Licab (Lithium Carbonate / Lithium Citrate)
Also sold as: Licab, Lithosun, Priadel, Lithocarb, Camcolit
Pregnancy
Cat D
Lactation
Avoid
Schedule
H
Forms
Tablet 150mg, 300mg, 400mg (carbonate) +2
Indications
- Bipolar disorder — acute mania treatment and prophylaxis (gold standard for long-term mood stabilisation)
- Bipolar depression (augmentation or monotherapy)
- Recurrent unipolar depression (augmentation of antidepressants)
- Suicidality reduction (lithium reduces suicide risk — strongest evidence of any psychiatric medication)
- Schizoaffective disorder (adjunct)
- Aggression / cluster headache prophylaxis (off-label)
Adult Dosing
Bipolar disorder (acute mania / prophylaxis)
Start 300 mg PO BD–TDS; titrate to achieve serum level 0.6–1.2 mmol/L (mania: 0.8–1.2 mmol/L; prophylaxis: 0.6–0.8 mmol/L)
Measure serum level 12 hours after last dose, 5–7 days after dose change. Therapeutic window is narrow — toxicity at > 1.5 mmol/L.
Pediatric Dosing
Avoid in children < 7 years. Paediatric dosing requires specialised monitoring.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl 10–50 mL/min | Reduce dose by 50%; check levels more frequently (lithium is renally excreted) |
| CrCl < 10 mL/min | Generally AVOID — risk of severe toxicity |
Hepatic Adjustment
No dose adjustment for hepatic impairment (lithium not hepatically metabolised)
Pregnancy & Lactation
Pregnancy: Category D
Associated with Ebstein's anomaly (cardiac malformation) in 1st trimester — risk is small (< 1%) but higher than general population. Risk-benefit must be carefully discussed with specialist. If continued: detailed fetal cardiac USS at 18–20 weeks. Perinatal lithium toxicity: stop or reduce dose 2 days before delivery; monitor neonate.
Lactation: Avoid
Lithium excreted in breast milk at 30–50% of maternal serum level — significant neonatal exposure; avoid breastfeeding. Neonatal toxicity reported. If mother must continue lithium, formula feeding is recommended.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| NSAIDs (ibuprofen, naproxen, diclofenac) | MAJOR — NSAIDs reduce renal lithium clearance → toxicity. Even single dose of ibuprofen can be dangerous. | Major |
| ACE inhibitors / ARBs (lisinopril, enalapril, losartan) | Significantly increase lithium levels — toxicity risk; monitor closely if combination unavoidable | Major |
| Thiazide diuretics (hydrochlorothiazide, chlorthalidone) | Reduce lithium clearance — toxicity; if diuretic needed, use loop diuretic (furosemide — smaller effect) | Major |
| Metronidazole, fluconazole | Increase lithium levels — monitor | Moderate |
| Caffeine | Caffeine withdrawal or sudden increase increases/decreases lithium levels — patients on stable lithium should maintain consistent caffeine intake | Minor |
| Antipsychotics (haloperidol, olanzapine) | Can mask early lithium toxicity symptoms (encephalopathy reported); used in combination in mania — requires careful monitoring | Moderate |
DoctorScribe — AI Medical Scribe
Stop looking up Licab — just speak the prescription
"Licab as per dose, BD for 5 days." DoctorScribe writes the full prescription with brand, strength, frequency, and route — auto-applies pediatric weight-based dosing and renal adjustments. Try the live demo.
Side Effects
Common
- Fine tremor (hands — most common; dose-related)
- Polyuria and polydipsia (nephrogenic diabetes insipidus — ~40% on long-term therapy)
- Weight gain
- Cognitive slowing/memory issues
- Acne and psoriasis exacerbation
- Nausea (take with food to minimise)
- Hypothyroidism (20% long-term — monitor TFTs)
Serious / Discontinue If
- Lithium toxicity: Early (1.5–2.0 mmol/L) — coarse tremor, confusion, diarrhoea, ataxia; Moderate (2.0–2.5 mmol/L) — severe confusion, dysarthria, seizures; Severe (> 2.5 mmol/L) — coma, arrhythmia, death. Toxicity precipitated by dehydration, NSAIDs, diuretics, diarrhoea.
- Nephrogenic diabetes insipidus (chronic — irreversible tubular damage with long-term use)
- Chronic kidney disease (long-term — regular eGFR monitoring essential)
- Cardiac arrhythmias (T-wave changes, sinus node dysfunction)
Contraindications
- Severe renal impairment
- Brugada syndrome / cardiac conduction disorders
- Addison's disease
- Concurrent diuretics without close monitoring
- Low-sodium diet (reduces lithium excretion)
- Significant dehydration
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Licab 300mg | Sun Pharma | 50 tab ₹75 |
| Lithosun SR 400mg | Sun Pharma | 30 tab ₹85 |
| Lithocarb 300mg | Intas | 50 tab ₹65 |
Monitoring Required
- Serum lithium (12h post-dose trough: 5–7 days after any change, then every 3 months when stable; target 0.6–1.0 mmol/L prophylaxis)
- Thyroid function (TFT every 6 months — hypothyroidism in 20%)
- Renal function (eGFR and serum creatinine every 6 months)
- Calcium (hyperparathyroidism — rare long-term effect)
- Weight
- ECG (baseline; if cardiac concerns)
Patient Counseling Points
- ⚠️ NEVER take ibuprofen or any NSAID pain killer — even one dose can cause lithium poisoning
- Stay well hydrated — dehydration (fever, diarrhoea, hot weather, excessive sweating) increases lithium to toxic levels
- Keep salt intake consistent — sudden low-salt diet causes lithium to rise dangerously
- Tremor of hands is common and expected — reduces with dose adjustment or propranolol
- Blood tests every 3 months (level + kidney + thyroid) are mandatory — lithium is effective but has a narrow safety margin
- Early signs of toxicity: persistent diarrhoea, coarse tremor, confusion, unusual drowsiness → hospital immediately
- Do not stop suddenly — rebound mania/suicidality can occur on abrupt discontinuation
Stop Googling drug references mid-consultation
EasyClinic auto-flags Licab interactions, renal cutoffs, and pregnancy warnings the moment you write the prescription. Built-in safety net for every Indian doctor.
Clinically reviewed by: Dr. Vikas Desai, MD (Psychiatry), Senior Consultant Psychiatrist
Last reviewed: 2026-04-01
References
- NICE Bipolar Disorder Guidelines CG185 (2014)
- BAP Bipolar Guidelines 2016
- BNF — Lithium
- Lancet — Lithium and Suicide Prevention Meta-analysis
- ICMR Psychopharmacology Guidelines India