Synopsis
Initiate lithium only with complete baseline and shared-care safeguards, interpret correctly timed plasma levels, prevent interaction and dehydration-related harm, and act on clinical toxicity without waiting for a numerical threshold.
- Required baseline includes weight or BMI, full blood count, urea and electrolytes including calcium, eGFR and thyroid function; add ECG for cardiovascular disease or risk and assess pregnancy where relevant.
- Do not initiate lithium without facilities for regular plasma levels, organ monitoring, safety information and an explicit specialist-primary-care shared-care arrangement.
- First plasma level is measured one week after starting and one week after every dose change, then weekly until stable using the locally specified post-dose sampling time.
Key red flags
Coarse tremor, unsteady gait, dysarthria, confusion, reduced consciousness, seizure or new neuromuscular signs suggests clinically significant neurotoxicity.
Investigation priorities
Measure weight or BMI, FBC, renal function, electrolytes, calcium and thyroid function before exposure.
Management branches
Lithium is selected for an adult who has not previously taken it or is restarting after a clinically significant interruption.
- Discuss benefits, adverse effects, toxicity, interactions, pregnancy, adherence and discontinuation and confirm the person can use monitoring and safety information.
- Complete weight or BMI, FBC, renal-electrolyte-calcium and thyroid tests, plus indicated ECG and pregnancy assessment, before prescribing.
The lithium dose and plasma concentration are stable without current toxicity or relapse concern.
Key medicines
Priadel prolonged-release lithium carbonateThe product regimen is individualised; an average-weight adult may start 400 to 1200 mg by mouth daily as one or two doses, with a plasma level four to seven days later and subsequent dose adjustment to the agreed target.