Optimizing Lithium Dosage for Patient Comfort and Kidney Safety

Patients often experience a sense of accomplishment after tolerating 150 milligrams of lithium, which can then be increased. Starting with controlled release lithium helps reduce side effects like tremor and nausea. Changing to instant release after a few months reduces the chance of nausea, with more focus on kidney safety at this point. Evidence suggests that instant release lithium may be less damaging to the kidneys. Dosing all the lithium at night is safer for the kidneys, although initial divided dosing during the day can reduce nausea and other side effects. Monitoring for parathyroid dysfunction through yearly calcium level checks is recommended, with referrals to an endocrinologist if issues are detected.