Lithium Carbonate a white light alkaline powder. It is soluble in water, insoluble in alcohol. The mechanism of action of psychotropic drugs lithium under intense study. It is established that drug ions affect the transport of sodium ions in nerve and muscle cells, resulting in drug acts as antagonist of sodium ions.
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Under the influence of drug increases intracellular deamination of norepinephrine and decreases the amount of free norepinephrine, deystvuyuscheho on adrenergic receptors in tissues of the brain. In high doses, lithium reduces the content of serotonin in the brain. Lithium ions increase the sensitivity of neurons in the hippocampus and other regions of the brain to dopamine. Thus, lithium has an influence on flowing in the brain neurochemical processes that may underlie its therapeutic activity in mental illness.
The most common drug is lithium carbonate. Drug salts are rapidly absorbed after ingestion; dissotsiiruyut in the body. Lithium ions are found in different organs and tissues after 2 to 4 h after a single reception of the drug. Drug is excreted from the body predominantly via the kidney. And excretion is correlated with the concentration of drug in the blood plasma, as well as the level of sodium and potassium in the blood. With a lack of sodium chloride in the body is reabsorption of drug in the renal tubules. When excessive introduction into the organism of sodium chloride excretion of lithium increases.
In the course of treatment the drug lithium should therefore monitor the water-salt balance. Drug crosses the placenta; excreted in the milk of lactating women.
Instructions for using Lithium.
The main indications for use of drugs are lithium manic and hypomanic States of different Genesis (especially with frequent attacks), prevention and treatment of affective psychoses (manic-depressive, schizo-affective, organic affective psychoses). There is evidence of the effectiveness of lithium not only with endogenous psychoses, but also in patients with organic psychoses, epilepsy, psychopaths with different speed fluctuations.
Has also applied drug for the prevention and treatment of affective disorders in patients with chronic alcoholism. Assign inside after eating (to reduce irritants in the mucous membrane of the stomach).
Dose Of Lithium Carbonate.
Doses should be set and monitored individually on the content of lithium in the serum. Definition produced by the method of flame photometry. The concentration of lithium in the blood plasma should not be below 0.6 and above 1.2 – 1.6 mmol/l. At lower concentrations the effect usually does not occur, at higher concentrations possible toksicheskie phenomena. In the absence of a laboratory study adjust dose for therapeutic effect and tolerability, however, this also increases the risk of side effects.
Usually used drugs for medicinal purposes, ranging from 0.6 – 0.9 grams per day. With good endurance dose on the following day, increased to 1.2 g, then every day is added 0.3 C to a daily dose of 1.5 – 2.1 g, sometimes up to 2.4 g, making sure, however, that the concentration of lithium in the blood did not exceed 1.6 mmol/L. If the concentration of lithium in the blood is not determined, it is possible to appoint in a dose of more than 2.1 g per day should not be. In doses exceeding 2 g per day, not recommended to appoint drug over 1 to 2 weeks. Prescribers equal doses throughout the day in 3 – 4 admission. After the disappearance of the maniacal symptoms daily dose is gradually reduced to 1,2 – 0,9 – 0,6 G. If after reducing the dose again showing signs of mania, the dose increases.
After 7 – 10 days after receiving the full effect again gradually lower the dose, then the drug is withdrawn or continue to be administered in prophylactic doses. For prophylactic the drug is prescribed ranging from 0.3 – 0.6 grams per day, then the dose increase to 0.9 – 1.2 g a day, making sure that concentration in the blood was 0.6 to 0.8 mmol/l, but not above 1.2 mmol/L. If the concentration of lithium in the blood exceeding 1.2 mmol/l, should reduce the daily dose.
The drugs carbonate can be administered concurrently with neuroleptics and antidepressants. Side effects more commonly seen at the beginning of treatment until stable drug concentrations in the blood and expressed tremor of fingers, fatigue, ataxia, drowsiness, increased thirst, dyspeptic phenomena, a diarrhea, heart rhythm disorders, etc. Side effects are usually observed if the serum lithium level exceeds 1.6 mmol/l, but the high sensitivity of the individual can occur at lower concentrations. At the beginning of treatment concentration of lithium in the blood should be determined at least once a week, in subsequent long intervals (once in 2 weeks – 1 month). The appearance of increased thirst and tremor of the fingers should be considered as early signs of drug overdose that requires treatment interruption (1 – 2 days) with the further use of the drug in a reduced daily dose. Note that in the human kidney excretion of lithium may slow down, and the concentration in the blood will increase. During treatment with lithium carbonate possible temporary increase of body weight and the formation of goiter.
When adverse events recommended the appointment of sodium bicarbonate, aminophylline, diakarba, urea. In the case of goiter prescribed thyroid hormones. The drug is contraindicated in violation of renal excretory function, in cardiovascular disease events with decompensation and conduction disturbances, in pregnancy. Relative contraindications are thyroid dysfunction.
Should not be administered to patients lithium carbonate under salt-free diet, because of the risk of increased drug reabsorption by the kidneys.