At what dosage does Lithium require blood tests?

Am currently on the following cocktail:

--Effexor
--Risperdal
--Clonazepam
--and Lithium.  The latter was started at 300mg, then increased to 600 mg due to SI.  Now thinking of stepping up Lithium to 900 mg to cope better with hypomanic symptoms.  Have not had any blood tests so far.

At what dosage does Lithium require blood tests?

Thanks,
aadel

[monkeyc]

Every dosage.

Lithium dosage is different for every person, what might be fine for me (1250mg a day) might not be for you and it needs titration - to achieve any meaningful level you need blood tests to get your mmol levels - you need to be in the 0.7 to0.9 mmol range to get theraputic benefit for lithium and if you are on 900mg you should be getting tested along with a thyroid test as well.

for most adults 600mg is a low dose, it would be doubtful you have a level about 0.5 or so on that UNLESS there are other factors - for example James here has damaged kidney function and 600mg a day was bad for him but a physically healthy adult would not likely be in a theraputic range at 600mg - from memory the base therapy dose is 900-1000 mg a day and up with 1200 being common from the literature BUT it is vital to understand thtat due to the mechanism of action lithium is VERY dependant on following the guidelines - hydration, eating well and limiting alcohol are all important - anything that can cause dehydration or affect liver or kidney efficiency can cause lithium build up and possibly toxicity.

The good thing is these are all common sense things - drink 2litres of water a day and more in the hear, eat a balanced diet and minimise salt where possible and drink in moderation adding 1 glass of water to each unit of alcohol and you will be fine.

[bernie40]

As monkeyc has said, any dose requires blood tests.  On the patient information leaflet that came with my prescription the other day it states that following either, being on it for the first time or increasing the dose a blood test should be taken no less than 5 days after commencement.

Its important to have the blood tests when first starting this med.  Once you have reached a stable level then the tests are reduced to every 3 months - well according to the leaflet anyway ;-)

I had my first blood test 4 weeks after commencement, I have started on a low dose of 400mg.

[elwoodsf]

Any dose requires a blood test. I started Lithium so long ago I do not remember when my first blood test was taken. I do remember having to have Lithium levels (blood test) taken once a month for quite some time. Now my Lithium levels are taken every six months (after 23 years). NOW - I have a friend who found out his kidneys were affected in a negative way upon his first blood draw which indicated to his Pdoc that he needed to stop taking Lithium right away hense the blood test asap after starting the medication. FYI - I started at 300mg a day and I have been at 900 mg for years. As monkeyc stated, the theraputic levels are between .7 to .9 which is measured through a blood draw.

[LeftCoastChick]

Yep I have to agree, testing should be done at any level. I had my first at 450, and it came back that I wasn't metabolzing it well enough so it was upped to 600, then I was tested 5 days later, to make sure it was correct. It's also important to get a ecg done as well once a year. I had one done when I started Lithium. My pdoc said it's required to ensure proper monitoring, as well as checking kidney and liver function like monkey, bulldozer  and elwood suggested. As a teen, I was tested every week because I was at 1200mgs, that's a high dose. It's a salt and needs to be monitored because it can unbalance other natural occuring salts in the body.

[elwoodsf]

Thank you for stating that Lithium is a salt. My kids tell me it's an element. I just say to them that it is a salt on the element chart. Either way, it is Lithium. Kids!!!!!

[monkeyc]

They are right actually !

Lithium is an element - L1 and an atomic number of 3 - its the lightest metal and the lest dense solid element - its alkaline and highly reactive and commonly only found as c compound - it appears on the periodic table if you look as one of the base elements and sits just under hydrogen.

http://www.elementsdatabase.com/

Lithium we use is a chemical salt - Lithium Ion or LI+ which is commonly taken in the form of Lithium Carbonate (Li2CO3) though there are other types around.

Its also the 32 or 33rd most common element in the universe and scientists therorise it was formed in the big bang.

If they do some reading (good edcuation) they will find a fascinating element in lithium because it rarely exists in natural form due to its reactivity and alkaline nature but its used in so many places - It was splitting lithium ion atoms that led to the first  nuclear reactors for example and lithium deuteride is used to fuel the fusion stage in thermo nuclear weapons.

Versatile stuff really.