{"id":58433,"date":"2024-02-27T18:35:26","date_gmt":"2024-02-27T18:35:26","guid":{"rendered":"https:\/\/medsname.com\/monolith\/"},"modified":"2026-04-30T10:24:14","modified_gmt":"2026-04-30T10:24:14","slug":"monolith","status":"publish","type":"product","link":"https:\/\/medsbase.com\/nl\/monolith\/","title":{"rendered":"Monolith"},"content":{"rendered":"

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\u26a1 Snel antwoord<\/h3>\n

Monolith (Lithium carbonate 300 mg, immediate-release) is the gold-standard mood stabiliser for bipolar disorder. The only mood stabiliser with reproducible evidence for reducing suicide rate. Narrow therapeutic index \u2014 mandatory serum-level monitoring.<\/p>\n<\/div>\n

\nWat u krijgt bij MedsBase:<\/strong> WHO-GMP gecertificeerde fabrikant \u00b7 Discrete verpakking \u00b7 Wereldwijde verzending \u00b7 1.400+ geverifieerde klantbeoordelingen<\/a>\n<\/div>\n

\ud83d\udce6 Elke bestelling is gedekt door onze Reshipment Assurance Policy<\/strong><\/a> \u2014 als uw pakket niet binnen 20 werkdagen arriveert, sturen wij het opnieuw.<\/p>\n

Waarom bestellen bij MedsBase<\/h3>\n

Monolith at MedsBase is supplied directly from a WHO-GMP certified manufacturer in plain, discreet packaging. Every order is covered by our Reshipment Assurance Policy<\/a> \u2014 20 werkdagen levertermijn of wij sturen kosteloos opnieuw \u2014 en komt in aanmerking voor ons klantenloyaliteitsprogramma<\/a>. Wereldwijde verzending is beschikbaar naar de meeste bestemmingen.<\/p>\n

What Monolith is and how it works<\/h2>\n

Monolith is a lithium carbonate immediate-release tablet supplied by Cipla. Available strengths: 300 mg<\/strong>. Lithium is a monovalent cation that has been used in bipolar disorder for over 70 years (Cade, 1949). Its mechanism is multi-modal: inhibition of inositol monophosphatase (IMPase), inhibition of GSK-3\u03b2, modulation of glutamate transmission, and effects on circadian-clock genes. The clinical translation: prophylaxis against both manic and depressive episodes, antidepressant augmentation, and a reproducible reduction in suicide rate (~ 60% in long-term studies).<\/p>\n

\nNarrow therapeutic index \u2014 mandatory level monitoring<\/strong><\/p>\n

Therapeutic range: 0.6\u20131.2 mEq\/L<\/strong> for maintenance (acute mania up to 1.2). Toxicity begins at 1.5 mEq\/L<\/strong>; severe toxicity (confusion, seizures, renal failure, death) at 2.0+ mEq\/L<\/strong>. Check level: 12 hours post-dose at trough. Schedule: 5\u20137 days after every dose change, then 6-monthly when stable. Plus baseline and 6-monthly TSH, creatinine\/eGFR, calcium.<\/p>\n<\/div>\n

Indicaties en dosering<\/h2>\n\n\n\n\n\n\n\n\n
Indicatie<\/th>\nStartdosering<\/th>\nTarget dose<\/th>\nTarget level<\/th>\n<\/tr>\n<\/thead>\n
Bipolar mania (acute)<\/td>\n600\u2013900 mg\/day in divided doses<\/td>\n900\u20131800 mg\/day<\/td>\n0.8\u20131.2 mEq\/L<\/td>\n<\/tr>\n
Bipolar maintenance<\/td>\n\u2014<\/td>\n600\u20131200 mg\/day<\/td>\n0.6\u20131.0 mEq\/L<\/td>\n<\/tr>\n
Bipolar depression \/ unipolar augmentation<\/td>\n\u2014<\/td>\n600\u2013900 mg\/day<\/td>\n0.4\u20130.8 mEq\/L<\/td>\n<\/tr>\n
Older adults \/ renal impairment<\/td>\n150\u2013300 mg\/day<\/td>\nby level<\/td>\n0.4\u20130.8 mEq\/L<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

XR formulations are dosed once or twice daily (smoother level curve, lower peak side effects). IR formulations are typically dosed BID-TID.<\/p>\n

Belangrijke veiligheidsoverwegingen<\/h2>\n
\nRenal \u2014 chronic interstitial nephritis on long-term use<\/strong><\/p>\n

After 10\u201320 years of lithium therapy, approximately 20% of patients develop a chronic interstitial nephritis with progressive eGFR decline. Mandatory creatinine \/ eGFR at baseline, 3 months, 6 months, then 6-monthly. Stop or reduce dose if eGFR drops below 60 with otherwise unexplained progression.<\/p>\n<\/div>\n

\nThyroid \u2014 hypothyroidism (common) and hyperthyroidism (rare)<\/strong><\/p>\n

Lithium concentrates in the thyroid and inhibits hormone release. Hypothyroidism develops in 20\u201330% of long-term users; mandatory TSH at baseline, 3 months, 6 months, then 6-monthly. Add levothyroxine if symptomatic \u2014 usually no need to stop lithium.<\/p>\n<\/div>\n

\nParathyroid and calcium<\/strong><\/p>\n

Lithium can produce mild hyperparathyroidism with hypercalcaemia. Check calcium at baseline and 6-monthly.<\/p>\n<\/div>\n

\nDrug-induced lithium toxicity \u2014 dehydration, NSAIDs, ACE inhibitors, thiazides<\/strong><\/p>\n

Most lithium toxicity in clinic comes from dose-stable patients whose lithium clearance dropped because of: (1) dehydration (D&V, fever, hot weather, vigorous exercise without fluid replacement); (2) NSAID initiation; (3) ACE inhibitor or ARB initiation; (4) thiazide diuretic initiation; (5) sudden low-sodium diet. Counsel patients explicitly about each. Hold lithium for 24\u201348 h during D&V and check level on resolution.<\/p>\n<\/div>\n

\nPregnancy \u2014 Ebstein anomaly + first-trimester risk<\/strong><\/p>\n

Lithium has historically been associated with cardiac malformation (particularly Ebstein anomaly of the tricuspid valve) on first-trimester exposure. Modern studies suggest absolute risk is small but real (approximately 1.2\u20137%). Ideally switch before pregnancy; if not, fetal echocardiography at 20 weeks. Late-pregnancy and post-partum lithium are generally safer than first-trimester. Lithium passes into milk in significant amounts \u2014 usually avoided in breastfeeding.<\/p>\n<\/div>\n

Veelvoorkomende bijwerkingen<\/h2>\n