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Lithium does not equal Lithium?


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Ok I'm now prescribed slow realease lithium as an alternative to regular Lithium. Trying to lesson gastric upset from regular Lithium. Hand in RX.

An hour later pharmacist calls me and says although doc prescribed same 900mgs - he said switching brands to get the slow release could mean a totally different amount of milligrams getting into your system. He says it is the other ingrediants they put in there, affects what you get. Well what the F..... So 900mgs does not = 900mgs!

Anyways he advises me to get pdoc to do new blood tests to check levels of new slow release formulation. I guess it makes sense don't know what the pdoc will say.

One last other bit of info from drug store, I'm told that some times you can just take your 900 mgs of regular Lithium at once and you may get same desired effect as slow release. Been with this drug store over 20 years, I think they know what their shit is.

Any thoughts on either of these two muses?

Thanks

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Um, if there's 900 mg in there there's like...900 mg in there.

How your body absorbs it, well, that depends on you. And yeah, the formulation (slow release vs. whatever) will affect your levels throughout the day...but 900 mg is still 900 mg.

Some people can take it all at once and be fine--I did, when I was on it--but soem people are better off splitting the dose throughout the day, and it's better on their stomachs or whatever. (I dropped it all at once cuz it was easier to remember...I'm sure it would have been better to take it 3X a day)

Been with this drug store over 20 years, I think they know what their shit is.

Sure, the store--I've been with my store about my whole life, 30 years--but in the last couple years they got a new managing pharmacist. So, do you think he has the experience/knowledge of the guy who was there 30 years? And besides that is everything that even a very experienced pharmacist says true? Hey I've been at my job two years--yesterday I corrected my boss's boss, who's been there like fifteen years, on a fairly elementary but technical point.

Get your levels checked as usual.

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The half life of lithium carbonate is about 5 days, regardless of whether its immediate or controlled release. The main purpose of the controlled release form is to A. be easier on the gut and, B. maintain a steadier blood level during the day. Your pdoc may want to test your blood level about 7 days after your changeover, and anytime you change dosages. Blood levels should be checked generally every 3 - 6 months, max 1 year if you have been really stable. BTW, ideally blood draw is supposed to be a "trough" or lowest level check. So one should arrange to have the draw made 12 hours after taking your normal dose. If you have to do different just tell your pdoc the circumstances.

- Second item: No, thats exactly the opposite. If you want to try to mimic the controlled release formulation with immediate release tabs, then you would space them out during the day and take them twice a day, 12 hours apart, for example.

cheers, a.m.

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From what I've seen, Lithium is a very tricky drug. You need your levels tested a lot. Since you are trying a new version, you should have your levels tested until you are stable on it. Don't worry about what might happen. Because everyone is different, I can imagine that it is possible that it will get absorbed and excreted differently due to it being a slow release form. Just give it a try and see what happens.

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Some people can take it all at once and be fine--I did, when I was on it--but soem people are better off splitting the dose throughout the day, and it's better on their stomachs or whatever. (I dropped it all at once cuz it was easier to remember...I'm sure it would have been better to take it 3X a day)

Nope, the once-a-day plan is cool. If it has to be split up for tolerability (so that it isn't all yarked up), then that's fine, but nephrologists like it to be given all at once in a great whacking dose if at all possible, and I'm all about listening to a good nephrologist these days.

In fact, there is at least one renally-oriented article that recommends dosing a double-dose every other day, which I can ref when I get home (it's in the Big Blue Book of Lithium.)

Having had daily and every-other-daily lithium levels for much of last winter and summer, I can testify that for me, at least, there was no level variation whatsoever between the immediate and sustained release generics I was using. But that clearly isn't true for everyone.

900 mg IR all at once may have the same psych effect, but it might well have a different GI effect. Since that's what you're trying the different formulation for in the first place, then why would one load-up the dose all at once of the formulation that may be causing problems?

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In fact, there is at least one renally-oriented article that recommends dosing a double-dose every other day, which I can ref when I get home (it's in the Big Blue Book of Lithium.)

Kidneys need time to "recover"?

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Yes. Hence the once-a-day dose, especially in the elderly.

Also, I should add (sorry for the threadjack) that the every-other-day dosing is NOT standard, and it is a special-case thing, and it's for higher doses to boot. If the level drops below threshold for that person, there's a significant risk of relapse. So if anyone was thinking they would just try that every-other-day thing on their own at home, DON'T. Again, it's for certain situations only.

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Nope, the once-a-day plan is cool. If it has to be split up for tolerability (so that it isn't all yarked up), then that's fine, but nephrologists like it to be given all at once in a great whacking dose if at all possible, and I'm all about listening to a good nephrologist these days.

In fact, there is at least one renally-oriented article that recommends dosing a double-dose every other day, which I can ref when I get home (it's in the Big Blue Book of Lithium.)

Having had daily and every-other-daily lithium levels for much of last winter and summer, I can testify that for me, at least, there was no level variation whatsoever between the immediate and sustained release generics I was using. But that clearly isn't true for everyone.

900 mg IR all at once may have the same psych effect, but it might well have a different GI effect. Since that's what you're trying the different formulation for in the first place, then why would one load-up the dose all at once of the formulation that may be causing problems?

Interesting. I did have GI effects, not necessarily so bad as to need to split the dose, but still.

My kidney tests have always shown clean, but I wonder as such a long-term diabetic, what would be best should I ever go on lith again...something to keep in mind for the future, I guess.

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