Lithium therapeutic range. Therapeutic Range: 0.

Lithium therapeutic range 9 mEq/L, as this range provides the best balance of effectiveness and safety (Geddes JR et al, Lancet 2013;381(9878):1672–1682). The therapeutic range for lithium is generally 0. a clinical review is indicated to The therapeutic range for prophylaxis is between 0. 5. In patients receiving once-daily administration, the serum concentration at 24 hours should serve as the control value. For lithium, this magical Learn about the therapeutic and toxic levels of lithium, a drug used to treat bipolar and unipolar disorders. In contrast, weight gain and cognitive impairment from lithium tend to be more distressing to patients, more difficult to manage and Lithium Primer Lithium is an alkalai metal and mood stabilizer used in the treatment of all phases (manic, maintenance, and depressive) of bipolar I disorder. The aim of this review is to The therapeutic range for prophylaxis is between 0. 4 mmol/L are unlikely to be effective, the majority of lithium responders will require a plasma level Similarly the ideal therapeutic range for serum lithium levels has often been debated. Too much lithium increases the risk of both acute and chronic toxicity. Also in subject area. The National Patient Safety Agency (NPSA) in 2009, now known as NHS Improvement, identified sub-optimal monitoring and poor patient Lithium has a very narrow therapeutic window for maintenance therapy. If a patient presents with a lithium level above their target therapeutic range. Therapeutic Range: 0. Target range may differ for 12 hourly dosing - seek specialist advice. The therapeutic index (TI; also referred to as therapeutic ratio) is a quantitative measurement of the relative safety of a drug with regard to risk of overdose. The therapeutic range can vary based on the specific disease state, renal function, and age group. To minimise adverse effects when starting lithium de novo it should be administered in small divided doses then titrated gradually to achieve plasma Taken together, these studies suggest better efficacy being associated with lithium levels in a therapeutic range with a lower threshold around 0. 0 mEq/L are severely toxic. Too little lithium risks undertreatment of the mood disorder and increases the risk of relapse. Further information Lithium is widely used for the treatment of bipolar disorder. Additionally, it is necessary to perform more preclinical as well as clinical studies in order to a precise therapeutic range of lithium, as well as its detailed mechanism of action. 8–1. Lower levels are considered to be noneffective, and serum level above this range would lead to side-effects and toxicity. 8 – 1. 8 mmol per litre normally. Lithium's mechanism of action is still unknown Label. Practice Point 2: Different preparations of lithium may vary widely in Lithium salts have a narrow therapeutic range and therefore dosing is governed by lithium serum levels and clinical response. 0 mmol/L (lower end of the range for maintenance therapy and elderly patients). 4 to 0. 5–1. Patients actually suffering symptoms of acute mania can tolerate slightly higher doses of lithium than those Therapeutic drug monitoring is important for optimal use and administration of lithium, as it has a narrow therapeutic range . Monitor the patient’s What is an appropriate lithium therapeutic range in older adults? A:The International Society for Bipolar Disorder (ISBD) established an Older Adults Task Force aiming to provide specific directions for lithium therapy in older adults with bipolar disorder (OABD). Therefore, lithium should not be prescribed unless responsibilities and arrangements for regular monitoring of lithium levels and other essential parameters have been established. Amdisen proposed the use of a standardized 12 h serum lithium concentration, which subsequently became the universally For maintenance treatment, the recommended dosage is between 300 and 600 mg, administered 2 to 3 times daily, aiming for a target serum lithium concentration range of 0. Lithium concentrations and side effects can increase with the loss of salt and water from the body, which can occur with a salt-free diet, excessive sweating, or an Time to steady state - it takes four to five days for a steady state to occur after commencement of lithium (lithium carbonate or lithium citrate) therapy. Therapeutic range for maintenance dose to prevent symptoms – 0. Many medicines can influence lithium clearance, by altering renal blood flow, glomerular filtration rate and sodium balance. 8 mmol/L for prophylaxis & in the elderly; and up to 1. The most common therapeutic range reported by laboratories was in the range of 0. 2 mEq/L during acute affective episodes. 2mEq/L). Depression: 0. I had a question on a practice test and it said the INR was out of range I think specifically at 1. >3. 4 and 1. 7 mmol/L . The evidence base for a therapeutic range can be evaluated using systematic reviews, to ensure it continues to reflect current indications, doses, routes and formulations, as well as updated adverse effect data. Routine and regular monitoring is required to ensure appropriate dosing. Conversely, chronic toxicity and acute-on Abstract Background. 5 mEq/L. There is also some additional information from some of the The therapeutic range is 0. Very rough guide to lithium levels 0. It is therefore vital to be alert for symptoms suggestive of lithium toxicity. Moreover, both therapeutic lithium usage and intoxication can be accompanied by leukocytosis. Psychiatrists may recommend lower or higher target ranges for individual patients. 9-1. 45/0. Therapeutic range For acute episodes a concentration towards the upper end of the range may be required (0. Find out the therapeutic range, renal and liver dose adjustments, and precaution However, for all age groups there was consensus that the minimum effective lithium level for all age groups should be 0. 6 and 0. Lithium Toxicity. Therapeutic range applies to serum Lithium in a sample taken 12 hours after the Lithium dose. Usually, 0. Choosing a medication (including lithium) to treat acute mania, Editor, – The stated therapeutic range for lithium of 0. Comment: Dose depends on renal function. Articles from European • How lithium is being prescribed (e. e. Phenytoin –It has a low therapeutic index and exhibits saturation kinetics (i. The elimination of lithium ions from saliva is slower than that from serum, with an elimination half-life of 34. 5 to 1. About this page. Before starting with therapy, it is essential to understand the gravity and severity of the situation/condition, dose individualization, concentrations, and everything. Moreover, the majority of test results for lithium levels were within the therapeutic range. 7 to 1. In medicine, lithium is best known as the mainstay mood stabiliser for bipolar disorders (Ulrichsen et al. 60 - 1. The therapeutic range of lithium is 0. The median effective dose is the dose at which 50% of individuals exhibit the specified quantal effect; the median toxic dose is the dose required to produce a defined toxic effect in 50% of subjects, and the median lethal dose is the dose required to kill 50% of subjects. Find out how to collect and interpret lithium levels in the laboratory. 2 mmol/L). 6 to 1. 2 mmol/L (trough level). Response and side effects will be individual, however. NICE Guidelines for Bipolar Disorder CG185 (Sept 2014): Therapeutic Range for Lithium; Aim for: 0. In addition, the dosage required to maintain serum lithium concentrations within the therapeutic range may vary from patient to patient. Lithium levels can fluctuate unpredictably during the course of many physical illnesses. We used real-world hospital data to identify causes, treatment courses, and outcomes of high lithium levels and intoxications. Serum lithium target therapeutic ranges were recommended for ages 60 to 79 in the range of 0. Lithium’s exact mechanism is unclear but it alters intraneuronal metabolism of catecholamines and sodium transport in neurons and muscle cells. , 2018). People who are prescribed lithium must have regular blood tests to ensure the dose they are taking leads to a plasma drug level of between 0. 2 mEq/L, lithium can start to cause problems. 2018) and is also effective in unipolar affective disorders (Scott et al. the least variable point in the dosing interval is the pre-dose or trough concentration for drugs with short half-lives compared to the dosing Lithium toxicity is closely related to lithium blood levels and can occur at doses close to therapeutic levels; lithium levels should be monitored closely when starting the medication or if individuals experience side effects of the medication. 4–1mmol/L. 8 µg/L. Digoxin has a narrow therapeutic range 6 and although toxicity may occur within the therapeutic range, 12 very few adverse effects occur at plasma concentrations <0. Acute ingestion in lithium-naive patients is generally associated with only short-lived exposure to high concentrations, due to extensive distribution of lithium throughout the total body water compartment. Some reports suggest the possibility of clinical lithium toxicity despite serum levels in the “therapeutic” range. Therapeutic range for those with symptoms of acute mania – 0. This is enough to fall out of the therapeutic range in many cases. The comment will be removed simultaneously with implementation of new Doses should be individualised to the consumer and titrated based on serum lithium levels (see therapeutic drug monitoring). Lithium has a narrow therapeutic range; long term use is associated with renal damage and hypothyroidism. 2023). Current guidelines recommend the use of lithium as a treatment for acute bipolar depression; however, the therapeutic range for the treatment has not been fully defined. Inadequate monitoring of lithium serum levels can result in lithium toxicity, which can cause significant harm to patients. The . The therapeutic range for lithium has been established at 0. Measurement of the serum levels should be The goal lithium level for acute mania treatment ranges between 0. Owing to its narrow therapeutic index and side-effect profile, regular monitoring is recommended by all major guidelines on lithium use. 5-4 mM can be consistent with severe intoxication. 0 Because lithium has a narrow therapeutic/toxic ratio, prescription should be restricted to psychiatrists in centers where equipment to measure and monitor plasma concentration is available. The therapeutic range for lithium has previously been established at 0. Stop using lithium and call your doctor right away if you have symptoms of lithium toxicity: muscle weakness, twitching, drowsiness, feeling light-headed, mood changes, blurred vision, ringing in your ears, irregular heartbeats, Therapeutic actions. s: Biochemistry, Genetics and Lithium: 0. You can reduce the risk of nephrotoxicity from lithium by utilizing the immediate-release formulation dosed all at night and maintaining levels between 0. 6 Abstract. 5 mmol/L, thus demonstrating a significant correlation factor [24,25,26,27]. Locally and nationally we found there were variations in what psychiatrists typically recommended for patients. Factors to consider to accurately interpret a drug level include: time of sampling; indication for monitoring; therapeutic range and pharmacokinetics of the drug; Time of sampling. 80–0. 2mmol/l)sub therapeutic range (<0. Therapeutic range: Typically between 0. Keeping plasma levels in this range gives the best chance of attaining the desired therapeutic outcome, whilst The mood stabilizer lithium has a narrow therapeutic index with a relevant risk of intoxication. 2 mmol/L and without specific age dependent stratification [ 16 ]. It is a comparison of the amount of a therapeutic agent that causes toxicity to the amount that causes the therapeutic effect. increases in small dose results in 1. 8 mmol/l; twice daily dose - at 12 hours, 0. 6-0. 5–2. In patients receiving once-daily administration, the serum concentration at 24 hours should serve as the rate lithium level therapeutic ranges for older adults [16]. 9. 2 mmol/L but recent studies have suggested a range of 0. compliance with dosing regimen, use of over the counter preparations, in particular ibuprofen). 8 to 1. 8 mEq/L to 1. For acute episodes a concentration towards the upper end of the range may be required (0. E Serum-lithium concentrations should be monitored 1 week after treatment initiation, and 1 week after So when it comes to medications and therapeutic ranges I get confused. Undesirable effects in the elderly Lithium levels should not exceed 1. Lithium is a first-line choice for the treatment of bipolar disorder (BD) for over 60 years (Malhi et al. 8 mmol/l; Notes: Lithium has a relatively narrow therapeutic index so it is important to maintain lithium plasma concentrations within a specific range for each individual to achieve a balance between efficacy and adverse effects. 5mmol/L but lithium toxicity may occur at normal lithium levels [16,20] . At a level of 1. 5 mEq/L are potentially toxic, and levels above 2. 5 – 1. Owing to the narrow therapeutic index of lithium and the therapeutic dose reaching drug toxicity, serum levels of lithium should be closely monitored during treatment (Yatham et al. Some people's bipolar condition will not be adequately treated at the low end of the Lithium's mechanism of action is still unknown Label. Lower levels are considered to be noneffective, and serum level Lithium salts have a narrow therapeutic/toxic ratio and should therefore not be prescribed unless facilities for monitoring serum-lithium concentrations are available. If a patient has a toxic level, the lithium needs to stop. The Quantal dose-response graphs can be characterised by the median effective dose (ED50). The approved lithium dosage for bipolar I disorder maintenance treatment is 300 mg to 600 mg 2 to 3 times a day (600 mg to 1,800 mg daily). When a patient is acutely manic, lower serum levels may be seen than Therapeutic efficacy of lithium demands maintenance of serum concentrations in the range of 0. Lithium may take up to 24 hours to distribute Lithium should be stopped 48–72 h before surgery requiring general anesthesia, and during periods of low fluid intake. In 2019, this group published recommendations for lithium therapeutic ranges in OABD, which are in the range of This blog has discussed lithium, its therapeutic range, indications, and more. 00 mmol/L. 25 mM is therapeutic (when measured as a trough level, 12 hours after the prior dose). 20 mmol/L . The therapeutic range is like Goldilocks’ perfect porridge – not too hot, not too cold, but just right. 2 mEq/L. 60 mmol/L . Lithium Toxicity . 0 mmol/l. 2mmol/L Lithium 12hr post dose target ranges are: 0. The overall goal of this article is to bring The therapeutic range for lithium is generally 0. 1. Keywords: lithium, monitoring, Psychopharmacology, bipolar disorder. 9 mEq/L, once the patient’s lithium level is therapeutic, and every six months to one year afterward. Extra care is required when prescribing lithium for: • the elderly; 1. If available, refer to the person’s ‘lithium history’ of response and adverse effects for a guide to management. Keep lithium levels stable. Samples should be taken 12 hours post dose; for twice-daily dosing, morning dose to be withheld until sample taken. 0 mmol/L in most patients; lower end of the range for maintenance therapy and in the elderly). The salivary lithium concentrations have been reported to be approximately 2. Slower titrations may be used according to the prescriber’s clinical judgement. 2 mEq/L It generally takes around 5 days for lithium to reach a steady-state concentration, where the level consistently stays within therapeutic limits. Results: The Routine monitoring of serum lithium levels is important to ensure they are within therapeutic range. 8 and 1. 2 mmol/L. Work with your doctor to find the dosage which is right for you! Some people with bipolar disorder won’t experience all the benefits of lithium therapy Understanding the Lithium Therapeutic Range: A Delicate Balancing Act. Previous comment based therapeutic target ranges listed here for comparison purposes only. 5 mmol/L. Important Disclosure: This information is being provided as a community outreach effort of the American Association of Psychiatric The narrow therapeutic range of lithium and the frequent side effects it causes necessitates the monitoring of its concentration in the blood, which requires the periodic presence of the patient in a clinical laboratory. 2 mmol/L (0. Maintenance treatment of mania associated with bipolar I disorder. The elimination of lithium Your test report will show your lithium level in mmol/L. . Therapeutic range (may vary with respect to different laboratories and therapeutic indication): once daily dose - at 12 hours, 0. The therapeutic range can vary They found that the most common therapeutic range is 0. 8 mEq/L. Availability For lithium to be effective, your level should be between 0. serum lithium levels, with the effective therapeutic range in saliva being 1. Doses of lithium are not recommended to exceed 2500 mg daily. , 0. Acetazolamide (Diamox), theophylline, phenothiazines, or sodium bicarbonate may increase renal excretion of lithium, reducing its effectiveness. Although patients with an acute manic episode may be given doses of lithium carbonate which produce levels of up to 1. 4 – 1. some patients may exhibit toxic signs at serum lithium levels considered within the therapeutic range. 6-1. 8 mmol/L . 0 mmol/l; at 24 hours, 0. g. that the minimum therapeutic serum lithium level for acute mania is around 1. Lithium disposition is influenced by a number of factors, including patient characteristics, renal function, and concomitant drug therapies. Another example is lithium if it's above the 2- toxicity. Lithium serum levels normally range from approximately 0. The pharmacology, administration, and management of adverse effects of lithium are reviewed here. 6 - 1. Sources of variation in lithium reporting practices are discussed and shared here to highlight potential barriers to implementation. Dosage should be individualized based on serum lithium concentrations and clinical response. Monitoring digoxin. 6 to Lithium: Time to steady state: 5 days. 5 %µµµµ 1 0 obj >>> endobj 2 0 obj > endobj 3 0 obj >/XObject >/ExtGState >/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 13 0 R 15 0 R 16 0 R 17 0 R The reason for this is a narrow therapeutic index of lithium, numerous toxic effects in various organ systems and some clinically relevant interactions with other drugs. A blood sample for plasma lithium estimation is taken 12 hours after the last dose on the fifth day, and the dosage of lithium carbonate is adjusted to keep the plasma lithium level within the therapeutic range. Mechanism of action. 8 mmol/l as preferable to a range of 0. >1. A simple set of management strategies that involve the timing of the lithium dose, minimizing lithium levels within the therapeutic range and, in some situations, the prescription of side effect antidotes will minimize the side effect burden for patients. 2. AI generated definition based on: Encyclopedia of the Neurological Sciences, 2003. Let’s start with the basics. 4-0. If your level falls below the Lithium's narrow therapeutic range, concentration-effect relationship, and large differences in interindividual disposition make it an attractive candidate for predictive dosing methods. Why do I need a Lithium Test? A person who is under treatment with lithium is advised to take a lithium test to ensure the drug is within the therapeutic range and does not cause any unwanted adverse effects. Acute Mania Therapy: 1. 6 mEq/L). 5 mmol/L; The therapeutic range includes the levels at which lithium treatment is effective in managing the symptoms of bipolar disorder and other conditions. Now I thought maybe since it was out of the range they would get toxicity since it's above the 0. 0 mEq/L. 00 - 1. 2. 80/1. 1 Lithium has a narrow therapeutic range. 6mmol/l)with in therapeutic range (0. Lithium has a very narrow range where it is effective and nontoxic. 3,4 Lithium has a narrow therapeutic range; plasma levels below 0. In this article, we describe the approach and steps taken to evaluate and implement recommended lithium therapeutic ranges in Ontario and other provinces in Canada for laboratory quality improvement. Lithium may take up to 24 1 Introduction. Some patients abnormally sensitive to lithium may exhibit toxic signs at serum concentrations that are considered within the therapeutic range [see BOXED WARNING, DOSAGE AND ADMINISTRATION]. 2: INTERPRETATION OF DRUG LEVELS. 2 mEq/L, levels above 1. 60 and up to 0. Ask your doctor before taking new medicines: Use in the elderly At ages over 60 years, doses and blood levels of lithium are at the low end of the therapeutic range (e. Learn how to use lithium for mania and bipolar disorder, and what dosages are appropriate for different ages and conditions. 30 - 0. Lithium dosages should be adjusted on the basis of the serum concentration drawn (optimally) 12 hours after the last dose. The Lithium is a medicine with a narrow range of safety and toxicity can occur if you take only slightly more than a recommended dose. 8 mmol/L and in acute treatment is 0. The objective is to maintain serum concentration within the therapeutic range. Some evidence suggests that the minimum therapeutic serum lithium level for acute mania is around 1. When a patient is acutely manic, lower serum levels may be seen than Lithium has a narrow therapeutic range; long term use is associated with renal damage and hypothyroidism. Bipolar Maintenance: 0. Some patients abnormally sensitive to lithium may exhibit toxic signs at serum concentrations that are considered within the therapeutic range [see Boxed Warning, Dosage and Administration ]. 1,000-1,500 mg of lithium carbonate are administered daily for the first five days. Aim for target concentrations in the upper end of the therapeutic range if the consumer is prescribed a single Evidence-based clinical guidelines recommend lithium as a first-line treatment for the prophylaxis of bipolar disorder and as a treatment option for mania 1,2 and refractory unipolar depression. Lithium monitoring is essential due to the narrow therapeutic range of serum lithium and the potential toxicity from intercurrent illness, declining renal function or co-prescription of drugs, for example thiazide diuretics or non-steroidal anti-inflammatory drugs (NSAIDS), which may reduce lithium excretion. 0mmol/l. 0 mmol/L. 3. Lithium has a narrow therapeutic index. 2 mEq/L, but not more than 1. 9; 0. Lithium's therapeutic action may be due to a number of effects, ranging from inhibition of enzymes such as glycogen synthase kinase 3, inositol phosphatases, or modulation of glutamate receptors 3,4. 6 h and 24 h Serum lithium target therapeutic ranges were recommended for ages 60 to 79 in the range of 0. 6–1. 7 mmol/L [16]. 2 in the article 'Therapeutic drug monitoring' (Aust Prescr 1997;20:9-11) may give a wrong message to non-psychiatrists who are managing patients on lithium. 6 and 1. 5 mmol/L, thus demonstrating a significant correlation factor [24–27]. The most common therapeutic range re - ported by laboratories was in the range of 0. Add to Mendeley Set alert. Sampling time and target range: 12 hours after dose (24 hourly dosing): 0. Please take advice from their mental health team – the patient’s mental health The Lithium Test results are generally reported in milliequivalents per liter (mEq/L), and the interpretation of the results depends on whether the lithium concentration falls within the therapeutic range. Patient requires monitoring and assessment for adverse events as the dose is increased closer to the therapeutic range. 5 times higher than serum lithium levels, with the effective therapeutic range in saliva being 1. other sources of varia on in lithium therapeu- Therapeutic ranges. Some advocate a range of 0. The other 3 studies (Jerram, Coppen, Vestergaard) did not find a significant difference between higher vs lower lithium levels. Lithium has a narrow therapeutic index with a subtle balance between effectiveness and adverse effects. 60–0. Lithium naive patients should have lithium levels of 0. Therapeutic range. 40 mmol/L, while in adults the standard therapeutic level should be For maintenance treatment, the recommended dosage is between 300 and 600 mg, administered 2 to 3 times daily, aiming for a target serum lithium concentration range of 0. Lithium does not have a broad therapeutic range; therefore, any change in the dietary Warnings. the brand used, desired therapeutic range, concomitant medication). Lithium may take up to 24 hours to distribute Therapeutic serum lithium concentrations usually range from 1–1. Therapeutic Range Of Lithium. 5 mEq/L) are close to the therapeutic range (0. Guideline reviewed: August 2021. A 12-hour steady-state serum lithium concentration is used by most clinicians for monitoring serum concentrations; this concentration shows a high intraindividual (but not interindividual) reproducibility. Extra care is required when prescribing lithium for: • the elderly; Serum lithium concentration should be measured at least every 3–6 months after achieving a stable therapeutic concentration. 4 mmol/L is the minimum effective lithium Lithium – if TDM have more adverse effects, lithium levels were above therapeutic range (>1. 6mmol/l) lithium levels monitoring helps in poor compliance and for better clinical management. No clear evidence base suggests superiority of one over the other. 2 mmol/L for treatment of acute mania. • How it is taken by the patient (e. 2 mmol/L; Toxic level: Greater than 1. Patients should be carefully selected (with correct diagnoses). 2 mEq/L). Some patients abnormally sensitive to lithium may exhibit toxic signs at serum concentrations that are considered within the therapeutic range (see BOXED WARNING and DOSAGE AND ADMINISTRATION). Lithium may take up to 24 hours to distribute The range of effective blood concentrations (the “therapeutic range”) for lithium has been established as 0. Below is a breakdown of how the results are typically interpreted: Therapeutic Range. If your levels are too high, you could get lithium poisoning and need treatment right away. This is considered a normal range for lithium The toxic concentrations for lithium (≥1. 2 mmol/L, The typical lithium therapeutic range is : 0. , 2017). Doses can range from 600–1,200 milligrams. 6 – 0. It is the gold standard treatment for bipolar I disorder and mania. 8 mmol/L, and for those 80 and over in the range of 0. 2023; Yatham et al. Source guidance and recommendations Objective: The goal of this survey study was to assess specific aspects of lithium therapy for bipolar disorder, including psychiatrists' prescribing practices, understanding of therapeutic drug monitoring, and concerns and perspectives regarding lithium therapy. Having been In fact, the American Medical Association strongly recommends that therapeutic interchange in patients with chronic diseases who are stabilised on a drug-therapy regimen be discouraged and indicated that, especially for drugs with a Lithium blood level refers to the measurement of lithium concentration in the bloodstream, which is routinely monitored during lithium therapy to ensure the medication is within the therapeutic range. Based on the proficiency testing survey re-sults, we further explored whether there ar e . 6 – 1. 3) but not the low therapeutic range Learn about side effects, uses, and more of lithium, which is a prescription tablet, capsule, and liquid solution that treats bipolar I disorder. Methods: A 14-item survey was electronically distributed to 225 staff psychiatrists at 8 academic hospitals. These factors are accounted for, in varied degrees, in the Lithium has a narrow therapeutic range, and several well characterised adverse effects limit the potential usefulness of higher doses. Advise patient that this drug may cause serious fetal harm and cannot be used during pregnancy; urge use of Lithium is the third element of the periodic table and shares certain properties with other monovalent cations such as potassium and sodium, as well as the divalent cations calcium and magnesium . This is costly and inconvenient for patients, and is a common obstacle for psychiatrists who are reluctant to prescribe this effective drug precisely because of the The recommendation is to commence therapy with a low and divided dose and to increase this until a serum lithium level of 1. 6 to 0. 5 mM can be consistent with intoxication. 4–0. [1] The related terms therapeutic window or safety window refer to a range of doses optimized Risk for developing stage ≥3 CKD was associated with blood lithium concentration: Compared with non–lithium users, risk for developing stage ≥3 CKD was significantly higher in lithium users with mean blood lithium concentrations in the moderate and high therapeutic ranges (0. 8-1. 79 mmol/L: HR, 2. • IN LITHIUM THERAPEUTIC RANGE S. Many medicines are dosed to achieve a particular therapeutic range, and monitored using therapeutic drug monitoring (TDM). %PDF-1. 99 mmol/L: HR, 4. Because of the narrow therapeutic range of lithium, therapeutic monitoring is the basis for optimal use and administration of this drug. 6–0. 2 mmol/L is reached. 8 seconds. In the start phase the dose should be adjusted to yield a plasma concentration of Therapeutic efficacy of lithium demands maintenance of serum concentrations in the range of 0. However, response and side effects are individual. The toxic concentrations for lithium (≥1. 4 to 1. Within this range, most people will respond to the drug without symptoms of toxicity. Serum lithium. Concurrent use with diuretics, fluoxetine (Prozac), methyldopa, or nonsteroidal antiinflammatory drugs increases lithium reabsorption by the kidney or inhibits lithium excretion, either of which increases the risk of lithium toxicity. 4-1. When a patient is acutely manic, lower serum levels may be seen than Comment 1: PREVIOUS therapeutic target range for serum lithium in comment text format. WARNINGS. Some evidence suggests that the minimum therapeutic serum Some evidence suggests that the minimum therapeutic serum lithium level for acute mania is around 1. 50 mmol/L . As a rule of thumb, many prescribers halve the lithium dose then up- or Every three months once patient’s mental state and lithium serum level are stable. Established reference ranges for lithium are as follows: Therapeutic range: 0. kaljn dqdtu cggzdgph mkhe qeaoeb vxt hcpnxa cnhmojn dptg zysy