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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by sac on March 12, 2005, at 12:45:30
Hi, I'm currently taking 450 mg. daily Eskalith. I have bipolar II and am also taking prozac 30mgs. My question is since I'm on such a low dose of Lithium, is it still possible to have lithium poisoning. My most recent blood level taken 3 weeks ago was .5. but this past week I became increasingly lethargic. I had bouts of diarrhea and nausea but was most bothered by an extreme feeling of fatigue. Is it possible that I was experiencing lithium intoxication? How careful does one have to be on such a low dose with regard to toxicity?? Any info is very helpful. Thanks. -Stacey
p.s. - I did not take my lithium last night and I don't feel the extreme lethargy although I do feel a bit agitated.
Posted by med_empowered on March 12, 2005, at 13:36:46
In reply to Lithium poisoning on low dose??, posted by sac on March 12, 2005, at 12:45:30
hey! There are *MANY* factors that can effect lithium levels. How hydrated/dehydrated you are, exposure to heat, other medications, the amount of sodium in your diet (I think the rule is high sodium=low absorption, low sodium=high absorption), your build, genetics, etc. I don't mean to pry, but why Lithium? It is a VERY effective med, of course, but there are alternatives. I personally like Trileptal a lot...there aren't any blood-tests for it. Lamictal is another option that (I believe) is blood-test free. Some docs use just about ANY anti-epileptic as a mood-stabilizer, so some people are taking Keppra, which is supposed to be great in terms of side-effects and, again, I believe is blood-test free. ANYWAY, I guess what I'm saying is that first of all, if you suspect lithium poisoning, please get blood-levels checked. Don't be embarassed or anything--this is your health. Equally important, though, is that you do have mood-stabilizer options that involve less risk and, usually, fewer side-effects. I have had to negotiate with shrinks who suggested lithium right off the bat; I just nicely told them that I don't do blood-tests, so lithium,depakote,and tegretol are out. Sometimes they fight it a little, but I stick to my position, and they work with me. Good luck!
Posted by Ritch on March 12, 2005, at 14:58:04
In reply to Lithium poisoning on low dose??, posted by sac on March 12, 2005, at 12:45:30
> Hi, I'm currently taking 450 mg. daily Eskalith. I have bipolar II and am also taking prozac 30mgs. My question is since I'm on such a low dose of Lithium, is it still possible to have lithium poisoning. My most recent blood level taken 3 weeks ago was .5. but this past week I became increasingly lethargic. I had bouts of diarrhea and nausea but was most bothered by an extreme feeling of fatigue. Is it possible that I was experiencing lithium intoxication? How careful does one have to be on such a low dose with regard to toxicity?? Any info is very helpful. Thanks. -Stacey
> p.s. - I did not take my lithium last night and I don't feel the extreme lethargy although I do feel a bit agitated.
I was on lithium and prozac for several years (just those). Do you think the Prozac might be the one causing your diarrhea? If it is, it could be causing the lithum levels to rise due to fluid loss. I had to take about double what you are taking to get roughly .5mEq on a blood test (900mg). How much do you weigh? I used to get some serious transient nausea from lithium also, and GatorAid would usually help a lot with that. Your other electroytes might be getting a little low.
Posted by Phillipa on March 12, 2005, at 16:39:04
In reply to Re: Lithium poisoning on low dose?? » sac, posted by Ritch on March 12, 2005, at 14:58:04
Everyone is different. Get your levels checked. If you feel better today without the lithium, it may indicate that your levels were too high. Fondly, Phillipa
Posted by sac on March 13, 2005, at 6:37:52
In reply to Re: Lithium poisoning on low dose??, posted by Phillipa on March 12, 2005, at 16:39:04
Thank you all for your quick responses. As far as the other meds... I've been on Lamictal, Depakote, Trileptal, Neurontin, and Gabitril and I've discontinued them for various reasons. That's what brought me to lithium which was not my first choice. However, I found that I liked the slow release version and could tolerate it only at a low dose. I will see my pdoc tomorrow and ask about the toxicity thing. I didn't think it could happen on such a low dose and I do drink water and all that. But since I've stopped it for two days (and have increased water intake)I do not have the extreme weakness and fatigue.
Posted by prodgirl on March 16, 2005, at 0:03:13
In reply to Lithium poisoning on low dose??, posted by sac on March 12, 2005, at 12:45:30
When's the last time you had your TSH levels checked? I was having the same problem and found out I've got some serious Thyroid issues, partially due to the Lithium.
If it keeps up, maybe speak with your pdoc about fiber supplements. It's helped me a good bit.
Posted by sac on March 16, 2005, at 7:54:19
In reply to Re: Lithium poisoning on low dose?? » sac, posted by prodgirl on March 16, 2005, at 0:03:13
Actually, I am under the care of an endocrinologist as well (for subclinical hypo thyroidsim that I had before starting Lithium) and currently take Armour thyroid. What exactly does the fiber do? -Stacey> When's the last time you had your TSH levels checked? I was having the same problem and found out I've got some serious Thyroid issues, partially due to the Lithium.
>
> If it keeps up, maybe speak with your pdoc about fiber supplements. It's helped me a good bit.
Posted by prodgirl on March 16, 2005, at 12:28:12
In reply to Re: Lithium poisoning on low dose??, posted by sac on March 16, 2005, at 7:54:19
>
> Actually, I am under the care of an endocrinologist as well (for subclinical hypo thyroidsim that I had before starting Lithium) and currently take Armour thyroid. What exactly does the fiber do? -StaceyThe fiber will help with your GI problems, stop the cramping, firm "it" up (if you will). If you decide to go that route, make sure you take it no less than 1 hour before you take your Lithium so that it wont effect the absorbtion. Another thing to try is to take your Lithium with a meal.
Posted by CareBear04 on March 18, 2005, at 17:52:45
In reply to Lithium poisoning on low dose??, posted by sac on March 12, 2005, at 12:45:30
hey stacey-- i take 450mg of eskalith cr, too. regular lithium makes me sick as a dog so i can only take brand-name.
lithium is a crazy drug. last summer, i was on a dose of 1800mg, and my lithium level was only 1.12. even so, the side effects like thirst and tremor got a lot worse, so i dropped to 1350mg, which has been my dose for most of two years. in the fall, i started having symtpoms like yours, and i had a lithium level of 1.7. my pdoc had me go off lithium for a few days, then restart at 900mg. at that dose, i got severely toxic at 2.7. no doctor has been able to explain the wacky levels. during that period, i was losing weight, but there's not a clear connection between nutrition and lithium levels in the way that there is with hydration.
i stayed off lithium for a few months and took lamictal. in january, i restarted lithium and went as high as 750mg (450 eskalith and 300 lithobid). i'm at 450mg currently, and i think i'm going to stay put. my level at this dose is around .5 like yours. i wish i knew why my body could metabolize a lot more lithium previously.
regarding lithium poisoning on 450mg-- it's possible but not likely. things that would increase the likelihood include dehydration, pain meds like advil or motrin, and water losses from sweating. since lithium is like a salt, if you have low sodium levels, your body will hang onto more lithium. since lithium is renally excreted, if your kidney function is decreased, your body can't clear out lithium properly and your levels will be higher.
diarrhea and fatigue happen when you're toxic, but, unfortunately, they're also side effects that occur with a therapeutic lithium dose. both eskalith and lithobid are easier on the stomach than regular lithium, but some people do better with one or another. taking lithium on a full stomach helps me. i don't think it affects the level; it just impacts the rate of absorption.
even at only 450mg, my doctor has me get a level every week, but i think that's excessive. my previous doctor had me get a lithium level, electrolytes, and kidney function tests once every 3-4 weeks and thyroid tests maybe every six months. at that point, we were experimenting with different lithium levels, but once you have stable levels at a dose, you don't need tests as often.
usually people start getting toxic around 1.5, but maybe you're very sensitive to lithium and are having symptoms at a lower level. between .5 and 1.5, there's a lot of room so i would guess you're not toxic, but if you're worried, definitely get it checked. oh, here's a determining factor for me-- how's your coordination? can you walk in a straight line? do you have tremors? can you speak clearly? can you focus your eyes? at higher doses but no toxicity, i was sleepy and foggy-headed but not looking intoxicated. if you look and feel drunk, your level is probably too high.
i hope you're feeling better by now!
Posted by sac on March 22, 2005, at 18:21:26
In reply to Re: Lithium poisoning on low dose?? » sac, posted by CareBear04 on March 18, 2005, at 17:52:45
Hi, thanks for your response. Any feedback helps. I talked to my Pdoc about it and he was surprised that I felt that way on such a low dose. I definately felt drunk or as I described it "drugged". I then stopped the lithium for 2 days and I no longer had that feeling. Perhaps I need to drink even more water than I was. I don't know but be he says I'll have enough warning symptoms to know if I'm getting toxic. And, as you suggest, I may be sensitive to it, even at a low dose.
> hey stacey-- i take 450mg of eskalith cr, too. regular lithium makes me sick as a dog so i can only take brand-name.
>
> lithium is a crazy drug. last summer, i was on a dose of 1800mg, and my lithium level was only 1.12. even so, the side effects like thirst and tremor got a lot worse, so i dropped to 1350mg, which has been my dose for most of two years. in the fall, i started having symtpoms like yours, and i had a lithium level of 1.7. my pdoc had me go off lithium for a few days, then restart at 900mg. at that dose, i got severely toxic at 2.7. no doctor has been able to explain the wacky levels. during that period, i was losing weight, but there's not a clear connection between nutrition and lithium levels in the way that there is with hydration.
>
> i stayed off lithium for a few months and took lamictal. in january, i restarted lithium and went as high as 750mg (450 eskalith and 300 lithobid). i'm at 450mg currently, and i think i'm going to stay put. my level at this dose is around .5 like yours. i wish i knew why my body could metabolize a lot more lithium previously.
>
> regarding lithium poisoning on 450mg-- it's possible but not likely. things that would increase the likelihood include dehydration, pain meds like advil or motrin, and water losses from sweating. since lithium is like a salt, if you have low sodium levels, your body will hang onto more lithium. since lithium is renally excreted, if your kidney function is decreased, your body can't clear out lithium properly and your levels will be higher.
>
> diarrhea and fatigue happen when you're toxic, but, unfortunately, they're also side effects that occur with a therapeutic lithium dose. both eskalith and lithobid are easier on the stomach than regular lithium, but some people do better with one or another. taking lithium on a full stomach helps me. i don't think it affects the level; it just impacts the rate of absorption.
>
> even at only 450mg, my doctor has me get a level every week, but i think that's excessive. my previous doctor had me get a lithium level, electrolytes, and kidney function tests once every 3-4 weeks and thyroid tests maybe every six months. at that point, we were experimenting with different lithium levels, but once you have stable levels at a dose, you don't need tests as often.
>
> usually people start getting toxic around 1.5, but maybe you're very sensitive to lithium and are having symptoms at a lower level. between .5 and 1.5, there's a lot of room so i would guess you're not toxic, but if you're worried, definitely get it checked. oh, here's a determining factor for me-- how's your coordination? can you walk in a straight line? do you have tremors? can you speak clearly? can you focus your eyes? at higher doses but no toxicity, i was sleepy and foggy-headed but not looking intoxicated. if you look and feel drunk, your level is probably too high.
> i hope you're feeling better by now!
This is the end of the thread.
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