Lithium


Avoid. Antipsychotics should be avoided in elderly patients with delirium, dementia, dementia-related psychosis, and dementia-related behavioral problems as there is an increased risk of cognitive impairment, tardive dyskinesia, neuroleptic malignant syndrome, stroke, and death. May also increase the risk of hyponatremia or SIADH.

Antipsychotics (with the exception of quetiapine, clozapine, and pimavanserin) should be avoided in Parkinson’s disease due to the potential worsening of motor symptoms.

Antipsychotics should be avoided in patients with a history of syncope, falls or fractures, due to the potential for impaired motor function, orthostatic hypotension, and bradycardia. It should only be used for indications of schizophrenia and bipolar disorder without dementia.

Antipsychotics with strong anticholinergic properties should be avoided in patients with obstructive disease of the genitourinary tract.

Antipsychotic use during chemotherapy to prevent vomiting, if used on a short-term basis, may be appropriate.

 


Taper Guide

Unlike the anticonvulsants, the use of lithium is largely restricted to people with significant mood disorders. Lithium withdrawal is poorly characterized other than in terms of relapse. Those who become dependent on it have a new illness episode if lithium is stopped. If happening as the drug dose is lowered this is almost certainly dependence and withdrawal even though the process slips into a full-blown manic or depressive episode.