Brief Answer:
consider lowering dose to 900mg, consult treating psychiatrist

Detailed Answer:
Dear,
Welcome to HCM
I can understand the distress that you must be through.
The complaints mentioned are clearly suggestive of Gastrointestinal side effects of lithium drug.
Lithum as one should be aware of is a drug with very narrow range of therapeutic window. The difference between its effective dose range and toxic dose range is very small, therefore maintaining and monitoring stable and healthy blood levels of Litihum is very important.
Measuring serum lithium levels is indicated in your case here. Blood samples should be taken 12 or 24 hours after the previous dose of lithium, just before the next dose is due, to measure the serum lithium level at its trough. The serum level should not exceed 1.5 mmol/l. Side effects generally appears on level exceeding 1.2mmol/l.

Secondly, you have'nt mentioned the preparation of tablet. It is recommended that sustained released preparation can be used, the advantage being that it can be taken once a day only.
It is strongly suggestible that you discuss with your treating doctor, the option of titrating the dose to minimum effective dose required for control of symptoms.
At the same time very gradual tapering is advised as it takes time for body to tolerate effects of any drugs. Rapid up-titrating any drug dose increase the chances of toxicity.
Consider adding or shifting to another class of mood stabiliser drug if you are being treated for mood condition.

My suggestion
1) consider reducing the dose levels. may be upto 900 mg a day with two times a day dosing.
2) Monitor serum lithium levels.
3) consider shifting to different drug.
4) take tab pantorazole+domeperidome once a day for five days.
5) Have adequate food and fluids. Dehydration can further worsen toxicity.
6) Finally, consult your treating doctor, do not skip of stop drug without consultation as it can precipitate underlying condition. And watch for other signs of toxicity.

Hope you find my opinion satisfying.
Thanks for asking.
Regards,
Dr Pankaj Borade

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Brief Answer:
reducing the dose or augmentation with another drug can be considered

Detailed Answer:
Thanks for the reply.
Well, if you have shown a good response to the drug, i suggest reducing the daily dose to 900 mg should be considered. If 900 mg is not proving sufficient to maintain desired serum levels of drug required for its therapeutic effect, then increasing the dose to 1200 mg makes sense.
The only way to confirm if 900 mg is adequate is to check the blood lithium levels while on 900 mg dose. If adequate blood levels are maintained, the treatment aim is fullfilled!
The other options that can be considered besides dose increment is an addition of another mood stablizer such as sodium valproate, olanzapine, quetaipine, etc. However, it shall be discussed with the psychiatrist as one need to weigh the risk against the benefit.
Addressing the litihum tosicity issue is vital as there are dreadful complication in long term. It is strongly suggested to discuss with your treating psychiatrist about above mentioned options.
Considering the lithium toxicity, it is advisable to get a thyroid, renal function test done.

Thanks for asking.
Ragards

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