General Description
Lithium citrate is the citric acid salt of the alkali metal lithium, formulated as a salt with three lithium cations per molecule (Li3C6H5O7). The citrate moiety enhances water solubility compared to lithium carbonate, making it suitable for liquid preparations. Lithium is the smallest monovalent cation and has unique properties as a mood stabilizer. The citrate salt does not alter the pharmacological activity of lithium but provides a more soluble, less irritating form for oral solutions.
Mechanism of Action
The precise mechanism of lithium is not fully understood but involves multiple effects: inhibition of inositol monophosphatase and depletion of inositol, disruption of phosphoinositide signaling; inhibition of glycogen synthase kinase-3β (GSK-3β); modulation of neurotransmitter release (increasing GABA, reducing glutamate); and neuroprotective effects via brain-derived neurotrophic factor (BDNF) upregulation. Lithium also alters sodium and calcium channel function and affects gene expression related to circadian rhythms.
Application
Lithium citrate is indicated for the treatment of acute manic episodes and maintenance therapy of bipolar I disorder. It also reduces the risk of suicide in patients with mood disorders. Off-label uses include treatment-resistant depression (as augmentation to antidepressants), cluster headache prophylaxis, and neutropenia. Lithium has a narrow therapeutic index; serum concentrations must be monitored. The citrate salt is less commonly used than carbonate.