Lithium dose vs. Lithium blood level

Is there a correlation at all or is everybody different?

For example, I am on 1200mg of lithium daily. My recent blood text just came back and my blood levels are only .6

I've read places that 1500 is the most a person can take. But is the blood level more important? Could someone take 10,000mg a day if their blood level was in range?

And vice versa...does my stability have to do with my blood level? I feel stable, but my blood level is on the lowest end of the spectrum for therapeutic levels. Are some people stable with lower blood levels, even below therapeutic levels?

I got this ****.

a) Different.
b) .6 is good level.
c) 2400 is the max. No.
d) It's not. .4 is common.
e) Glad you're feeling good.
f) Yes.

Dose and level don't correlate. For me it didn't even correlate in one person. I needed a higher level to feel good for the first 4 or 5 years I was on lithium and I took I think 1500 mg. Then I had toxicity #1 and it took a lot of trial and error to find my new right level and dose. I don't remember those numbers. I had toxicity #3 when things had been fine for a while and it was bad enough to land me in the medical hospital for a while. After that I took a lower dose (425 mg) and we tried to keep my level about .4. After a bad period with a suicide plan the hospital increased it so that my level would have been I think .8 or .9 but that didn't last very long because my level was all over the place and my pdoc put me back on the lower dose/.4 goal. But I got toxic again despite having been consistently that low and that was the end. We tried again out of desperation a few months ago but I needed a higher level than we know is safe for me so I had no response.

Lithium is weird. But it did work well for me when it wasn't making me toxic.

This is important for those of us on lithium. How do you know when you're toxic.
Please, describe the symtoms(sp). Thank you.

First time: nausea. HOrrible nausea. I actually was toxic for a very long time b/c I missed a level when I had stomach flu. Then work was busy and I didn't get it done for a few weeks and at that point my therapist announced she was moving to another country in a few weeks. So everything thought it was stress, an ulcer (had one of those too) and I had my gall bladder tested. I had lithium levels done but they were always fine b/c I had not taken the drug enough days without vomiting it up. Eventually I stayed off work and forced myself to not throw up until we got a level and that was toxic. Just before that was done my therapist happened to walk behind me and noticed I was off balance and more shaky than usual after he started observing more, so he called my pdoc.

2nd time was more insiduous. I actually went to the ER because I was hallucinating, not normal for me. When asked about toxicity symtpoms I said no and then when the dr was teaching the resident and going through things I realized "oh yeah, I have been nauseous, had diarrhea, been unsteady, tremors are worse, headaches for a few weeks". That time my level was really high, I think 1.9 40 hours after a dose.

3rd time I just got SICK. I was in the car almost home and told my mom I was going to vomit so she tried to fly home. I had to jump out and vomit in the snow. I threw up and had diarrhea for a long time. It's gross but both times I've had toxicity at home I've been so sick I've peed my pants and laid in it between throwing up. I didn't bother going to the ER that time because I was so sick my level would have been lowered naturally. My mom almost called an ambulance because she was afraid of how sick I was. She said she'd never seen/ heard anyone that sick. But the worst of it ended in a matter of 2 hours. I'm sure I should have gone in for fluids but my local hospital is not good with psych issues and I didn't feel good enough to ride 2.5 hours to my hospital.

Toxicity is tricky because the symptoms can vary and aren't always consistent. Each of mine was really different. For sure any time you are nauseous and/or having vomiting/diarrhea you should have a level drawn. Rule of thumb for me was if in doubt get a level. (I tended to get slightly toxic when I was hot for too long and a lot of water and salt would help but it took playing with labs to learn that).

Wow. I'm so sorry you went thru all that.
I thank you for the info. Everybody on lithium should read this. Thanks again!.

Just one of many medication adventures...

Hope you never experience it.

I am on 1250mg and my levels were 1.1 last I checked with little to no side effects so I am not getting toxic.

Just keep checking and be aware of all signs of toxicity. Mine were fine at 1.1-1.2 for a long time (years) before my first toxicity. (Not trying to be scary, just wish I had known that myself. I think it is rare since my pdoc was very surprised by my toxicity that time but obviously not unheard of

What is the long term effect of toxicity? Does it do any permanent damage? Or do you just get sick temporarily

If it is extreme it can harm your kidneys and you can wind up on dialysis. That's pretty rare.

The worst for me was 3 days on IVs and getting poked for labs frequently while some intern cut half my psych meds and nobody could figure out how or why and didn't get me back on what I needed so I couldn't sleep and wound up yelling at a dr on the phone at 2 AM after threatening to sign out AMA (would've if I hadn't had half my psych meds and couldn't drive).

Just found this; it's more comprehensive than my stories.

The Risk of Lithium Toxicity | Bipolar Laid Bare

That's a great article, thanks.

If you keep levels healthy, is it possible to be on lithium very long term? 20-40 years even? Or will it eventually run its course through your kidneys and thyroid regardless?

You can stay on it long term. Even if your thyroid doesn't handle it that's not a big deal. The kidneys just need a lot of monitoring and appropriate responses if anything changes. After about 10 years I developed something called diabetes insipidus which meant that my kidneys weren't pulling electrolytes from my urine so I was peeing a ton of water and losing electrolytes. Often they stop the lithium for that but it helped me so much that I stayed on it and took a med to help. When I stopped lithium that went away.