Lithium Carbonate

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:

• Maternal Psychotic Disorder. Maternal psychosis, schizophrenia, bipolar disorder (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)