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Q:  Differences in the Forms of Lithium

What is the difference between all the different prescriptions of Lithium(Carbolith, Duralith, Cibalith- , Eskalith, Lithobid, ect...). Is one form better than another? Or does any one have less side effects than other?  I am currently restarting on 900mg of Lithium Carbonate, was off for over a year without any major mood swings, but recently went through a hypomanic episode follwed by depression, and  would like to know if the other forms have less side effects? Especially the weight gain factor, as when I went off Lithium I lost 45 lbs and do not want to gain it back. 

Dear Michele -- 
Unfortunately, from the weight gain perspective, I'm unaware of any data, nor have I seen anything in my patients, to suggest that any of these is different from the rest.  Most of the names you've cited, as you know, are just different "brand names": 

 Carbolith, Cibalith-S, Duralith, Eskalith, Lithane, Lithizine, Lithobid, Lithonate, Lithotabs

If you skip the brand name differences, there are basically two forms of lithium (and one internet-only form which does not disclose the amount of lithium it contains and claims to have no side effects and no risks -- so must have very little lithium in it! that's the "orotate" version).  

The first is regular lithium carbonate, which is just the plain old element of lithium, combined with the carbonate ion to make it into a form that can be placed into a pill.  It can also be combined with the citrate ion, for the same purpose of making it packageable, but in this case, in a liquid form (lithium citrate).  

The other form is any of several "slow release" versions, including trade names Lithobid and Eskalith, but now also including several generic manufacturer's versions.  So far I haven't seen any indication that the generics are any less effective than the trade name versions (after all, Lithobid is just highly compacted lithium in a powder form -- there isn't anything very fancy about how it has been made "slow release", if I understand correctly). 

So far it does not appear that the timing of your lithium dosing has any impact on risk of weight gain, so other than side effects like tremor (which is often less on the slow-releases) or diarrhea (which is often worse with the slow releases), which you use doesn't make much difference.  I only use the slow-release versions when I need to, as they're a bit more expensive, even with the generics out now.  

Dr. Phelps

Published Jan. 2005


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