Clinical safety rating: caution
Positive evidence of fetus risks but benefits may outweigh risks in some cases
Mechanism information is still being processed. Check the DailyMed link in the sidebar for the official prescribing information.
Dosing varies by indication and patient profile. Always follow your institution's current prescribing guidelines.
| Renal impairment | Consult protocols for adjustment. |
| Liver impairment | Consult protocols for adjustment. |
| 1st trimester | Caution. Risk of cardiac malformation (Ebstein anomaly) is real but lower than originally reported. Fetal echocardiography at 18–22 weeks recommended. |
| 2nd trimester | Caution. Monitor serum lithium levels frequently due to changes in renal clearance. |
| 3rd trimester | Caution. Reduce dose near term to avoid neonatal toxicity. Neonatal lithium toxicity syndrome: hypotonia (floppy baby syndrome), cyanosis, bradycardia, poor feeding. |
Clinical note
Used for bipolar disorder. Early case reports (1970s Register of Lithium Babies) suggested a high rate of Ebstein anomaly (tricuspid valve defect), leading to decades of avoidance. More recent large cohort studies have substantially revised this estimate downward: the absolute risk of Ebstein anomaly is approximately 1 in 1,000 to 1 in 2,000 (versus 1 in 20,000 background) — a relative increase but low absolute risk. Fetal echocardiography at 18–22 weeks is recommended. Risk-benefit analysis is essential given that untreated bipolar disorder in pregnancy carries severe risks. Requires careful serum level monitoring as volume of distribution changes throughout pregnancy.
| Breastfeeding | Avoid during breastfeeding. Lithium is excreted in breast milk at approximately 40–50% of maternal serum concentration. Risk of infant lithium toxicity (hypotonia, ECG changes, cyanosis). Breastfeeding is generally not recommended while on lithium. |
tremor
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