Lithium Carbonate (Lithobid, Eskalith)

Bipolar I disorder, including the acute treatment of manic episodes and long-term maintenance therapy. It is also used off-label as an adjunct for treatment-resistant depression and schizoaffective disorder.

Lithium is a mood stabilizer that affects several signaling systems in the brain involved in emotional regulation, neuronal communication, and stress response. Although lithium has been used in psychiatry since the mid-20th century, its exact mechanism of action is not fully understood, though is clearly complex and not explained by a single pathway. Instead, lithium influences multiple biological processes, like the below examples, that regulate mood stability.

Common side effects of lithium carbonate include tremor (shakiness of the hands), increased thirst and urination, nausea, diarrhea, weight gain, cognitive effects such as memory problems or mental fogginess, and fatigue. Many side effects are related to lithium levels in the blood and may improve with dose adjustments. Because lithium has a narrow range of therapeutic and safe blood levels (“therapeutic window”), regular blood monitoring is essential. Contact your clinician if side effects are severe or persistent.

Lithium carbonate is an FDA-approved prescription medication used at therapeutic doses to treat bipolar disorder and is closely monitored by blood tests.

Lithium orotate is an over-the-counter supplement sold in low doses and is not FDA-approved for the treatment of any medical or psychiatric condition. There is limited clinical research on lithium orotate’s effectiveness or safety for psychiatric conditions, while lithium carbonate has decades of clinical evidence supporting its use. Individuals seeking treatment for bipolar disorder or other mood disorders should consult a psychiatric clinician about FDA-approved treatment options.

Lithium carbonate and lithium citrate are both prescription forms of lithium used to treat bipolar disorder. Lithium carbonate is most commonly prescribed as an oral tablet or capsule (including extended-release formulations). Lithium citrate is available as an oral solution and may be preferred by those who have difficulty swallowing tablets or need a liquid formulation. Both forms require the same careful blood monitoring. Your prescribing clinician will determine which formulation is most appropriate based on your individual needs.

Lithobid is an extended-release (ER) formulation of lithium carbonate, while immediate-release lithium carbonate is the standard tablet or capsule. Lithobid is designed to release lithium more slowly over time, which may result in more stable blood levels and potentially fewer side effects such as tremor and gastrointestinal upset. Immediate-release lithium carbonate is typically taken multiple times daily. Your prescribing clinician will recommend the formulation that best fits your treatment needs and lifestyle.

When people refer to “lithium” as a psychiatric medication, they are almost always referring to lithium carbonate or another lithium salt (such as lithium citrate). Lithium is the active element in these compounds. Lithium carbonate is simply the specific salt form most commonly prescribed. The terms are often used interchangeably in clinical settings.

There is research that suggests lithium may have neuroprotective effects that could reduce the risk of dementia. Several observational studies and clinical trials have found that people treated with lithium for mood disorders may have lower rates of Alzheimer’s disease and other dementias compared with those who are not taking lithium.

Lithium carbonate dosing is highly individualized and is determined by your prescribing clinician based on your blood lithium levels, clinical response, and tolerability. Dosing must be carefully managed to keep blood levels within the therapeutic range. Do not adjust your dose without consulting your prescribing clinician.

For acute manic episodes, some improvement may be noticeable within 1–2 weeks of starting lithium carbonate. Full stabilization of mood and the full benefit for long-term maintenance may take several weeks to months. Regular follow-ups with your clinician are important to monitor your response and adjust your care plan as needed.

Regular blood tests are essential when taking lithium carbonate. Because lithium has a narrow therapeutic window (i.e., range of therapeutic and safe blood levels), periodic monitoring of serum lithium levels is required to ensure the medication remains effective without reaching toxic levels. Your clinician will also typically monitor kidney function and thyroid function, as lithium can affect both organs over time. Your clinician will determine how frequently blood tests are needed based on your individual situation.

Weight gain is a commonly reported side effect of lithium carbonate. Increased appetite, fluid retention, and changes in metabolism can contribute to weight changes in some individuals. Not everyone will experience weight gain, and the degree varies between individuals. Speak with your prescribing clinician if weight changes are a concern so they can discuss with you strategies to manage this side effect.

Try to avoid alcohol while on lithium carbonate. Alcohol can affect lithium levels in the blood, potentially increasing the risk of lithium toxicity. It can also worsen side effects such as dizziness, cognitive impairment, and tremor, and may interfere with the effectiveness of the medication. Always discuss alcohol use with your prescribing clinician.

Lithium toxicity can occur when blood levels rise too high, which can happen due to dehydration, changes in sodium intake, or interactions with other medications (particularly NSAIDs and certain blood pressure medications). Early signs of toxicity include coarse tremor, nausea, vomiting, diarrhea, drowsiness, confusion, and muscle weakness. Severe toxicity can lead to seizures, cardiac arrhythmia, and other serious complications. If you experience these symptoms, immediately contact your prescribing clinician or seek emergency care.

Your symptoms may return, especially if it is stopped suddenly. Some people may also experience a rebound of mood symptoms, such as depression or mania. Always follow your psychiatric provider’s directions on when to stop taking medications or change dosages.

No. Lithium carbonate is not a controlled substance. It is a prescription-only medication, meaning it requires a clinician’s prescription to obtain, but it is not classified as a controlled substance by the Drug Enforcement Administration (DEA).

Yes. Several medications can affect lithium levels in the body. Common interactions include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Diuretics (“water pills”)
• Certain blood pressure medications such as ACE inhibitors
• Some antidepressants and antipsychotics

Always consult your prescribing psychiatric clinician before starting or stopping any medication while taking lithium.

Lithium is widely known for its long-term treatment when monitored by a prescribing clinician appropriately. Regular medical follow-ups and blood tests help ensure the medication is less likely to cause side effects.

The cost of lithium carbonate varies depending on whether you receive the generic or a brand-name version (Lithobid or Eskalith) and on dosage. As of publication date, potential pricing is listed below.

Generic lithium carbonate:
For a 100-capsule supply:

• 150 mg lithium oral capsules start around $12.24 for 100 capsules (about $0.12 per capsule).
• 300 mg lithium oral capsules start around $13.26 for 100 capsules (about $0.13 per capsule).
• 600 mg lithium oral capsules start around $19.31 for 100 capsules (about $0.19 per capsule).

Prices can vary by location, pharmacy, and discount program.

Brand-name Lithobid: Lithobid is the extended-release brand version of lithium carbonate.
As of publication date, Lithobid 300 mg extended-release tablets start around $1,235.27 for 100 tablets, or about $12.35 per tablet.

If you have insurance, your out-of-pocket cost will depend on your supporting diagnosis and plan type (e.g., commercial, Medicare, Medicaid) and may include a copay or coinsurance.