A Suggested Dosing Regimen for Lithium in Children
At the 57th Annual Meeting of the American Academy of Child and Adolescent Psychiatry (AACAP) in October 2010, Bob Findling of Case Western Reserve University reported finding a 58% response rate to lithium in children with bipolar I disorder. He explored three different dosing regimens, and recommends starting children off with 300mg capsules TID (three times a day) for a total of 900 mg/day, and then increasing by a single 300mg capsule every week until there is a good effect or until side effects emerge. The most typical side effects that he saw were headache, nausea, and vomiting.
Starting at a relatively high initial dose of 900mg/day is consistent with the finding that even high doses of lithium are absorbed and transferred into the brain quite slowly. This loading approach appears to be an excellent strategy for rapidly achieving the blood levels necessary for optimal therapeutics in young children. Findling also suggests that an upper limit of blood levels as high as 1.4 mEq/l is acceptable in children because, in his experience, children often appear to need higher doses and blood levels than do adults.
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