y lactancia artificial. . . ¿o mejor lactancia materna? [Lithium and artificial breastmilk; or is maternal breastfeeding better?]. An Pediatr (Barc). 2011 Abstract Full text (in our servers)
  30. Sharma V, Burt VK, Ritchie HL. Bipolar II postpartum depression: Detection, diagnosis, and treatment. Am J Psychiatry. 2009 Abstract Full text (link to original source) Full text (in our servers)
  31. Tanaka T, Moretti ME, Verjee ZH, Shupak M, Ivanyi KE, Ito S. A pitfall of measuring lithium levels in neonates. Ther Drug Monit. 2008 Abstract
  32. Viguera AC, Newport DJ, Ritchie J, Stowe Z, Whitfield T, Mogielnicki J, Baldessarini RJ, Zurick A, Cohen LS. Lithium in breast milk and nursing infants: clinical implications. Am J Psychiatry. 2007 Abstract Full text (link to original source) Full text (in our servers)
  33. Even C, Dorocant ES, Thuile J, Kalck-stern M, Guelfi JD. [Pregnancy, breast feeding and mood stabilisers: review and recommendations for practice]. Encephale. 2006 Abstract
  34. Newport DJ, Viguera AC, Beach AJ, Ritchie JC, Cohen LS, Stowe ZN. Lithium placental passage and obstetrical outcome: implications for clinical management during late pregnancy. Am J Psychiatry. 2005 Abstract
  35. Rubin ET, Lee A, Ito S. When breastfeeding mothers need CNS-acting drugs. Can J Clin Pharmacol. 2004 Fall;11(2):e257-66. Epub 2004 Dec 8. Abstract
  36. Moretti ME, Koren G, Verjee Z, Ito S. Monitoring lithium in breast milk: an individualized approach for breast-feeding mothers. Ther Drug Monit. 2003 Abstract
  37. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Abstract Full text (link to original source) Full text (in our servers)
  38. Iqbal MM, Sohhan T, Mahmud SZ. The effects of lithium, valproic acid, and carbamazepine during pregnancy and lactation. J Toxicol Clin Toxicol. 2001 Abstract
  39. Moretti ME, Lee A, Ito S. Which drugs are contraindicated during breastfeeding? Practice guidelines. Can Fam Physician. 2000 Sep;46:1753-7. Review. Abstract Full text (link to original source) Full text (in our servers)
  40. Koren G, Moretti M, Ito S. Continuing drug therapy while breastfeeding. Part 2. Common misconceptions of physicians. Can Fam Physician. 1999 Abstract Full text (link to original source) Full text (in our servers)
  41. Austin MP, Mitchell PB. Use of psychotropic medications in breast-feeding women: acute and prophylactic treatment. Aust N Z J Psychiatry. 1998 Abstract
  42. Schou M. Treating recurrent affective disorders during and after pregnancy. What can be taken safely? Drug Saf. 1998 Abstract
  43. Villeneuve A, Lajeunesse C, Pires A. [Lithium, pregnancy and breast feeding]. Encephale. 1989 Abstract
  44. Ohishi K, Higashimura T. A case of manic state in which lactation occurred after Li2CO3 administration. Folia Psychiatr Neurol Jpn. 1983 Abstract
  45. Lanng Nielsen J, Amdisen A, Darling S, Pedersen EB. Plasma prolactin during lithium treatment. Neuropsychobiology. 1977 Abstract
  46. Skausig OB, Schou M. [Breast feeding during lithium therapy]. Ugeskr Laeger. 1977 Abstract
  47. Sykes PA, Quarrie J, Alexander FW. Lithium carbonate and breast-feeding. Br Med J. 1976 Abstract Full text (link to original source) Full text (in our servers)
  48. Schou M, Amdisen A. Lithium and pregnancy. 3. Lithium ingestion by children breast-fed by women on lithium treatment. Br Med J. 1973 Abstract Full text (link to original source) Full text (in our servers)
  49. Tunnessen WW Jr, Hertz CG. Toxic effects of lithium in newborn infants: a commentary. J Pediatr. 1972 Abstract

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